Patient Bill of Rights as a Tool for Health Accountability
Introduction
One of the key functions of the health system is responsiveness to the needs and demands of the public (citizens). It involves how well the health system meet the expectations of the public (WHO 2000).
Quite often the expectations are:
- Protection Of Consumer Interests ( against fraud and abuse, respect)
- Client Satisfaction with Health Service.
Improving responsiveness require simultaneously working on the protection of consumer rights on one hand and the client satisfaction with health service on the other hand. However, overall improvements would require management attention and citizens engagement and public spotlighting, and working in collaboration with key stakeholders.
The Patient Bill of Rights (PBoR)
Nigeria has had a formal definition of patients’ rights included in specific legislation since 2014 (National Health Act). However, Patient Bill of Rights (PBoR) was only officially launched on 31 July 2018. The development of the strategic document was made possible by the Consumer Protection Council in collaboration with the Federal Ministry of Health and other stakeholders.
The Patient Bill of Right is an aggregation of patients’ rights that exist in other instruments including, The Constitution, Consumer Protection Act, Child Rights Act, Freedom of Information Act, National Health Act, the Hippocratic Oath, other professional ethical codes and sundry regulations.
The bill spells out the patient's right to information, urgent medical intervention, secure healthcare environment, to be treated with respect and timely access to medical records which must be treated with confidentiality. However, this may only be best achieved by presence of an efficient, accessible and user-friendly means of redress, should the patient consider his or her rights have been violated.
The Patients’ Bill of Rights is more or less a demand side approach to making health service responsive to the desires and the demands of the citizens and clearly defines the levels of care which patients can "expect" from the health service providers. However, the supply side requires that health provider is sufficiently empowered to provide services that is secure and of good quality – “quality assurance”.
Principles Guiding Patients’ Rights:
Guarantees Fair Treatment:All Nigerian patientsirrespective of background, religion or tribe are guaranteedfair treatment and every patient can make his own medical decisions.
Drives Quality Service:The Patient’s Bill of Rights will eliminate quacks in the country's healthcare sector, as it will serve as a weapon in the hand of the patients to demand quality healthcare service from the providers and medical practitioners.
Consumer Awareness:The bill brings a lot of awareness on patient rights, provides guidelines that can assist patients in making decisions regarding healthcare, and to support active participation in healthcare planning.
Aggregation of all the Rights for Consumers: The CPC Nigeria through the PBOR aggregated all the patient rights in a concise manner, that gives them a clearer understanding and will be available to organization personnel, the patient, and his or her representatives as well as other organizations and the interested public.
The 12 fundamental rights of every patient:
- Right to relevant information in a language and manner the patient understands, including diagnosis, treatment, other procedures and possible outcomes.
- Right of timely access to detail and accurate medical records and available services.
- Right to transparent billing and full disclosure of any cost, including recommended treatment plans.
- Right to privacy, and confidentiality of medical records.
- Right to clean, safe and secure healthcare environment.
- Right to be treated with respect, regardless of gender, age, race, religion, ethnicity, allegations of crime, disability or economic circumstances.
- Right to receive urgent, immediate and sufficient intervention and care, in the event of an emergency.
- Right to reasonable visitation in accordance with prevailing rules and regulations.
- Right to decline care, subject to prevailing laws and upon full disclosure the disclosure of the consequences of sure a decision.
- Right to decline or consent to participation in medical research, experimental procedures or clinical trials.
- Right to quality care in accordance to prevailing standards.
- Right to complain and express dissatisfaction regarding service received.
Patients Responsibilities
- Giving the health care provider accurate information about present complaints, past illnesses, hospitalizations, medications, and any other information about his or her health.
- Reporting unexpected changes in his or her condition to the health care provider.
- Reporting to the health care provider whether he or she understands a planned course of action and what is expected of him or her.
- Following the treatment plan recommended by the health care provider.
- Keeping appointments and, when unable to do so, notifying the health care provider or facility.
- His or her actions if treatment is refused or if the patient does not follow the health care provider’s instructions. Making sure financial responsibilities are carried out.
- Following health care facility conduct rules and regulations.
The Complaints Mechanisms
Citizen’s Complaint Structures can be defined as the institutions and channels that can receive and hear a citizens' complaint against grievances and problems, and provisions that allow a citizen to file a complaint. If the complaints structures are effective, citizens can complain about the wrong doing of an individual and institutional provider and initiatives are taken by appropriate authorities address the complaints.
It is essential for citizens to know how, where and when they can complain against anything that goes wrong at the health service delivery level.
They should also know about the legal complaint provisions that exist if they have any difficulties with the law.
Implementing a proper complaint handling mechanism requires a step-by step process, ensuring that it is undertaken in time and is of good quality. A proper implementation of a complaint mechanism also necessitates providing sufficient human and financial resources, in addition to applying assigned roles and responsibilities defined during the set-up of the complaint mechanism.
Channels to report complaints
Channels to report complaints should allow all potential complainants to report their grievances.
Providers have heterogeneous approach at local levels, from having complaint boxes to relying in relationships of trust between patients and providers to voice complaints.
However, there are email addresses, online and offline reporting tools, helplines, personal conversations, SMS reporting and mobile applications.
Nowadays, online reporting tools such as email, online submission forms or online platforms are widely accepted. The reporting mechanisms should be tailored to the needs of the potential users. For example, a walk-in office or a phone message service might be more accessible for some communities. Particular efforts should be made to build trust in the various channels. Anonymous reporting should be possible and accessible.
Patients can complain directly to the facility managers at the health institutions and health facilities in the Primary Health Care facilities/clinics, General Hospitals, Teaching Hospitals.
They can also forward serious complaints to the Ministries of Health, State Hospital Management Boards, State Primary Health Care Development Agencies and Local Government Health Authorities
The Civil Society Organization channel: The role of the Civil Society Organizations in promoting and protecting patients’ rights is widely acknowledged.
In Nigeria, the Initiative for Health Accountability and Transparency (IHAT), a local NGO is in the forefront of promoting the protection of health consumers’ interests and client satisfaction with health service.
The role of the complaints system is that upon review and confirmation of the complaints related to quality and patient safety, appropriate government institutions/organs are contacted and may impose sanctions on facilities and practitioners.
A more systematic approach needs to be promoted to ensure that the principles enshrined in the patients’ charter are implemented.
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Mr Idris Jibril (08038702376)
Initiative for Health Accountability and Transparency
