Record keeping is as old as the creation of man and it’s importance can never be over emphasised. Kuni Tyessi looks into health recording system in Nigeria and compares it in the face of global thoughts and local acts.
In many countries around the world today, Nigeria inclusive, healthcare is in a period of major transition which requires a workforce with new skills and education as well as the creation of standards that will govern information effectively in different settings of the nation’s health delivery system.
Health Records Officers Registration Board of Nigeria (HRORBN), the agency under the federal ministry of health is saddled with the responsibility of taking Nigeria to where it is expected to be by assisting health information managers and informatics professionals through the provision of resources, education and training that will help grow the knowledge base of the nation.
However, this has not been the case in the past 25 years of its legal birth. Besides the fact that many Nigerians do not know about its existence, structure, location, responsibilities and importance, it has been unable to live up to expectations due to a number of factors which needs to be properly addressed especially in terms of training.
To further prove that the above claims conforms to the present realities confronting the board, in its 2016 symposium with the theme “Patients/Health Records Officers Relationship and Quality Assurance in Training Schools Towards Promoting Efficiency in Healthcare Delivery Service”, the registrar/ CEO of the board, Alh. Mohammed Ibrahim Mami, in his speech, noted that no memeber of the health information management was nominated to serve on any of the committees on primary healthcare.
This could be as a result of several factors in which Barr. Adesina Salawu, a legal practitioner, attributes to the unethical attitude of many of the health record officers in both private and public hospitals.
She says “ it an take at least two hours for you to pay for your receipt before your file is even looked for.”
“The personnel are just wrong. They are just the wrong kind of people you can find working in a hospital. First of all, there is no sympathy and no empathy. I believe the jurisprudence of the healthcare provision is that anyone that is within that profession is expected to adhere to the level of ethical standard with the people you are dealing with.”
The registrar to a very large extent agrees with Barr. Salawu as he states that many of the health record officers are not trained and as such lack the basic skills and etiquettes needed to relate in the most civil manner with their patients and also advocates for training and in severe cases, a change will not be out of place.
“Most of them do not have a formal training in record keeping and therefore, they will not be able to translate the human elationship expected to the patient. The first person the patient meets if the health record officer who might not be trained and the first impression he takes away is that he has been treated badly. But in actual terms, that health record officer does not even have the authority to issue out cards to patients or to attend to them because he is not known by the profession.”
“However, the hospital management insists on employing such unqualified personnel due to cheap labour and it is both in government and private facilities. They are also not exposed to good knowledge and this has been a profession that has been existing in Nigeria and the first health record officer was qualified in 1963 and uptil now, we have not been given the opportunity to go beyond Higher National Diploma and it’s a big challenge.”
“The management has not also given us the due recognition to create an enabling environment for us to practice as professional practitioners. So these are challenges that have been a major setback and that is why the human relationship is not readily available in the department.”
“Nigerians should demand for their rights. Whenever they go to the records department, they should insist that the person attending to them must be qualified and they should insist that whenever they discover that the person is unprofessional, they should insist on reporting the person and that will make the management to ensure that only the right person(s) is there and whenever we get a report of such indiscipline, we will take up the necessary disciplinary action.”
“Every patient has a bill of right to be attended to and has the right to his confidentiality protected and anything short of that, the patient has the right to complain. By the time you spend more than 15 minutes in the record department, you have the right to ask questions and if you don’t get the right attention, you can walk into the office of any head of department and complain and you can even go beyond that. So if you don’t demand for your right, then it wouldn’t come.”
He further reveals and disturbingly too that “some training hospitals that were established since 1971 still have less than 10 qualified health record officers and the rest of the people there are not qualified. The best thing to do is to remove them and replace them with qualified people or train them so that they can be able to fill up the vaccum. This is a professional job and you must learn it before you do it.”
However, a medical expert, Dr Hashim Malami Saidu believes there’s hope when leadership, dignity and respect is observed between patients and record officers, as well as collaboration, information sharing and participation are observed.
He believes that the conduct of record officers can make or mar the image of a hospital as patients must be seen as first persons to to treated right. He also argues that satisfying the needs of patients can be a daunting task but it must be a job that must be done, hence the need for professionalism.
He does a psychoanalysis on the psyche of patients and their relatives and concludes that several questions come to their minds and they include: what policies and facilities does the hospital have for us to use? How trained are the workers in the facility as professionalism matters. They also want to know if they will be respected as well as their opinions and how they want to be treated.
He says “Health record practitioners must listen to and honour patients and relatives perspectives and they must receive timely, complete and accurate information about the patients’ status in order to effectively participate in care and decision-making.”
”Communicate and share complete and unbiased information with patients and families in ways that are useful so that they are encouraged and supported in participating in care and decision making at the level they choose.”
He also reveals that the healthcare sector is a complex service provider as their are times when clashes of culture occurs. He advised that to forstall such, health record officers must be provided with training or retraining of the desired attitude expected of them.
“They must define and consistently commit to desired attitude, must communicate to all team members the desired attitude, measure and evaluate compliance of the desired attitude” especially as Nigeria is a multi-cultural society.”