Some problem needs money to get solved, not plenty of reforms

Some problem needs money to get solved, not plenty of reforms

In my early years at the Ministry of Health Ethiopia years ago, we were struggling to get a small funding to strengthen a hospital system at primary and secondary level. In contrast, across Africa including my country millions of dollar, if not billions throughout the years have been spent for HIV, TB or other vertical program trainings, workshops and conferences. I trust these activities has a good but not significant progress to prevent, control and treat the aforementioned conditions. To maximize the return on investment in these programs we have to give due attention to primary and secondary hospital care.

During my time as a CEO of one of the hospitals in Ethiopia I learned that improving the overall condition of hospitals in low and middle income countries is so critical to prevent health care acquired infections and to prevent or contain antimicrobial resistance. These two conditions are costing or about to cost us a lot of life. We are investing a huge chunk of money on the community awareness creation and health education programs to create better health care seeking behavior. This is a wonderful job. The point is imagine a laboring mother convinced to come to hospital for delivery where there is no electricity, no safe and clean water, no basic equipment’s, no essential drugs and no well trained professionals. Everyone want to fund vertical programs, so who will going to fund improving these situations in the hospitals?

In majority of hospitals in a low and middle income countries, the week begins with complaints. Morning sessions begins with complaints. Bedside teaching, where the seniors bully students, begins with complaints. The outpatient follow up clinic starts with complaints. Laboratory, pharmacy, all start with complaints. For all the days, months and years, everyone has to be a slave to complaints. Is there any possibility in the table of the global or regional health sector leadership to say good-bye to the Supreme Court of Complaints?

The so-called hospitals in those countries are in no way the kinds of institutions that are equipped to make up for either the minimum standard of care, based on the national minimum standard or global standard, or to make up the minimum expectation of the client from rural part of the country. The situation neither prepares them for the challenges of the future health care or for aspiring to start accreditation from the current accreditation organization. The hospitals are overcrowded, badly equipped, poorly managed, inadequately staffed, discouraging and demotivating to the work force, and devoid of any semblance of a stimulating learning environment.

Senior health professionals in the tertiary hospitals either lack the interest or condition to teach and share their experience with undergraduate or post graduate students. They do not have the time to involve them in continuous quality improvement, research and in challenging learning situations that would prompt them to think, explore new experiences and to be creative and independent, while at the same time learning new meaningful facts. The regimented hospital environment evokes in every pupil a feeling of disgust and hatred toward medicine, health and health care.

At different times so many reform agendas were introduced in the hospital setting to change the current misery and havoc. In Ethiopia, years ago the hospital management initiative later called hospital reform was introduced. This reform initiative created an opportunity to understand the definition of hospitals in Ethiopian health system. Later in the years, the hospital reform implementation guideline was supported with different reforms like the clean and safe hospitals initiative, the hospital alliance for quality initiative, hospital performance monitoring and improvement framework, and many more. The initiatives finally ended up with clearly framing the hospitals’ problem for everyone, but not necessarily solving the problems, because the problems need money to get solved, not these huge pager reform guidelines. Our government system in general, and our health system specifically, are not interested in making a huge investment or comparable investment in the medical care.

Funder, Good hearted philanthropic people, global health leaders, governments and private sector entrepreneurs must

1.    Advocate a government to Invest in healthcare development. Leaders in low and middle income countries especially African leaders must honor their commitments to allocate at least 15% of their annual budgets to the health sector, as they agreed to do in 2001 in Abuja. 

2.    Local production of pharmaceuticals. Strengthen the locally owned institutions for local manufacturing, research, disease surveillance and human resource development

3.    Accelerate research and development: Must provide sustainable funding for research and development, with a focus on diagnostics, therapeutics, and vaccines for infectious and non-communicable diseases. Can create a lot of jobs, stimulate economy, reduce poverty and improve human condition of living. This will ultimately can ensure peace and security

4.    Invest in early emergency preparedness and response. Expand the Regional Integrated Surveillance and Laboratory Network (RISLNET) consisting of genomics laboratories and National Public Health Laboratories to all regions and incorporate systems. This has to advocate a concept of one health 

5.    Partnership and Networking: Investment in sophisticated medical care would definitely be expensive. Countries cannot afford to avail every care to its citizen. For this fact countries should work to strengthen partnership between facilities, professional societies and local production companies across the region. Facilitating a safe and easy patient transfer, experts exchange and technology transfer can help.