Problems

& Challenges

Problems & Challenges

Illustrative Cases

Hadiza

A 27 year old woman with three children was brought by her mother to the emergency ward of major hospital complaining of shortness of breath. Her husband, an inter-state truck driver, was away. Chest X-rays showed that Hadiza had fluid in her lungs compromising her oxygenation. She later tested positive for HIV and the verdict was AIDS.  Thanks to PEPFAR, anti-retrovirals were available for her treatment. However, after pooling all their resources, her family was just able to afford the cost of the hospital bed. A crucial diagnostic test was delayed for more than 10 days while the treatment team awaited an additional deposit and, despite our eventual assistance, she would die of an otherwise treatable cause 3 weeks after initial presentation.

Austin

A 32 year old software engineer was brought to the emergency wing of a major hospital after the motorcycle taxi on which he was traveling was struck by a car.  Neither the rider nor passenger wore protective helmets.  Diagnostic and therapeutic delays due to cost barriers and inherent inefficiencies/sub-optimal resource use led to a four day delay in his triage and treatment. Austin eventually made it into an intensive care unit after his church congregation rallied to raise the pre-admission deposits demanded or his admission. Further cost and process related delays would lead to the ultimate cost to ‘the system’ of Austin’s life 7 days after the accident from an easily preventable and manageable complication. His fiancée was 28.

Analysis and Relevance

The cost barrier is a common denominator across the healthcare landscape in Nigeria and continually undermines efforts at potential sustainable programs of even basic preventive care. This barrier is perhaps the most salient impediment Austin and Hadiza encountered. 

These two individuals were seen at a major medical center where state-of-the art diagnostic and therapeutic resources along with appropriate personnel had recently been introduced. In both cases, crucial infrastructural and personnel resources at the hospital’s disposal were either never put into play or entered the equation much too late to be significant.  Furthermore lack of infrastructural capacity introduced significant process delays that contributed to morbidity.  In essence, for all their new found capacity and equipping, the health care centers remain effectively out of play, underutilized, due to these barriers with consequences toward null outcome benefits.

Sub-optimal or inefficient resource utilization reciprocally exacerbates scarcity of resources.  Essentially, sub-optimal resource use impedes implementation of even the most well-thought-out policies and may manifest as failure to record improved outcomes for a given healthcare intervention or resource investment.  An enduring challenge is to capacitate a robust infrastructure framework on which resource use objectives are realized.  This may take a number of forms from community health worker programs, DOTs, to providing taxi drivers with basic life support training to give oft cited examples. 

We  believe that one of the most effective ways of relieving point of care cost barriers is through organized health insurance.  We are also committed to improving the quality of available care by streamlining process relays (e.g. appropriate triaging; mobilization of available resources in cases of emergencies outside or within the hospital) within the health care delivery system. 

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