IMPROVING HEALTHCARE IN SIERRA LEONE: ENHANCING ATTITUDES AND BEHAVIOURS OF HEALTHCARE WORKERS FOR BETTER SERVICE DELIVERY

IMPROVING HEALTHCARE IN SIERRA LEONE: ENHANCING ATTITUDES AND BEHAVIOURS OF HEALTHCARE WORKERS FOR BETTER SERVICE DELIVERY

IM Kapuwa, MD. 

In our ongoing series of "Improving Healthcare in Sierra Leone," we delve into one of the most pressing and often overlooked issues: the attitudes and behaviours of healthcare workers and their impact on healthcare delivery. Addressing this issue is essential if we are to create a truly patient-centred healthcare system in Sierra Leone.

The quality of healthcare services is not determined solely by the infrastructure, equipment, or expertise and qualifications of healthcare workers. While these are crucial, the attitudes and behaviours of healthcare workers play an equally, if not more, important role in shaping patient experiences and outcomes. In many healthcare systems, especially those in resource-constrained environments like Sierra Leone, patients often report poor treatment by healthcare providers, ranging from indifference to outright disrespect. This is not only unacceptable but detrimental to the overall goal of providing patient-centered care.

THEORIES AND RESEARCH ON HUMAN ATTITUDE AND BEHAVIOUR

Human behaviour is shaped by both internal and external factors. Psychological theories like Maslow’s Hierarchy of Needs and Herzberg’s Two-Factor Theory help explain why healthcare workers may exhibit negative behaviours. According to Maslow, when basic needs (such as job security or decent wages) are unmet, workers may struggle to move up the hierarchy toward self-actualisation, where they are more likely to display positive behaviours like empathy and compassion. Herzberg’s theory categorises job satisfaction into "hygiene" factors, such as salary and working conditions, and "motivators" like recognition and meaningful work. When hygiene factors are poor, as in many under-resourced healthcare settings, workers may exhibit negative behaviours, even if they are highly skilled.

However, a behaviorist approach, as seen in B.F. Skinner’s Operant Conditioning Theory, suggests that behaviour can be modified through positive and negative reinforcement. For healthcare systems, this means that promoting good behaviours, recognizing empathy, and addressing poor treatment can gradually shift worker behaviour toward a more patient-centred approach.

IMPACT OF HEALTHCARE WORKERS' ATTITUDES ON PATIENT CARE

It is essential to acknowledge that healthcare workers deal with significant stressors: long hours, emotional labour, limited resources, and often insufficient pay. However, patients remain at the center of healthcare, and the treatment they receive should not depend on the personal mood or frustrations of the healthcare provider. Studies have consistently shown that patient satisfaction and trust in the healthcare system are directly correlated with how healthcare workers treat them. The Theory of Planned Behaviour, proposed by Ajzen, suggests that individual behaviour is influenced by their intentions, which in turn are shaped by attitudes, subjective norms, and perceived behavioural control. If healthcare workers cultivate positive attitudes towards their roles and the patients they serve, they are more likely to engage in supportive behaviours. A study published in the International Journal for Quality in Health Care found that empathetic communication from healthcare providers significantly improves patient satisfaction and adherence to treatment plans. When patients feel respected and valued, their trust in the healthcare system deepens, leading to better health outcomes.

A research study published by the British Medical Journal (BMJ) emphasised that healthcare workers' attitudes profoundly affect patient adherence to treatment and overall satisfaction with the healthcare experience. Patients are more likely to follow medical advice, return for follow-up visits, and trust the diagnosis or treatment plan if they feel respected and valued.

RESPECTING PATIENTS: THE FOUNDATION OF GOOD HEALTHCARE

Respecting patients goes beyond politeness; it means listening to them, explaining procedures in a way they understand, and treating them as equal partners in their care. Research conducted by the World Health Organization (WHO) found that in many low- and middle-income countries, disrespectful treatment of patients, particularly vulnerable groups like women and children, was one of the leading causes of mistrust in the healthcare system. This mistrust discourages patients from seeking care early, resulting in worse health outcomes and, ultimately, higher mortality rates. A patient-centered healthcare system prioritises the needs and interests of patients above all else. This philosophy aligns with the Patient-Centered Care Model, which emphasises the importance of understanding patients' needs, preferences, and values. A study by the American Journal of Medical Quality indicated that negative interactions with healthcare workers can lead to patients avoiding medical visits altogether, worsening health disparities.

In Sierra Leone, many patients experience healthcare workers shouting at them, using demeaning language, or ignoring their concerns. Such behaviour not only undermines the therapeutic relationship but can also exacerbate health conditions, particularly mental health issues, which are often linked to stress and anxiety.

TRANSFORMING HEALTHCARE THROUGH BETTER ATTITUDES

Improving the attitudes of healthcare workers can have profound effects on healthcare delivery. Studies from Harvard Business Review highlight how healthcare facilities that implemented customer service training and adopted a patient-centered care model saw significant improvements in patient satisfaction and trust. In fact, one study reported a 25% increase in patient adherence to medical advice following training aimed at improving communication and respect in patient interactions.

Additionally, countries that have successfully transformed their healthcare systems, like Rwanda, emphasie continuous professional development that includes not just clinical skills but also emotional intelligence and communication skills. Sierra Leone can adopt similar strategies by incorporating behaviour change programs and regular assessments of healthcare workers’ interactions with patients.

BUILDING A RESPECTFUL HEALTHCARE CULTURE

For healthcare in Sierra Leone to improve, workers must view patients not as burdens but as the very reason the healthcare system exists. Training programs that emphasise empathy, communication, and respect must be integrated into the core of professional development.

At the policy level, systems that reward good behaviour, like performance-based incentives, can help encourage healthcare workers to improve their interpersonal skills. While qualifications and technical skills are essential, without a corresponding improvement in attitude, they are insufficient. A patient-centric culture should be the bedrock of any healthcare system. To foster a culture of respect and trust, healthcare organisations should implement training programs focused on emotional intelligence, communication skills, and empathy. This not only enhances the interpersonal skills of healthcare workers but also reinforces the idea that every patient deserves dignity and respect, regardless of their circumstances.

 

CONCLUSION

Improving healthcare in Sierra Leone requires a multi-faceted approach that prioritises the attitudes and behaviours of healthcare workers. Respecting patients, listening to their concerns, and creating a more compassionate environment can transform the healthcare experience, build trust in the system, and, ultimately, improve health outcomes. No matter how qualified or well-equipped a health professional is, a bad attitude is a major deterrent for patients. Therefore, focusing on customer care improvements, alongside better training and motivation for healthcare workers, is vital for progress.

DISCLAIMER:

The views and opinions expressed in this article are those of the author and do not necessarily reflect any official policy or position. The information provided is for general informational purposes and is based on current observations and knowledge. While efforts have been made to ensure accuracy, readers are encouraged to verify details and seek professional advice where applicable.

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IMPROVING HEALTHCARE IN SIERRA LEONE: EQUIPPING PUBLIC HOSPITALS AND HEALTH CENTRES

IM Kapuwa, MD.

In our ongoing series of “Improving healthcare in Sierra Leone”, we begin by addressing one of the most critical issues: the need to equip public hospitals and health centers across the country.

One of the critical pillars in enhancing healthcare in Sierra Leone is equipping our public hospitals and health centres with modern medical equipment, instruments, and adequate supplies. This need is paramount because while our doctors, nurses, and other healthcare professionals are among the best trained globally—often returning home with specialised skills and high qualifications—their ability to deliver optimal care is hampered by a lack of essential equipment and supplies. The government and the Ministry of Health (MoH) must pay keen attention to the equipment gaps in our hospitals, as this is crucial not only for delivering high-quality care but also for maintaining the morale of healthcare workers.

THE NEED FOR HIGH-END EQUIPMENT AND SUPPLIES

To ensure that public health facilities operate at their best, several critical pieces of equipment and supplies are necessary; they must be equipped with modern diagnostic tools, surgical instruments, and everyday medical supplies. Examples of these include:

• Laboratory Equipment: Hematology analysers, blood gas machines, and biochemical analysers for diagnosing a wide range of conditions. Pathology tools.

• Radiology Machines: MRI scanners, CT scanners, PET-scan, ultrasound machines, and X-ray equipment to support accurate diagnosis.

• Surgical Instruments: Laparoscopic tools, endoscopy, advanced anaesthesia machines, and operating microscopes for specialized surgeries.

• Patient Monitoring Systems: Vital sign monitors, infusion pumps etc.

• Emergency Care Supplies: Defibrillators and crash carts etc.

These tools are essential not only for providing care but also for motivating our healthcare workers. Many of our professionals are highly skilled and were top performers in their training programs both home and abroad. However, upon returning home, the absence of adequate tools and equipment can stifle their ability to perform at the same high level. Equipping our hospitals not only prevents the so-called “brain drain,” but it also provides healthcare workers with the confidence that they are working in an environment where they can fully apply their expertise.

PREVENTING BRAIN DRAIN AND HOLDING PROFESSIONALS ACCOUNTABLE

Sierra Leone has already made strides in improving health outcomes, but there is still much work to be done. One area of focus should be preventing the migration of talented healthcare workers to countries with better-resourced facilities. By ensuring that healthcare institutions are fully equipped, we can reduce the frustration that leads many of our best and brightest to seek opportunities elsewhere.

Furthermore, with a well-equipped system, healthcare workers can be held accountable for their performance. It is unfair to expect world-class outcomes from doctors and nurses when they lack the necessary tools to diagnose, treat, or manage diseases. Once the facilities are properly equipped, we can set higher expectations for healthcare delivery across the country.

THE IMPORTANCE OF STANDARD MEDICAL DIAGNOSTICS

Standardised diagnostic tools are the backbone of effective healthcare. Without proper diagnostic equipment, many Sierra Leoneans are forced to seek care abroad for procedures and treatments that could otherwise be performed locally. High-functioning diagnostic departments—including laboratory, radiology, and pathology services—are essential for accurate diagnoses and effective treatment plans. If we equip our facilities with the necessary tools, it will not only improve patient outcomes but also reduce the financial burden on families and the country.

Moreover, the absence of adequate resources leads to frustration among healthcare workers. When professionals are unable to perform at their full potential due to insufficient tools, it not only affects their morale but can also contribute to brain drain. Many talented individuals seek opportunities abroad where they can practice effectively, leading to a loss of skilled professionals in our healthcare system.

Building more health facilities is commendable and beneficial, but ensuring that the existing ones are fully equipped should take precedence. Without the tools to perform the necessary tests and procedures, the additional facilities will remain underutilized, and the nation will continue to face challenges in its healthcare system.

A HIGHLY MOTIVATED WORKFORCE

A well-equipped health system fosters a highly motivated workforce. When healthcare professionals feel empowered to do their jobs effectively, the ripple effect is seen in better patient care, higher staff retention, and reduced burnout. Healthcare workers want to serve their communities, and providing them with the necessary resources enables them to deliver the quality of care they are trained to give.

For the average Sierra Leonean, the Ministry of Health is only as visible as the functionality of public hospitals. Ordinary citizens deserve functional healthcare services, if these institutions are operating efficiently, they will see tangible results and have faith in the healthcare system. Therefore, equipping our hospitals is not just an investment in the facilities but in the nation’s overall health and well-being.

CONCLUSION

Sierra Leone has made tremendous progress in improving health outcomes in recent years, but we must continue the momentum. Equipping public hospitals with the right tools and resources is a key factor in sustaining these improvements, it is not just a logistical necessity; it’s a moral imperative. It is also a powerful motivator for healthcare professionals, preventing brain drain, and ensuring accountability. With well-equipped facilities and a motivated workforce, we can provide better healthcare for all Sierra Leoneans and reduce the need for expensive medical trips abroad. By addressing these needs, we can not only enhance the capabilities of our healthcare system but also honor the dedication of our healthcare professionals. As the proverbial Oliver Twist, we must continue to ask for more. Our healthcare system depends on it. Together, let’s advocate for a healthcare system that reflects the potential of its people.

DISCLAIMER:

The views and opinions expressed in this article are those of the author and do not necessarily reflect any official policy or position. The information provided is for general informational purposes and is based on current observations and knowledge. While efforts have been made to ensure accuracy, readers are encouraged to verify details and seek professional advice where applicable.

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