Public healthcare systems serve millions of people. Governments require complex systems and extensive management to provide care. To do this effectively, the patients the systems are created to serve have in many cases been reduced to numbers rather than people. What will it take to reimagine healthcare in Africa for patients as people first?
The most important place to begin is by asking people what they want. In its work to support governments in Africa to help people have better access to medicines, particularly ARVs, and healthcare services, the Africa Resource Centre has found that one of the biggest changes people are looking for is flexibility. People want to be able to access essential care and medicines in a way that is convenient for them.
Patients want to feel like they’re cared for. For some chronic, stable patients, this means that they want to be able to access their medicine in the quickest, most convenient way possible. For others, it’s about being able to talk to a healthcare worker for as long or short as they need to about any concerns or questions they have.
Is it reasonable to expect that expansive, entrenched ways of delivering public healthcare can change? We believe that they absolutely can. Small changes and smart differentiated service delivery models can have a significant impact. In some cases without even requiring substantial capital expenditure or drastically increased staffing costs. One of the urban-focused differentiated service delivery models that is being piloted in Uganda leverages the existing private pharmacy network to deliver government-supplied ARVs to people living with HIV.
Obviously patients cannot be given total flexibility in terms of the types and quantities of medicines that they get, but when and where they are able to access their medicines and healthcare services can be significantly reimagined.
In rigid systems when people are required to travel far and wait for long periods in congested facilities, sacrificing time and, often, income, it can fuel frustrations. These are exacerbated when strained healthcare workers end up scolding patients and treating them like children. These conditions often leave little room for individual care because of the pressure healthcare workers are under to serve large volumes of people.
By contrast, in some mission hospitals in rural locations in Africa, although service is free in the same way as government-provided healthcare, the care at these facilities is often more welcoming and caters for patients as people, rather than as numbers to get through in a day. This anecdotally suggests that management approaches can also have a significant impact on people’s experience of healthcare.
If people were empowered to access their regular medicines and health indicator checks in places closer to home and at more varied times, some of the pressure on healthcare workers could be alleviated. This would increase their capacity to give more personal, time-intensive care to patients at the facilities. It would also decongest government healthcare facilities so acute cases can be prioritised.
Patients vs consumers
While there are some overlaps in systems designed to serve consumers and those for healthcare delivery, the main difference for a patient is that they have little choice to go elsewhere if they don’t have a good service experience. A consumer inherently has more choice while patients are dependent on the health facilities that are available in their communities. If people seeking healthcare are able to choose where they access some of their healthcare services, it could significantly improve their sense of agency with the system. Creating more choice for the patient drives a better service and experience.
About the authors
Paul Bitarabeho has over 23 years’ experience in supply chain management in the FMCG industry. He has worked with Coca-Cola in Africa and Asia, Uganda Breweries and Kenya Breweries Ltd, all subsidiaries of Diageo and In Nile Breweries, in supply chain management, Sales and Human Resources at Director Level.
Le Beau Taljaard has over 25 years’ experience delivering growth for clients and his own organizations in the FMCG industry. He gained significant experience and expertise in the Route to Market and Supply Chain with the Smollan Group where he participated in and led new business development, establishing new business units, operational implementation, operational/general management and client interaction.
They have both spent the last 18 months in the Public Health arena supporting the Uganda Aids Control Program (ACP) in developing Alternative Drug Distribution Points (ADDP) for the Aids Control Programme in Uganda with a view to leverage these models to more than just ARTs.