HealBy Collins Mwai

Instances of medical negligence have been found to be one of the contributing factors to high mortality rates in the region by most indexes, including the World Health Organisation. Studies show that a significant majority of deaths in African countries are actually avoidable.This week on Thursday, the Sustainable Development Goals Center for Africa will host a two day summit that will seek to build and strengthen accountability in African health care systems. The New Times’ Collins Mwai spoke to the Dr. Belay Begashaw, Director General of the Sustainable Development Goals Center for Africa for insights.

Excerpts below:

Would we be correct to say that the high mortality rates in Africa are partly a result of negligence in health care provision?

It is difficult to say that mortality rates are exclusively related to negligence, but in general it is very alarming. Mortality even though at a low level is still a concern. It is even worse if it is due to avoidable causes. Globally mortality rates have gone down but in Africa, it is still very significant. When you go down to different segments of the population, mortality is more harsh and unacceptable when it comes to maternity and some of it avoidable.

What worries most is that on one hand the mortality rates we have in Africa is high and most of it is avoidable. While we are working to increase the coverage of health care services and the number of health care professionals, at the same time we have to look into the issues of reducing avoidable deaths.

By your statistics, to what extent does negligence lead to overall mortality rates?

It is significant. If you look at the data, the WHO data from 2015 referring to the maternity deaths of about 300,000 mothers in that year, 99 per cent is in Africa which is huge. We do not have a vigilance system which can help us focus on why this deaths happened. This is a very focused study which indicates that almost all the deaths could have been avoidable. Some of the deaths is because the ambulances came late among other avoidable circumstances.

When you see from this perspective, the rate is quite high.

We have also had other reports that show for instance deaths after surgery as a result of infections. That report shows that the situation in Africa is 20 times higher than elsewhere in the world. The overall impression is that though death may not be avoidable but should be explainable.

What have you found to be the main challenges that lead to negligence?

The intention of the summit is not to finger point one segment of the health actors. Healthcare is about teamwork including the patient. Healthcare is about health systems, leaders, support systems, private players, professionals, policy makers among other stakeholders.

When we talk about accountability, we often talk about professionals who are on the front line but there are times when these people are doing their jobs but require further support. For instance, a surgeon could be doing an operation then the lights go out. This is why we want to have a summit that will look at it as a team work perspective since we cannot do much when we look at individual actors. For that, governments have to play their role as do private sector partners. In order to be able to play your role, we also need to have rules and regulations as well as commitments that are driven by a mindset.

To ensure that the summit delivers the targeted impact in addressing the concern, what is the profile of participants?

The scope is quite comprehensive. The summit will include health practitioners, professional associations, health leadership like ministers, private care givers, NGOs within the health sector, insurance companies, finance ministers are also invited. We also have legal counsellors as we look to address rules and regulations on the aspect.

Who would you say are the worst culprits in regards to medical negligence?

This is why we cannot be very specific in what aspect needs the most help or is performing worst. Because we do not have a health management system. We do not have audits, or biopsy to be able to have reliable data. We live in a limbo in this aspect. When deaths occur, we do not have follow up or audit to find out the real cause. It is about audits, why did this person die? Could it have been prevented. It is not a joke that when we hear from time to time that people have heard surgeries and surgeons forgot equipment inside one’s body. The issue now is that while we have very strong information systems and multiple technologies, why wouldn’t we start working on this seriously and avoid what can be avoided.

The systems can show us what kind of faults we have in the process and how best to fix them. So that we can be able to identify what segments are falling short.

You can also tell that there is a level of impunity. If you do not perform by certain standards, no one will hold you to it. It is becoming an impulsive act, now the issue is to make sure that there is an incentive system as well as make sure that negligence is not treated with impunity. There is need to have accountability to ensure that services are in such a way that they work to save lives and responsible.

These will be some of the discussions held at the summit comprehensively. We will also look at how we can incentivize to increase the role of the private sector. The aspects of coverage will not only target the public healthcare players but also the private players as we want to make them part of the process.

The cost of quality healthcare in Africa continues to be the highest across the world. Even in comparison to places like Latin America, we still fare badly, what seems to be the issue?

There are two major issues compared to other parts of the world. For instance in Latin America, they have a comprehensive health system that includes research and development. Research and development is important for setting the price. If you go to most Latin America countries, most of the medicine is researched and developed there. In Africa, the research part is missing. In the region, you might find some vaccines and medicines being produced but the recipes and patent rights do not belong here. The research was done elsewhere, they only come to manufacture here because it’s probably a little cheaper.

The second most important thing in regards to cost is the insurance systems. Most health service providers here cannot be able to offer services without money as they have no guarantee that they will get their money. In other parts of the world, one is treated first before the medical service provider can worry about the availability of money to pay bills. That is not the case here. We are trying to push that at least in public health facilities, the services should be available first before worrying about the ability to pay.

When we have a working insurance system, maybe, we will have more subsidized healthcare. When more African countries invest in research and development, we can invent more medicines here which will make it cheaper to access medicines.

Sadly, regional countries have done little to implement commitments made at summits such as the one scheduled to be held this week. There are often well intended resolutions but little is done to implement them. Any idea how to avoid this in your oncoming summit?

That is our experience. We have had lots of declarations in the health care sector over the previous decades. The thing is that is why we are trying to say that we should do things differently. That is why we are saying that the health care is not a one institution problem. We are trying to bring in multiple stakeholders. We need to have the stamina and the zeal and have everyone understand that it is unacceptable to have people die when lives can be saved. Everything would be easier if you have that level of commitment.

We are calling for us to tap into technologies and capacities that we have at the moment. Technology is becoming the new sheriff, if you do not do your job, technology is going to expose you.

If we also empower the patients and show them how they can report cases of negligence using technology without necessarily having to go to any office, we will be able to follow up and eventually save more lives.

As SDG centre, we are not here to replace any department, we are here to raise the voices of the people and set agenda that would have otherwise been ignored. We want to bring out agenda that has probably suffered from stereotype whereby stakeholders do not see things outside the box. We are also here to create synergies, which no one will take the lead on. We are contributing this, we are trying to show that none of the SDGs is new, what we are trying to introduce is a new way of doing things.

editorial@newtimes.co.rw