THE QUALITY OF HEALTHCARE INFRASTRUCTURE AND LEVEL OF ACCESSIBILITY IN NIGERIA

CHAPTER ONE

1.1 Introduction

Owing to inadequate hospital design and distribution throughout the nation, public and private healthcare facilities have received the attention they need to close the infrastructural gap in Nigerian hospitals (Moedozie and John-Abebe, 2022; Agaja, 2012). Nigeria is widely acknowledged as one of the great African nations, yet despite changes and strategies to address the system's problems in both the local and state government sectors, the country's healthcare situation remains dire (Welcome, 2011; National Health Policy, 2016). According to Adeyinka and Olugbamila (2016), carelessness in the allocation of healthcare facilities is the reason Nigeria has a high population to facility ratio.High hospital costs, a lack of health insurance and services, ageing, and the availability of healthcare services are the most obvious obstacles to getting medical treatment(Moedozie and John-Abebe, 2022). Even during the coronavirus pandemic, Nigerian residents have been denied access to excellent health, one of their essential human rights.(Cohut, 2020). Several hospitals and centres limited services to just severe cases designated emergencies during this period due to a government mandate banning public gatherings, and other patient requirements were refused, making it more difficult than normal to receive care for non-emergency situations (Adeboyejo, 2020).

          Nigeria's health system, which combines orthodox and unconventional medicine, has only partially implemented health policies. This has resulted in resource optimisation issues and a failure to meet the Millennium Development Goals for health care.Any region's healthcare facilities' accessibility and utilisation are crucial since they impact the general health of the populace (Ephraim-Emmanuel, Adigwe, Oyeghe,and Ogaji, 2018). The accessibility issue that arises from the concentration of these facilities can be resolved by promoting even the dispersion of these crucial facilities.According to Fadahunsi et al. (2017), insufficient health care delivery has resulted from the majority of Nigerian states' healthcare facilities being located in areas that do not always match the demands of the populace. Regional differences in healthcare outcomes are a result of differences in healthcare facility accessibility and dispersion.Ensuring healthy lives and promoting well-being for all ages is the third Sustainable Development Goal (SDG) (WHO, 2022). In order to fulfil the third Sustainable Development Goal, it is essential to address disparity in healthcare requirements, particularly with regard to the accessibility to such services.

          On the other hand, low service quality, competition among healthcare providers, and limited accessibility are some of the reasons why many outlying public healthcare facilities are not being used (Anderson et al., 2007). Using the facilities that are available has both advantages and disadvantages in a number of areas, including cost, service delivery, cultural ethnicity, travel expenses, distance, road conditions, infrastructure, and service providers (staffing).Obstacles impeding the use of health care in hospitals and centres across demographic groups include the availability and calibre of staff, their attitude towards patients, scarcity of medications and the perception of expensive hospital bills, site of residence, and maternal education (Babalola et al., 2009; Salome et al., 2009; Nteta et al., 2010; John-Abebe andOsirike, 2015).

          Over the years, several studies on the calibre of healthcare service have been conducted. Determining whether the treatment given to patients is suitable and safe for the patient has piqued the interest of stakeholders.This is founded on the idea that recipients of health care services should receive high-quality care that complies with worldwide best practises (Ronda, 2008).The need for high-quality, reasonably priced healthcare is driven by the world's constantly changing political, epidemiological, and demographic landscapes as well as by the complexity of illness patterns and patient preferences.The level of patient-centered care that is offered by the healthcare facilities may be inferred from the patient's happiness following an interaction, which is now recognised as an indication of quality health care delivery. In reality, prior research has demonstrated a link between the calibre of medical services and the degree to which patients or consumers are satisfied with the treatment they receive (Kalinichenko, 2013). It is based on this background that this study seeks to review available evidence on the quality of healthcare infrastructure and level of accessibility in Nigeria.

2.0 Discussion of Literature Review

          As a guide to discussing the literature review, the research questions that were asked in this study were first determined the meanining of  quality health care, ways of achieving quality health care,and whether the quality health care in Nigeria has been  made accessible to the citizens.

          The inclusion criteria of this study included review related to the quality of health care delivery generally and in the Nigerian context; the key quality criteria were treatment effectiveness, acceptability, efficiency, appropriateness and equity. A totla of reviewed 15 relevant literatures which included retrospective studies, observational studies and reviews were dissected.

2.1 Quality Healthcare

          Healthcare facilities' perceived and technical quality criteria are typically used to categorise quality. In keeping with current care recommendations, the former pertains to the state of the health infrastructure and patient compliance with professionally specified practises and procedures; the latter is based on patient experiences and perceptions.The World Health Organisation (WHO) and other academics have created a number of metrics to evaluate the performance and infrastructure of healthcare institutions(Ibrahim, bin Mohtar and Dutse, 2015).These guidelines are also observed in Vietnam, where the quality of healthcare facilities is shown by the scores of hospitals and clinics in the country's quality evaluation(Ejughemre et al., 2015).  

Similarly, accessibility to health care varies greatly among regions based on regional organisation, and is influenced by population density and transit time. Accessibility is significantly greater in metropolitan regions even if it might take hours or even days to get primary healthcare services in Nigeria's rural communities (Ogaji, 2016).According to reports, even if the health care business has a good number of evidence-based innovations, there is still an issue with the proper distribution of these technologies. The acceptability and patient-centeredness of care, appropriateness of health care delivery, efficacy of treatment, efficiency of care, and equitable distribution of health care services are all components of quality health care (Mosadeghrad, 2014; Omachonu, V. K.and Einspruch,2010).

2.2 Accessibility/patient centredness in the delivery of health services

The provision of health services in a fashion or manner that complies with patients' and their families' preconceived wants and expectations is known as accessibility of health care. Patients and family members find the services satisfactory when the healthcare professional meets their preconceived expectations(Ephraim-Emmanuel et al., 2018). In contrast, if a patient or their family members feel that the health services are inadequate and their expectations are not fulfilled, then the situation is reversed. The use of health services in the future is directly impacted by such unfavourable experiences. Poor intercultural relations, a lack of trust and respect between the patient and the healthcare practitioner, and other issues are also known to have an impact on the acceptance of health services (Hergati et al., 2015; Bilquis et al., 2015).

          A portion of the answer would entail the healthcare provider doing all in their ability to deliver patient-centered healthcare, which provides the patient the autonomy to decide which medical facilities and services to use. A well-functioning health system should prioritise the significance of the patient.This is necessary because to the possibility of a mismatch between the patient's or family members' expectations and those of the healthcare professionals (Ephraim-Emmanuel et al., 2018). Patient-centered care, on the other hand, gives the healthcare provider the reassurance that the best treatment possible will be provided, leading to improved health outcomes and optimal patient acceptability of the care. This, in turn, produces optimal satisfaction and perceived quality of care.The highest level of happiness that patients might have with health services as a consequence of patient-centered care will also enhance the satisfaction of carers and their capacity to carry out patient-centered care (Gibbon et al., 2014).

          Reports have been made on the unsatisfactory acceptance of health care services in Nigeria owing to issues with staff and infrastructure, as well as physical and mental suffering. This has therefore had an impact on the population's use of Nigerian health services, as seen by the rise in the number of people seeing traditional medical practitioners (Moedozie and John-Abebe, 2022). This demonstrates the need for more patient-centered health care initiatives in health planning, health policy development, and the delivery of health care programmes and services to the general public through the provision of resources—both human and material—for health, investment in health infrastructure, and strengthened measures to guarantee that health care providers follow protocols that ensure patient safety, respect, and justice(Gibbon et al., 2014).