HEALTH OF AFRICANS PROJECT – PART 3
By Charlotte Ahmadu
From Project Team Leader
What makes a good pharmacist? Being a pharmacist (or pharmacy student) yourself, I’m sure your answer would vary from mine. But at the very heart of things, the one feature of a good pharmacist the universally all can agree on, is that the pharmacist is centred on patient care. Now comes the difficult question- how do you go about taking care of a patient? When I answered that question, I decided to be an economist.
Thus far, I would hope that we’ve been able to convince you of the disaster that 100% out-of-pocket health care payments are, and the terrible need that each and every African has some sort of protection against disaster expenditure due to falling ill. I hope that we have also been able to show you that these stories are not random, they could happen to even the best and healthiest of us.
Now, I want to convince you of something else. Something that requires for you to put to the side your righteous anger that the system is failing so many, and put to work your analytical and quantitative skills in answering the question of- what type of system would work? Should healthcare be free? Would a struggling third-world sub-Sahara be able to pay for all its citizens’ healthcare needs? Do we need more western handouts to set ourselves up? Is it corruption? Or is the solution found within a give-and-take… trade now by barter later?
What system will work and how sustainable will its financing and delivery be? I think that now you can understand how I chose to answer what one should do to take care of the patient.
Story Eleven: Biographical
Background: A lesson in medication non-adherence
When Mrs Eno was diagnosed with Diabetes Mellitus Type 2 and Hypertension ten years ago, she was a very unwilling patient. She’s never liked swallowing medicines or visiting the doctor’s office and unfortunately, her lack of medication adherence and non-compliance to the doctor’s advice resulted in her everything changing for her.
After being diagnosed with two conditions that have no straightforward cure but require strict management for optimal health, she knew she had to change. She began to visit the hospital twice monthly for tests, checkups and medication refills, but her good behaviour soon slipped up and in the last two years, she has been admitted to the hospital thrice due to very poor sugar control that required immediate emergency intervention.
A few months ago, her non-compliance caught up with her and two toes on her right foot were amputated after developing ulcers.
Mrs Eno is a retired public officer. The little pension she received is all spent on paying for her hospital and medication bills. Her children send her funds monthly to support her, but with their own burgeoning families, there’s little they can do. Every family member is involved in her healthcare expenditure. Her ill health has impoverished her and further disadvantaged her family.
We asked her how she now tries to stay healthy- she says she’s now accepted her condition and takes her medications as needed. She eats more vegetables and fruits and heeds to any advice given by the doctor.
Hopefully, this story will have a more ideal ending.
Story Twelve: Biographical
Background: A file full of medical cases, dwindling finances and anxious fears
Mr Aniefiok has had a slew of hospital admissions over the course of his life. He’s had cerebral malaria, severe typhoid sporadically and intense sleeping sickness (trypanosomiasis, after being unwittingly bitten by a tsetse fly) that ‘was like living in hell’. Fifteen years ago in 2003 while still working in public office, he was diagnosed with Type 2 diabetes. He confessed that his deepest fear is being diagnosed with an illness that has no cure. Fortunately, his fear has never materialised. He explained to us that he takes his ‘anti-sugar’ drugs regularly so that he can live to the fullest. I read, as his pharmacist, can attest to his current health status is very good.
Now retired and no more in active public service, affording his healthcare has become a strenuous task. He reportedly spends his personal savings and pension allowances on medical and medication bills. At some point, he was able to benefit from the National Health Insurance scheme for civil servants; but with the system being unable to afford, he was soon back to 100% out-of-pocket payments. Soon after, his pension allowance payments stopped being regularly paid and his financial situation took a nosedive.
As a civil servant, he earned less than 100,000 naira (~$270, £210) monthly, and after bills were paid, little was always left for his savings account. Now retired and dependent on his pension, keeping up his health costs have become extremely tasking. He has monthly checkups in the hospital and gets a medication refill in the pharmacy bimonthly. To stay healthy, he adheres to his medication therapy and regularly monitors his blood glucose level and other relevant vital signs, while also maintaining a healthy diet.
Please Note: Original conversation language: Oron dialect, was translated into the English language.
Story Thirteen: Testimonial
“I am more than 50 years old and I don’t see the need to be on the Ghanian National Health Insurance scheme. It doesn’t seem functional to me. Whenever I fall sick, I call my private doctor and friend to see me. I also do the same for all my family members, we call him and he pays a private visit. If the illness worsens or we have more complicated issues, we go to the hospital. My children pay for all my healthcare bills- they never complain. It’s more or less their responsibility to look after me now.
I don’t really remember the last time I visited a pharmacy. I prefer herbal preparations, you see. It’s what my body is used to, and I’ve been doing fine.”
Story Fourteen: Testimonial
“The Ghanaian National Health Insurance Scheme works very well for me. I have chronic asthma and I’m able to get most of the drugs I need. For those the scheme doesn’t cover, I’m given a prescription to buy them in a private community pharmacy to buy them.
I don’t earn a lot of money where I work, so my condition has affected my finances. The real challenge I experience is the accessibility to the drug, not necessarily the price. Sometimes I have to go long distances after checking many nearby pharmacies before I can get find the drugs I need, as a lot of pharmacies don’t stock the drugs prescribed to me.”
Story Fifteen: Testimonial
“My uncle is in his 50s and is now disabled because of his diabetes. His health condition has become a burden for the entire family because we have to support his health. We don’t really know what to do-we’ve hired people for home care, tried taking him to a private hospital, but nothing has helped. The financial strain is really being felt because everybody is trying their best to be supportive.
We haven’t been able to find a place where he can live in 24/7 and be given professional care, so we have to hire healthcare workers to come in every week. It has been very expensive.
We aren’t on the Ghanaian Health Insurance scheme because to my knowledge, it only covers 30% of medical bills and that’s almost pointless because it won’t do anything to help alleviate my uncle’s health expense burden. I think the government can do better but I also don’t think much will be done to change things, anytime soon.”
From Project Team Member
Health issuance schemes are designed to help the population have access to affordable and quality health care without necessarily causing financial stress to people. Getting these systems to work efficiently has always been a challenge across Western African states and its failure to meet the standard has caused people to have mistrust in the system. Patients have been abused and disregarded by hospital front line staff, experiencing this and seeing it being done to others has always been a reason why people choose to not access healthcare services using the health insurance scheme. The rationale that I will be treated better if I pay for the service being rendered is firmly believed.
Considering palliative healthcare services, a blatant disregard of the aged at hospital fronts, by health workers, discourages them and causes them not to patronize the health insurance scheme which was supposedly created to ease the financial constraint that prevents people from accessing good healthcare.
Distrust in public services has led patients to believe that since the government provides free drugs, they must be on inferior quality to that which they could purchase in a private pharmacy on their own tab. Another instance is where the drugs prescribed for patients, are not covered by the insurance scheme when the bill needs to be paid when on paper, they are. Only a controlled number of drugs are covered by this scheme and this makes patients wonder “what is the use of the scheme to me if the drugs I need are not being provided?”
A system, no matter how perfect on paper it may look, is a failure if no one will prescribe to it.
Yours in Truth,