Accountability: A Call for Self-satisfaction

Rwanda Physicians in Simulation Exercise. The country hosted late last year Medical Instruments Trade Conference

Accountability is like a buzzword in today’s business culture irrespective of the business objectives. Whether it is a service, a nonprofit philanthropist or profit driven venture, they all share a common thread – a motive for a maximum level of satisfaction.

It seems from the outset that the concepts of accountability and self-satisfaction are contradictory, because it is assumed oftentimes that accountability requires the existence of another party to enforce it.

The whole concept of accountability is measuring performance against expected and/or agreed deliverables. Hence it could be self-initiated or carried out by a different body, but both can also happen simultaneously.  However, although accountability takes different forms, the most critical is the self-driven one; which sets conviction as a milestone.

RSBs Felix Tuyishime in the process of Sample Preparation

Most of the time in Africa, the lack of adequate amounts of services has been used as an excuse for delivery of poor quality service. Although it is hard to rule out the adverse impact shortage of services may have on the level of quality, over emphasizing on it could make us externalize all our weaknesses and risk of failure.

Quality is not necessarily a factor of abundance or quantity; it is rather a demonstration of a combination of conviction, professionalism and sense of responsibility to deliver the best of the best.

Quality service should be the language of the day.  There is no sector or service that will not benefit from delivering quality and standard products and services to its clients. However, the issue is even more critical in various sectors such as health, where a slight slip could result in a catastrophe.

Recognizing this fact, this piece is devoted to dwell with one of the most daunting but feasible challenge that our health system in Africa is currently facing; the issue of accountability. Several studies and opinions gathered suggest that there is a decline of professionalism in the health sector in Africa, causing enormous deadly and highly fatalistic risks.

A pharmacist checking medicine

What is even more concerning is that quite a good amount of these risks could have been avoided but are not; because of negligence and a high level of impunity and less incentive packages among other things.

While it is worth noting that this challenge is not exceptional to health and appears to be in several sectors such as education, construction and others; the issue on health is more appealing and compelling as it directly and instantly affects human beings, thus making it over sensitive.

Often times people associate almost impulsively the health system accountability with only health professionals, leaving out the health support system which includes; health logistics and financial systems,  as if the physicians could carry out their duties in isolation.

Efficiency in health delivery is an output of several internal and external factors, including the conviction and discipline of the patient. Thus, the panacea to curb the situation and improve health accountability should take into account all these factors and devise comprehensive as well as simultaneous actions.

The notion here is, death may be an unavoidable tragedy but should be explainable.  Every health service should be capable of collecting all the necessary information beyond treating patients that will enable it to make the required explanations.

Medical practitioner conducts NCDs test in Kigali this week

This piece, therefore, intends to highlight the seriousness of the issue across the continent and spur dialogue that will examine the magnitude of the challenge and come up with possible solutions as the way forward.

As recently reported by BBC news, a study done by the Lancet Medical Journal (2018) found that globally an average of 1% of patients die after surgery, whilst in Africa “twice as many die after surgery” at an average of 2.1%.

Another study by World Health Organization (WHO) in 2015 indicated that some 300,000 women died during and following pregnancy and childbirth globally; whilst 99% of these occurred in developing countries with more than 50% occurring in sub-Saharan Africa.

The underlining message in both stories is that our health system in Africa is severely suffering from lack of professionalism, high level of impunity and low incentive to keep the system to its standard.

To date, we are at a stage with unprecedented capacity of data gathering, processing and synthesizing. Although the data generated could give us clues into many aspects of our lives, it is often left to be understood by a select few.

Important intersections of data and innovation that will be crucial to bring about transformation in the health services are available more quickly and cheaply than before. The epidemiology, early warning, biopsies, forensic medicines, toxicologies and other important segments of the health services could excessively benefit from the real time data system and similar applications which could revolutionize the service.

The world is moving with the technologies and its stewardships aggressively.  Where IT is making things simpler, a patient will soon be his/her doctor- better phrased “Doctor You’! (The Economist, 2018).

The new Omnyx VL4 Scanner used in diagnosis of cancer

The recent experience of Unmanned Aerial Vehicles (drones) in Rwanda for blood transmission with huge potential of other drugs and supplies in the future is another good example worth noting.

The other part of the puzzle is how to make the health system a feasible business to all and realizing the long-standing challenge of the Universal Health Care.

One area where Africa should take advantage of its demographic endowment and come up with innovative and smart solutions is the health insurance and financing scheme.

The challenge on the purchasing capacity should be overcome by the enormous demand size that calls for scalable scheme. All that we need here is how to get out of the box and do things differently.

It is exciting to convene again in the city of Kigali and dwell on this important topic.  The upcoming gathering under the theme of Every Life Matters: Building and Strengthening Accountability in African Health Systems with the aim of bringing all stakeholders in the value chain together, the meeting will discuss the magnitude of the challenge as well as the enormous opportunities around us to curb the situation.

We do not have time to lapse! We should get it right and make it happen now!

The Every Life Matters conference will be held on 8th to 9th March 2018 in Kigali, Rwanda at the Radisson Hotel and Convention Center. The conference will convene stakeholders to galvanize greater accountability and calling for commitments and actions by all political and government actors and other leaders in the healthcare sector to deliver.

 The writer Dr. Belay Begashaw is Director General, The Sustainable Development Goals Center for Africa (SDGC/A)




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