Long queues at the hospital: The price you pay for service

Dar es Salaam. Long waiting time and queues at public referral hospitals, such as Muhimbili, have often been blamed on shortage of health workers and inadequate hospital infrastructure.

However, Dr Innocent Mosha, a researcher based in Dar es Salaam, wants to tell a different story—depicting how patients and their healthcare providers can contribute to the long files and the time lost in waiting for health services.

“If doctors and patients were able to manage their time well, the long queues that we often see at hospitals could have been reduced to a large extent,” says Dr Mosha, the Acting Head of Laboratory Services at Muhimbili National Hospital (MNH). He admits, however, that there is need to expand hospital infrastructure and increase man power.

Long wait times at hospitals are now known to cause economic losses in billions of shillings in other countries. In April this year, a Canadian Institute, Fraser, established that the estimated cost of waiting for care in Canada for patients who were in the queue in 2015 was almost USD1.2 billion.

This works out to an average of about USD1, 304 for each of the estimated 894,449 Canadians waiting for treatment in 2015, according to the Canadian researchers. Studies are yet to be carried out in Tanzania to establish how the long wait times at hospitals create economic losses. The study, titled, “The Private Cost of Public Queues for Medically Necessary Care, 2016 edition” said the estimated cost takes into account the losses that are borne by the individual waiting for treatment.

In his commentary on the study, a Senior Economist at Fraser Institute, Mr Bacchus Barua says, “What we often forget is that while some patients may be able to wait for treatment, others may be in considerable physical pain, may experience mental stress, and may have their illness worsen during their wait (ironically requiring more complex and costly treatment in the future).”

Recently, MNH’s Executive Director, Professor Lawrence Museru, was at pains to explain to reporters why the hospital intends to cut down the waiting time for its patients by improving diagnostic services and increasing the number of theatres for carrying out surgical procedures.

“If diagnostics are done and delivered timely, the in-patients don’t have to overstay in the hospital and the out-patients don’t have to wait for long at the hospital premises for their test results,” he told journalists.

But for Dr Mosha—the researcher, the need for an expanded infrastructure and services must go along with change of mindset—for healthcare providers and their clients, and attitude to time management.

He holds the view that the scenes of crowdedness often seen at MNH do not necessarily reflect shortage of man power or facilities. “The queues should not be taken at face-value,’’ he says and adds, “If a study is done on this aspect, basing on our attitude to time management, we are likely to see surprising results,” he adds.

“Take this scenario, where patients are allocated different schedules for their clinic visits but they all report to the hospital early in the morning [at around 7a.m] and they stand in line. But then, the doctors arrive at around 9:30 a.m or later, what do you expect?’’ he queries.

“I know cases of patients who have been scheduled to report for their clinic follow up visits at one o’clock in the afternoon but they all come in the morning, believing that doctors can fix them in the morning schedule. If you saw them crowded on the benches in the morning, you would think that there is no one to attend to them,’’ he points out.

However, a survey carried out last week by Your Health shows that there are patients who arrive on time and follow the hospital schedules but still don’t get their services on time.

Mr Ramadhani Mnubi, 50, woke up in the wee hours on Friday last week to try and catch an early bus that could lead him to MNH from Bunju suburb in Dar es Salaam, but, his resolve was met with disappointments. And he wasn’t the only one there with the same story.

“I didn’t want to miss my appointment with the doctor at 9:30a.m. I thought being timely meant I would not have to wait for so long to get services but I was wrong. I was only allowed to see the doctor at noon,” said Mr Mnubi as he sat on a bench at the Out Patient Department (OPD).

He had been previously diagnosed with diabetes and high blood pressure and was scheduled to meet a cardiologist. By the time all the necessary tests were done and his prescriptions went through the pharmacy, ready for him to return home, it was already 4pm.

But Ms Tausi Kagimbo (32) had reported to the clinic on the wrong day. The resident of Mbagala suburb in the city says she was due to meet an Endocrinologist but she was surprised that her name was not being read out by the nurse so that she could enter the doctor’s office.

“I was supposed to come yesterday. I arrived early in the morning today. And I complained to the nurse because I thought she was ignoring me but when she checked my appointment form, she realized I had come on the wrong day,” says Tausi.

An Oncologist at MNH, Dr Heri Tungaraza, who was attending patients at the cancer clinic, blames the long queues on long registration procedures. “There is a lot of time wasted on lining up for registration and payment. By the time such patients reach our clinics for consultation, it’s always too late,’’ he says.

MNH, with a bed capacity of 1,500, attends between 1,000 and 1,200 outpatients per week. Dr Tungaraza says the hospital can use innovative ways to accommodate the patients and serve them efficiently.

“There are patients who spend a lot of time moving from one department to another within the hospital seeking diagnostic services. If some diagnostic tools were placed within department blocks, patients would save a lot of time,’’ suggests the oncologist.

A researcher at Ifakara Health Institute (IHI), Dr George Sikalengo believes long waiting time at hospitals can also be reduced by motivating hospital staff so that they stick to one job—of treating their patients—instead of handling several responsibilities.

“There is shortage of staff in most of the facilities that I know, but even those few that are available may be assigned other duties alongside medical work, instead of concentrating on patients. Imagine a situation where, a doctor attending a seminar on the day he/she is supposed to be attending to patients,’’ he says.

MNH’s Head of Public Communication and Customer Care Unit, Mr Aminiel Buberwa, says the hospital has embarked on plans to reduce the long wait times at the facility by adopting cash-less payment systems and mobile-money transfer. He, however, insists that long waiting time at hospitals is a matter that is broad and complex to deal with.

“Anytime from now, the hospital will adopt a new payment system through the use of cards and mobile phones. This can reduce waiting time that is lost before and after receiving medical care,’’ said Mr Buberwa in an interview with Your Health last week.

“The hospital has also extended the time for doctors to see their patients. Patients don’t have to come early in the morning. There are clinic schedules that go up late in the evening at 6pm,’’ he said and added, “Doctors can also be consulted on Saturdays from 9a.m up to 3pm.”

Information Technology experts believe electronic systems such as the Queues and Appointment Systems (QAS) can be adopted in healthcare facilities—especially at Outpatient Departments (OPD) to try and manage queues of patients and appointments smoothly. QAS have been applied at banks and other settings to manage waiting time.