Healthcare Referrals In Nigeria Need an Institutionalized Telecom Culture & Gadgets for Better Outcomes

 

The twelve categories of healthcare providers in Nigeria, as computed by Dr. Adetolu Ademujimi, Sartorius Resources, Nigeria.

In August 2023, I published an article titled “First Eleven Providers Patting Health Care: Fierce elements for Professor Pate’s Headship’s Cure” (see the link https://sartoriusresources.blogspot.com/2023/08/first-eleven-providers-patting-health.html)  as a deep dive into the array of real and quasi-health care providers in Nigeria. One important message of that publication was the need for the Federal Ministry of Health, working with its 36 States & FCT counterparts, to beam its regulatory and collaborative lights beyond the conventional healthcare facilities owned by the Federal & State governments. In the concluding phase of that lengthy article, I made some recommendations to strengthen the regulatory mandate of the national & subnational Ministries of Health over non-conventional healthcare facilities as well as their conventional counterparts.

The non-conventional points of care in Nigeria are the Traditional birth centers, faith-based birth homes, traditional bone-setting centers, traditional herbal homes, traditional incision facilities and private patent medicine vendors, otherwise known as chemists while the conventional healthcare facilities owned by government and private entities include public primary health care facilities, private hospitals, general hospitals, specialist hospitals, private diagnostics, Federal Medical centers and Teaching hospitals. Chief among the recommendations was an inter-facility telecommunication system, comprising both a telecommunication culture and the requisite equipment, which are grossly lacking and significantly contribute to the weakness in medical referrals experienced among healthcare facilities in Nigeria.

Why is a functional telecommunication culture & system a necessity in facilitating seamless referrals in health care delivery?  Imagine a Community Health Extension Worker in a remote primary healthcare facility, who intends to refer a pregnant woman in labour to a General hospital within the Local government for an emergency Caesarean section. Even if there is no ambulance service, a phone call from the Primary Healthcare facility's designated & known telephone line to the General Hospital's equally designated & known telephone line can positively influence the outcome of that care. That phone call will foster inclusivity & team spirit, interprofessional respect, and cordiality in the professional working relationship between the primary health care worker who made the call and the receiving colleague at the higher level of care. It will give the distressed pregnant woman & her accompanying relatives a sense of belonging and confidence that the General Hospital eagerly awaits her. It will prepare the General Hospital ahead. It may also stimulate the necessary sense of urgency to decide on an alternative referral facility, if for instance, the call receiver at the General Hospital says, “the only Obstetrician we have is currently on leave, or our blood bank is presently out of service due to our malfunctioning Generator.”

Therefore, as basic as it sounds, and without asking the Federal Ministry of Health or the 36 States Ministries of Health to break the bank to purchase high-end and capital-intensive medical equipment like CT Scans, MRI machines, dialysis machines, Laparoscopic gadgets, and the likes, I recommend the following practical steps to institutionalize a strong telecommunication culture and its attendant tools within Nigeria’s healthcare delivery system in order to strengthen inter-facility and intra-facility medical referrals for better clinical outcomes.

1.  Creation of a ‘compulsory’ designated facility phone numbers  (not personal phone lines of the Hospital CMD or any other official, please) per health facility in Nigeria, whether they’re government-owned or privately owned) on any of the available public telephone network providers in the country that have network coverage within the geographical area in which each health facility is located.

2. Publication of these phone numbers as a national health facility telephone directory disaggregated into 36 States, the Federal Capital Territory, and their respective Local Government Areas. Please note that both physical and electronic publications on the internet are required.

3. Routine update of this national health facility telephone directory (if need be) by the Departments of Health Planning, Research & Statistics of both the Federal & States Ministries of Health.

4. Establishment of a central switchboard per health facility telephone system for routing phone calls, enabling call transfers, and managing phone extensions within the facility. The vendors responsible for providing the telecommunication service have a better understanding of what a central switch board is.

5. Provision of a physical phone desk for the designated facility phone line (preferably at the Outpatient unit) in the hospital, which is linked to the central switchboard, as the first or landing point for all incoming phone calls relating to medical referrals.

6. Training of all facility frontline health workers on telephone-related medical communication skills so as to enable anyone on duty within the Outpatient unit that is recommended as the telephone landing area, to receive the incoming referral calls and take further intra-facility telecommunication actions such as notifying the relevant Service Delivery Point of an incoming referral, which could be either an emergency or non-emergency request.

7. Provision of intra-facility intercom phones at all Service Delivery Points, for example, labour ward, laboratory block, children's outpatient, endoscopy unit, physiotherapy room, dialysis center, oncology department, etc., for easy & automatic linkage or redirection of incoming phone calls from the central switchboard to the appropriate Service Delivery Point in order to notify them of an incoming referral, which could be either an emergency or non-emergency request.

8. Automatic diversion of incoming phone calls from the Outpatient unit landing area, after a certain time of the day, to the Accident & Emergency unit intercom line of the hospital.

9. Provision of intra-facility personal pagers, bleeps, or WhatsApp-like smartphone apps to clinicians, either as an individual or a clinical team, at the concerned Service Delivery Point within the hospital to notify them of an incoming referral, which could be either anemergency or non-emergency request.

10. Development & forwarding of a bill to the National Assembly and possibly each State House of Assembly to support all the above-mentioned health system telecommunication propositions in order to strengthen inter- and intra-facility referrals in Nigeria.

Finally, please note that referrals can be from any of the non-conventional health service providers listed earlier to a conventional healthcare facility. It can also be from one conventional point of care to another. Hence, the institutionalization of telecommunication culture and gadgets in Nigeria's health care system should include both conventional and non-conventional healthcare providers to greatly improve our referral networks. I so submit.

My name is Adetolu Ademujimi, a Medical Doctor, Healthcare Finance Specialist, Author, Reformer, Public Policy expert, and social entrepreneur who can be reached in Abuja through adetoluademujimi@gmail.com. You can also visit my website www.adetoluademujimi.com.

MAKE SURE TO LISTEN AND SHARE THIS PUBLICATION TO ALL NIGERIANS!!!