When you visit your doctor or health worker, how much are you prepared to engage in the decision making in as far as your treatment is concerned without being judged as the unappreciative know-it-all type? Do you have a say on whether it is going to be an injection or a intravenous therapy (drip) in situations where either would be effective? When your right is violated, do you ever seek redress? When you do, do you ever get what you may consider “justice”? Do you enjoy your right to redress?
These are just some of those shelved patients’ rights.
Rights of a patient are basic human rights which ought to be protected at all times.
However, despite of having a plethora of laws and policies in place to guarantee the respect of patients’ rights, the situation still remains pathetic. The constitution provides that the state shall take all practical measures to ensure provision of free access to health care, emergency care, equality amongst all people, and generally guarantee patients’ rights. Other key legislation includes the Uganda Medical and Dental Practitioners Act, the Medical and Dental Act, Allied Professionals Act, and the Pharmacy Act.
As a public health policy to promote better practices which uphold patients’ rights, the Uganda Patients’ Charter was launched in 2009. This charter outlines a set of rights, responsibilities and duties under which a person can seek and receive health care service and empowers patients to responsibly demand for quality health care and also importantly, to participate in their care (decisions) at public health facilities.
Despite all these well-intentioned developments, our patient-burdened, ill-equipped healthcare system incessantly promotes and often protects violations of patients’ rights.
Access to quality health care delivery from a patients’ rights centered approach tailored to advance lucid and ethical practices still largely remains elusive.
Recent statistics reveal that after almost 3 years since the introduction of the Patients’ Charter, 81.5% of patients and 69.4% of health workers were not aware of the existence of the Uganda Patients’ Charter in a survey conducted at Mulago National Referral Hospital and published in the African Journal of Primary Health Care & Family Medicine. Approximately 79% of patients who felt their rights were being affected never attempted to demand for their rights. Only 40% of patients were “aware” of their rights as patients. Overall, above 36.5% of patients at least encountered a challenge where they felt their rights were abused whilst seeking health care.
If this is the state of affairs at Mulago National Hospital in the capital Kampala, it can only get worse in the countryside.
The question then is why do we find ourselves in this quagmire? How much has been done to create awareness about the Patients’ Charter? Or do the patients actually know their rights but simply choose to remain passive for fear of victimization.
Is it all about Institution-related factors associated with resource constraints such as poor remuneration or the fact that Uganda’s doctor to patient ratio is approximately one doctor for every 22,000 patients? Or are we simply dealing with a de-motivated lot of health workers who have ethical issues such as neglect of duty, patient exploitation and other complex issues related to the health workers superiority in the access to healthcare chain?
Either way, a few things are clear.
Only a handful of patients and health workers really appreciate the contents and spirit of the Patients’ Charter. How then do we expect them to promote what they do not know?
Few patients who have some knowledge about their rights understandably feel powerless and have no real negotiating power for their rights. They fear discrimination as a result of being perceived as to be questioning the clinical skills of health workers. What else would you expect from a patient who considers any treatment at these public facilities a favour and not a right? That is what the system has made them believe.
It is also a fact that the health sector is grappling with serious resource constraints which creates loopholes for human rights abuses. Only 56% of health posts have been filled and the basic facilities such as beddings, lighting, water, oxygen, drugs etc are inadequate.
The system continues to be largely reactive rather than proactive.
If we are to advance healthcare services through the patients’ right centered approach, we simply must engage in massive sensitization of patients, health workers and the communities. We have a lot of existing structures to easily do this with a little incentive.
Equipped with the knowledge of their rights and obligations, patients can then be empowered to demand their rights and the health workers will be in a more informed position to oblige.
We also need to find more resources for the health sector to equip it better. However, this argument ought not to be used to justify violations of patients’ rights in many instances which only require observance of simple ethical practices.
The need to address intrinsic patient and health workers issues through the implementation of an integrated multi-sectoral patient-centered approach to practically integrate patient’s rights approach in patient care is evident.