I recently stumbled upon a tweet by the respectable Senator Shehu Sani, a former federal lawmaker and a vociferous critique of the present administration. In his tweet he took a veiled jab at private hospitals in the country, mocking them for referring their patients to teaching hospitals. In his usual sarcastic manner, he wrote, ‘when a private hospital starts referring your patient to a teaching hospital….the thing don pass dem’.

I think this notion, unfortunately also held by many Nigerians, is a destructive representation of Nigeria’s health system and healthcare delivery around the world in general. Coming from someone as highly placed as Senator Sani who also enjoys a huge following on social media, and with a lot of affirmations to this tweet in his comment section, there is a risk of propagating a false notion. This is exactly what spurs private healthcare providers to ‘hoard’ patients. On the contrary, private hospitals should be encouraged to refer their patients to tertiary, teaching hospitals. Early!

Healthcare delivery is collaborative and not competitive. It is specifically designed to encourage referrals along an ascending chain of complexity. It is in fact very good medical practice to refer patients who one can’t treat given the circumstances (e.g. lack of expertise or equipment) early to other hospitals who are better suited to manage the patient. There is no heroism in medicine. The ultimate aim is to keep the patient alive, it does not matter under whose roof this happens.

Healthcare is delivered through primary, secondary or tertiary centers depending on the severity or complexity of the case. Relatively simple-to-treat ailments such as uncomplicated malaria should be managed in primary health centers, the more complex ones such as appendicitis or complicated labor should be handled in secondary health centers, while the most complex cases such as critically ill patients should be treated in tertiary centers.

60% of healthcare delivery in Nigeria is through private hospitals. Most of them are primary and secondary healthcare centers. Unfortunately, many private hospitals refuse to refer their complex patients to tertiary centers and when they do, they refer them very late. Personally, I have lost close relations to this criminal malpractice. The underlying cause for this stems from greed: the desire to keep a patient with you as long as possible and milk them financially till they are dry. This is not helped by the fact that most Nigerians have lost faith in the public health system.

The Medical and Dental Council of Nigeria (MDCN) must do more to discourage the practice of delayed referrals. Strong laws with very stiff punishments such as withdrawal of practicing licences or hefty fines on offenders will suffice. Establishing a national inquiry into hospital mortalities will be a good place to start from (patient’s relatives will be shocked when they discover the actual causes of death of their loved ones). Next time when a hemorrhagic stroke (bleeding in the brain) presents to a 5-bed, blue-curtain, road-side hospital in a village in Orlu, they will quickly refer the patient to Imo State University Teaching Hospital Orlu.

Alpha Chiemezie Madu

January 24, 2022