To Improve Quality of Health Services, We Must Build Trust

Three different but related forms of trust are required to undergird a strong health system. Patients must trust their care providers, providers must trust their patients, and providers must trust each other.
Dr. Agnes Binagwaho
Dr. Agnes Binagwaho

Three different but related forms of trust are required to undergird a strong health system. Patients must trust their care providers, providers must trust their patients, and providers must trust each other. Without these three interlocking relationships of trust, patients will not seek health services, and care providers will never sufficiently improve their efforts to increase the quality of the care they deliver.

To encourage patients to trust the health sector in Rwanda, we must not only provide high quality services that are based on the latest science but also use effective communication strategies to convince patients of this.

We have King Faisal Hospital (KFH), an internationally accredited hospital In Rwanda, we have well-trained and diligent health providers, from the most highly trained specialists doctors and nurses in referral hospitals to community health workers at village level. Along with our international partners, we start to provide high specialized quality services. For example we have performed more than 150 heart surgeries at KFH theatres in addition to two recent kidney transplants and many difficult neurosurgery procedures using our facilities and Surgeons with technical support of international collaborators. We have developed the charter of patients and there are new instructions for the implementation of customer care – a phone number and photo of the responsible health worker on duty placed at the entrance of each ward, a suggestion box in each hospital and a toll free number to reach a call center in case of a problem or a request. We need to follow up to assure proper implementation of these measures and we
have made steps but this is not enough.

However, some patients continue to prefer to travel abroad for care, choosing to pay more for basic services that exist in their homeland – such as dental or antenatal services.

Why is it that some Rwandans go spend their money on health services in another country instead of remaining here where those funds could help to develop our health sector? The answer is two-fold: first, we cannot deny that there are few cases of unacceptable malpractices that damage trust in the entire Rwandan health system. Now accountability is there as we investigate all complaints sent to the Ministry, the police or the Rwandan Medical council or the Rwandan council of Nurses and Midwifery Second, there has historically been a general lack of customer care, with providers not making the effort to smile, to welcome the patient, to carefully explain the causes of suffering to patients and their families. Sometimes it seems to patients that we do not like our work! This is a general problem in Rwanda as we find the same attitude in restaurants and hotel administration etc…

Such individual experiences undermine our collective efforts to increase confidence in and utilization of the public health sector. This is why health professionals must have zero tolerance for medical malpractices of any kind. They need to develop respect and compassion for patients. We should not expect of ourselves anything less than the highest standard of customer care. Declining trust places a massive cost on all aspects of the health system, for if our own people do not trust the services provided foreigners paying full prices certainly will not. As a result, potential tourists and investors who would need care during their stay in Rwanda may not wish to seek care here, and we lose money that could have served our development.

The second, and equally important, form of trust needed for a strong health system is that of providers trusting patients. In some critical care situations, health professionals may take risks for themselves to act quickly in order to save a life. If they do not trust the patient, they may take time at first to reflect on the risk they are putting themselves at and be unnecessarily cautious if they believe that the patient may later turn against them.

What are the reasons a provider may not trust their patient? One example occurred just this month, when a patient and family alleged that a doctor had forgotten to remove materials from her womb four full years ago. It took several national doctors, one international expert and a team of the Rwanda Police still working on it, so much time and energy to investigate and uncover the truth hence significant time that would have been used to serve other patients was lost.

The final form of trust essential for the health sector is related to team building and professional development. All members of a team engaged in the provision of medical care must be confident in each other’s ability to act quickly and to act as one for the benefit of their patients. If one provider lacks trust in their colleague, she/he will spend time to re-check everything her colleague has done before proceeding to the next step. Again, the time and energy lost constitutes a failure to serve additional patients.

So, all together, let’s work in the Rwanda health sector to inspire people and to build an enabling environment for trust to flourish and create positive changes. Trust is needed for the population to feel confident in seeking services, and for the health professionals to effectively deliver them. To advance this work, we will combat false perceptions and work to provide higher quality services and better customer care at all levels of the health system. This is our duty – not a favor that we give to our population.

It is in this spirit of trust that I encourage all in the Rwanda health sector to enter into the year 2012 with inspired standards of care, proper customer care, and overall trust in one another. I wish the entire nation a fruitful and successful year full of progress. We all have been or will one day be clients of the health sector, so let us all commit to working together to build the trust needed to achieve our collective goals. Happy 2012.

The Author is the Rwandan Minister of Health

Twitter: @abinagwaho

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