Challenges for patient safety in low and middle-income countries
Patient safety has emerged as a big issue globally. As per WHO patient harm is the 14th leading cause of mortality and morbidity globally. One in every ten patient get some form of unintentional harm by medical staff during their stay in hospital, if we look at the stats two-third of all the adverse events in hospitals globally (like temporary or permanent disability and even death) occurs in the low and middle-income countries (LMIC), 83% of these adverse events are preventable by putting in place systematic barriers which prevent these harms to reach the patients.
1. The overstressed and overworked medical professional – with a very poor doctor-patient and nurse-patient ratio the medical staff have to see the number of patients which is can be up to 50 times higher as compared to the patient seen each day by a doctor in developed countries. This enormous work pressure makes them more prone to cause unintentional harm to the patients.
2. Availability of resources – The medical professionals in the LMIC need to work with the limited resources available with them. There is no availability of modern medical equipment which can help them in quick and precise diagnosis, currently, most of the medical professionals need to rely on their past experiences for treating the patient and it has been proven globally that human factors have been the major cause of disasters.
3.The culture of hierarchy – Unfortunately in healthcare there is strict hierarchy at each level, which can be related to the money one earns, length of education, the scope of practice, prestige, and power. Multiple times even if a junior see a senior committing a mistake they don’t raise an alarm due to the fear of problems in the future as the senior mostly take it as an offense if some junior interrupts them which is incorrect.
4. Lack of training of medical professionals – There is a scarcity of skilled medical professionals in the LMIC, even the graduates and certificate holders don’t possess the required medical skills to do their work more reliably. Those who are skilled are so much overworked.
The developed countries have identified this as a very serious matter and they have developed the system in place which reduces the chances of medical errors. I always say simple solutions make a big impact. We need to start from the ground and fix the low hanging fruits first where there is not much requirement of additional resources for implementation, Simple and effective solutions like proper patient handover among clinical staff, medication management, infection control, surgical site marking, use of the safe surgical checklist, etc are few examples.
The policy on patient safety needs to be developed and implemented. Regular training of staff members to enhance their skill sets. The patients need to be involved actively in the treatment process and the healthcare organizations need to develop an environment where the staff can report the incident without the fear of punitive actions and all these incidents need to be analyzed for the root cause and corrective and preventive actions to be taken to prevent these type of incidents in the coming future.