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| EDITORIAL |
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| Year : 2012 | Volume
: 9
| Issue : 2 | Page : 51-52 |
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Effective healthcare and the challenges of resource-poor societies
MM Borodo
Department of Medicine, Bayero University/Aminun Kano Teaching Hospital, Kano, Nigeria
| Date of Web Publication | 12-Mar-2013 |
Correspondence Address:
M M Borodo
Department of Medicine, Bayero University/Aminun Kano Teaching Hospital, Kano
Nigeria
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0331-8540.108461
How to cite this article:
Borodo M M. Effective healthcare and the challenges of resource-poor societies. Niger J Basic Clin Sci 2012;9:51-2 |
Determinants of efficient healthcare include appropriateness of care to the setting, a well-informed and adequately sensitized healthcare products consumer population, an enabling environment to deliver the care, and finally an adequately trained and well-motivated healthcare delivery team - all of these in an appropriate mix to produce the desired satisfactory results. In the context of the developing world, satisfactory healthcare for the populace has remained challenging and illusionary because of varying shortcomings of the above-mentioned factors as reflected in the current level of care in the region, as is well captured in the articles reported in the current edition of the journal.
This dismal situation is further aggravated by the ever-widening spectrum of illnesses that healthcare providers have to contend with in developing countries, which dictates the imperative of constant review of the teaching curriculum of the health personnel, particularly doctors, and also the imperative of an appropriate working environment in terms of working tools and medicaments. As illustrated by the article on risk factors for chronic kidney disease (CKD) by Nalado and colleagues, 29.8%, 19.4%, 11%, and 3.6% of the studied civil servant population had evidence of hypertension, proteinurea, obesity, and diabetes, respectively, - all non-communicable disease conditions on their own right, apart from being significant risk factors for CKD. As rightly observed by the authors, "The global burden of risk factors for CKD is increasing and this has importance from the public health perspective for early prevention of end-stage renal disease (ESRD), and cardiovascular morbidity and mortality associated with CKD. These risk factors render CKD an important focus of healthcare planning even in the developed world, but the problem they cause in the developing world are far more challenging as the treatment of the endpoints (including ESRD and cardiovascular disease) are far more prohibitive in cost and unattainable for the developing nations." This increasing burden of non-communicable diseases is subsumed in an already existing endemic burden of communicable diseases as manifested in the article by Yakasai et al. on vomiting in early pregnancy where infections and infestations accounted for the greater majority of cases (60%) seen in the studied population of pregnant women.
Lack of preparedness for emergency care as manifested in the article on improvised emergency peritoneal dialysis in a child reported by Obiagwu and others, as well as the reported struggle to establish laparoscopic surgery services in an area of need reported by Ekuanife and colleagues are manifestations of the hostile and inadequately prepared environment of healthcare practice against the background efforts of physicians with a call to succeed and make a difference at all costs, which still largely characterise the terrain of practice in the developing world. The poor health-seeking behavior and accordingly late presentation to healthcare facilities by patients is well captured in the case reports by Muhammad and colleagues on chronic non-puerperal uterine retroversion, just like the article by Umoh and Azodo on gingivitis and periodontitis, two eminently preventable conditions seen in over 90% of the studied population, reflected the poor level of health education, inappropriate lifestyle inadequate sensitization and motivation manifested by the consumers of health care.
Arguably, the central figure that would make a difference for the better in the provision of efficient healthcare in the third world is the health worker who needs to harness both nature and nurture to do this. He needs to be trained in such a way that he innovatively responds, against all odds, to meet the aspirations of his ever-needy patient population. This can only occur with good training hinged on a relevant syllabus that from the onset prepares the heath worker appropriately for these challenges. It is in this regard that the review article by Asani on assessment methods of medical education is apt. While the article stresses both formative and summative forms of assessment as means of alerting students and teachers alike on how well they are doing in effective coverage of the syllabus, the often-neglected domains of learning at the apex of bloom's taxonomy of learning and Miller's triangle of assessment, which address higher skills application, behavior and innovation, are often more difficult to assess using these traditional methods of assessment. Yet, in medical education, more than perhaps in any other branch of learning, these higher learning objectives must be seen to be well evaluated in the training process in order to address the often unpredictable situations that the doctor is called upon to address in his practice. Furthermore, modern innovative theories of learning that emphasize self-directional, problem-based, and community-based learning approaches, communication and professionalism which are increasingly in vogue require new assessment methods to capture them effectively.
Finally, and happily, the article by Adamu and others on a prospective new method of personal identification through lip printing shows innovative drive to address human identification beyond the traditional fingerprint method, if only the results can be further generalized and actualized as the authors emphasized.
I hope readers find going through this edition stimulating and useful.
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