Going to hospital, public or private?

Jonah Kadiri is holding up a family tradition he was born into. “I have never used a public hospital,” he asserts, and he’s not kidding. “Not even as a child, I have never visited a public hospital.” His parents began the tradition of patronizing private hospitals, now a father, Kadiri is doing the same. “A […]

Jonah Kadiri is holding up a family tradition he was born into.

“I have never used a public hospital,” he asserts, and he’s not kidding.

“Not even as a child, I have never visited a public hospital.” His parents began the tradition of patronizing private hospitals, now a father, Kadiri is doing the same.

“A private hospital, you can easily access them any time of the day-day or night. Once you call, there is someone to attend to you.”

His concern is attention and response. Those two concepts have coloured perceptions toward private hospitals-and public hospitals seem to be trailing far behind.

A deep understanding of how the health system works in Nigeria means people know what goes on in both private and public. Frank Ajuka is a health journalist, and has written stories around hospitals across the country. He likes public hospitals, sees some of the best brains there, but is partial toward private hospitals.

“With private hospitals, you get more attention, more value for your money,” says Ajuka. “You are treated with dignity, not like in public hospitals where women are shouted at.”

Attitude of staff of public hospitals is a major turn-off for many people opting to visit private hospitals. They say with private hospitals run like a business, no owner wants to have a staff who turns away customers.

“If you keep getting complaints about a particular staff, it won’t work out. There are attitudes you will have as a staff, you can’t even work in the place,” says Ajuka.

Halima Adamu saw that first hand with nurses at the Nyanya District Hospital in Abuja which she had been visiting to vaccinate her son. On her first-ever visit, she was told she was late for the clinic day.

“I had to beg them, to beg and beg, for them to vaccinate my son. I wasn’t alone. One woman even went on her knees, but this nurse refused. That can’t happen in a private hospital,” she says.

“Whenever I take my child for immunisation, my husband would ask what vaccine shot he got. So when I asked the nurse what injection my son was getting, she just shouted at me, demanding why I wanted to know. I reminded her they had told us during the pre-immunisation lecture that it was our right to know what we were given. She just kept making noise about it and went ahead and gave the injection. It was when I was leaving she shouted, ‘It is pneumonia vaccine’.”

“These workers in public hospitals, they really know their work, they have experience, but their attitude is just bad. They don’t see you as a fellow human being. In this same hospital, I have seen nurses asking a woman in labour to make up the labour bed herself. She winced all the way through. When she was done draping the birthing mat over the bed, she signalled for the nurse. The nurse said, ‘Won’t you climb on, or do you need me to carry you onto it? Was I there when you were doing it?’ When I am done with child’s immunisation schedule, I am not coming here again. I will change to Customs Staff Clinic.”

Those are the public-hospital “pranks” that put off patients like Vincent Ikuomola. He’s not a patient himself, but he’s retained a public hospital where his children get care.

The “pranks” he talks about are reports of public-hospital staff treating patients indifferently or referring patients to their own private-run hospitals.

“You have the best hands in public hospitals. Apart from their pranks, public hospitals are the still the best,” he says.

“They have government backing, they go for trainings, they are experienced. What private hospital has enough funding to regularly train its staff?”

Public hospitals are all over. In some places they trail private hospitals in number and may cost less.

One respondent is looking for a public-hospital urologist after a private practice gave him a N600,000 for a surgery. A poll found nearly six in 10 Nigerians have visited a public hospital this year. Each visit is estimated to cost N3,204 on average in a public hospital, compared to N5,744 in a private hospital.

The feelings reflect in documentation about hospitals in Nigeria. In 2012, seven researchers collected responses from 520 people visiting four hospitals in Lagos and assessed performance of public and private hospitals. Wherever differences existed on domains of responsiveness, privately operated hospitals performed better, the researchers wrote in the Journal of Public Health Research.

“Users of private hospitals also reported a higher level of overall satisfaction. Private hospitals were found to perform particularly better on the domains of dignity, waiting times, and travel times,” according to the study. These findings have implications for the management of public hospitals in focusing their efforts on improving their performance in low scoring domains. Performance in these hospitals can be improved by emphasis on staff training and demand management.”