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Examining the quality of acute care in sub-Saharan Africa

The slums of sub-Saharan Africa are home to some of the world’s poorest and most vulnerable people. With inadequate access to quality healthcare, these communities are often blighted by disease and early death. In sub-Saharan Africa, more than 50% of urban residents live in slums.

Whilst people living in these slums often visit local doctors, hospitals and clinics, very little is known about the actual quality of the healthcare they receive.

Observing consultations

Building on some existing research examining the video-recording of doctor-patient consultations at University College Hospital in Ibadan, Nigeria, Professor Richard Lilford and Dr Navneet Aujla from the University of Warwick (working with the University of Ibadan) doubled the previous number of consultations observed to 150.

They also developed ten written case descriptions that can be used as part of quality assessment methods, such as a standardised patient approach, where actors are trained to portray patients and are sent out to providers to examine the quality of consultations. The team was also able to connect with Kenyatta National Hospital in Nairobi in order to extend the work into this setting in the future.

The quality of care study team

Assessing doctors’ clinical and interpersonal skills

This was a collaborative project with clinical and academic partners at the University of Ibadan’s College of Medicine and Family Medicine Department, at University College Hospital Ibadan, one of the largest teaching hospitals in Nigeria. The project assessed doctors’ clinical and interpersonal skills.

In sub-Saharan African countries, little is known about the quality of healthcare patients receive

“We undertook a pilot study to examine the feasibility of video recording doctor-patient consultations at University College Hospital in Ibadan to examine doctors’ skills - such as clinical guideline adherence, and empathy. We observed 150 consultations, covering nine doctors, with adults and children under five experiencing symptoms such as cough, fever, diarrhoea and abdominal pain” says Professor Lilford. “Overall, we found excellent quality of healthcare provision. We also uncovered specific issues in using a checklist and multiple raters to judge quality in the video recordings.”

The invaluable role of local knowledge

The local knowledge and experience of international partners has been crucial. Academics from the University of Ibadan are experienced in conducting research in slums. They also enabled access to the hospital outpatient department through connections with doctors at the Family Medicine Department at University College Hospital, Ibadan. The local team provided expert advice and guidance throughout this project. “We commend and thank the team for their involvement, without which the study would not have been possible” says Professor Lilford.

Professor Lilford welcomes delegates to a dissemination event for the study

Paving the way for a healthier future

The project is just the start of the team’s work in this area. They hope that moving forwards their work will help to inform government policies. “The Warwick team worked alongside the expertise of local partners and offered training and supervision as necessary. Our findings will be of interest to policy-makers, and will help in the training of healthcare providers at the range of healthcare facilities in Sub-Saharan Africa” continues Professor Lilford.

Dr Ilori - a key collaborator from the University College Hospital in Ibadan – presenting details about the study

"Our work is helping to develop future research studies on this important topic. Our plan is to assess and provide feedback to individual providers on their clinical skills, based on their interactions with patients, using the methods that we developed in the proposed work. We hope to develop and evaluate educational provision for improving clinicians’ skills in specific areas. As a result of our project, we are now in a stronger position to apply for funding to undertake future collaborative research. We hope that our work in the long-term will benefit patients and healthcare providers alike, across both Nigeria and wider sub-Saharan Africa" Professor Lilford explains.

The project directly links to the United Nations Sustainable Development Goal of Good Health and Well-Being.

Principal Investigator: Professor Richard Lilford

Countries: Nigeria and Kenya

UN Sustainable Development Goal(s) addressed: