Medical practice:Africa vs North America

Dr. Louis Uwaifo

Resident, Family Medicine,

University of Benin Teaching Hospital

(U.B.T.H.)

Outline• Introduction

• Definition

• Ideal medical practice model

• Reality check, comparison

• “Medicine is universal”

• Role of government

• Challenges facing medical practice in Africa and possible solutions

• Conclusion

• Thank you

Introduction

• Medical practice in Africa and North America have a

number of differences, and we will in this session

attempt to discuss some pieces of the puzzle.

Medical Practice

• Medical practice is a type of business in which a

medical practitioner or group of practitioners work with

patients in order to diagnose and treat illnesses,

injuries or other medical conditions that require care.

Ideal Medical Practice (IMP) model(L. Gordon Moore, MD, and John H. Wasson, MD, FAM PRACT MANAG. 2007)

• What is an Ideal Medical Practice?

Low overhead with high technology, wrapped around an excellent

physician-patient relationship.

• Ideal Medical Practice- A practice model designed to enhance doctor-

patient relationships, increase face-to-face time between doctors and

patients, reduce physician workloads, instill patients with a sense of

responsibility for their health and cut wasted dollars from the entire

system.

Ideal Medical Practice Typical Practice

Care is driven by the patient's needs, goals and

values- Patient Centered

Care is driven by the

practice's priorities-

Doctor Centered

Access is 24–7. Access is 9–5.

The care team uses technology to its fullest (e.g.,

electronic health records, e-mail, Internet scheduling).

The care team avoids new

technology.

Patients can see their own physician whenever they

choose.

Patients must see whoever

is available.

The majority of the office visit is spent with the

physician.

The majority of the office

visit is spent waiting.

Ideal Medical Practice

Overhead is low.

Typical Practice

Overhead is high.

Patients are seen the same day they call

the office.

Patients typically wait for an

appointment.

Physicians are able to see fewer

patients per day.

Physicians must generate high numbers

of visits per day to cover overhead.

Practices measure themselves regularly. Practices have little or no performance

data.

Practices are proactive in their care of

patients with chronic illnesses.

Practices are reactive in their care of

patients with chronic illnesses.

Physicians are satisfied and feel in

control.

Physicians feel harried and overbooked.

Reality Check: Case Scenarios (discussion)

Africa (Nigeria)

• A patient with an influential relative

as staff vs the average patient who

knows nobody

North America (US)

• Prof’s bilateral malleolar fracture

during a visit to the US

MEDICINE:

• is indeed universal, without special treatment to some, in other

words everyone should be treated with the same level of care

irrespective of who the know or their affiliations.

AFRICA (S.A) VS NORTH AMERICAN (CA) ER ACTIVITIES (VIDEOS)

ROLE OF GOVERNMENT

• United States (Population - 318.9million, United States Census Bureau, 2014);

Medicare, Medicaid, CHIP, and Marketplace Subsidies: Four health insurance

programs — Medicare, Medicaid, the Children’s Health Insurance Program (CHIP),

and Affordable Care Act (aca) marketplace subsidies — together accounted for

25 percent of the budget in 2015, or $938 billion. Nearly two-thirds of this

amount, or $546 billion, went to Medicare, which provides health coverage to

around 55 million people who are over age 65 or have disabilities. About $8,000

was spent per person, (The Center on Budget and Policy Priorities)

• It is estimated that approximately 62% of hospitals are non-profit, 20% are

government owned, and 18% are for-profit (Toronto Notes, 2015)

ROLE OF GOVERNMENT CONTD.

• Canada; (Population - 35.16 million, Statistics Canada 2013); In 2015, Total

health expenditure in Canada was expected to reach $219.1 billion, or

$6,105 per person. it is anticipated that, overall, health spending will

represent 10.9% of Canada’s gross domestic product, (Canadian Institute for

Health Information)

• Hospital services in Canada are publicly funded but delivered through

private, not-for-profit institutions owned and operated by communities,

religious organizations, and regional health authorities (Toronto Notes, 2015)

ROLE OF GOVERNMENT CONTD.

• Nigeria; (Population – 177.5 million, World Bank, 2014 )

N262b ($1.7billion) has been allocated to Health in Nigeria’s 2014

budget (Nigeria Health watch, 2014)

PERCENTAGE OF GDP SPENT ON HEALTHCARE, (World Bank, 2015)

Country Name Health expenditure, total (% of

GDP)

United States 17.1%

Canada 10.9%

South Africa 8.9%

Ghana 5.4%

Nigeria 3.9%

CHALLENGES: COMPARE AND CONTRAST

Criteria Africa North America

Rate of Litigation Low High

Remuneration Low (Lack of

motivation)

High

Audit system Poor Complete Audit/

review cycles

EMR Delay in communication,

distorted data pooling

for records and

research

Commonly used,

improved data

management

COMPARISON

Ambient environment Hot humid weather, lack

of good ventilation

Central air conditioning

or heating systems

depending on the season,

winter or summer

Strike Incessant strikes hamper

productivity and good

continuity of care

Almost non-existent, even

when it happens it is

relatively short-lived

Inadequate facilities/

Personnel

Poor acquisition/

maintenance, understaffed

hospitals

Modern facilities/

standards are kept, well

staffed with skilled

employees

Protocol/ guideline

adherence

Haphazard Protocol based and

Orderly

Suggestions to problems with medical practice in Africa

• Ambient environment: a conducive working environment is essential to enhancing

doctors’ efficiency and productivity; preventing us from wanting to rush through our

work to go get some fresh air

• Management Protocols/ guidelines: should be made readily available both physically

and in electronic format for doctors easy perusal; access to up-to-date journals,

attending training conferences

• Facilities: acquisition and maintenance of facilities ensures sustenance of otherwise

expensive machines, as it is cheaper to maintain than replace

• Electronic health/ medical records: introduction and training of doctors to use the EMR;

a systematized collection of patient and population electronically-stored health

information in a digital format

Suggestions contd.

• Remuneration: health professionals work passionately for long hours no doubt,

medicine is not all about money but cash and noncash incentives for work done is an

important motivating factor

• Audit: complete weekly audit cycles, with appraisals of targets and outcomes to see

where adjustments are needed, to ensure protocols are adhered to

• Strike: ‘excellent patient care’, our ideal model’s goal can be protected by promptly

addressing concerns health workers may have to prevent industrial actions that

disrupts our practice and jeopardise continuity of care

• Litigation: getting law enforcement involved when necessary and implementation

committees for existing laws; also education of the citizenry on their rights and

privileges

CONCLUSION

• Is there hope for an Ideal Medical Practice in Africa?

• There is hope! The largest room in the world is the room for improvement (Brian Tracy).

The reasons there are so many disparities between Africa and North American medical

practice is multifactorial and the fix wont be overnight; we will get there as long as we

“become addicted to constant and never ending self improvement” (M. Gandhi)

THANK YOU