PATIENT CHARTER GLOBAL AND DOMESTIC OUTLOOK

By Munachimso Ayo-Olagunju

A patient charter is a formal document typically prepared by the apex healthcare governing and regulatory body within a country – usually, the Federal Ministry of Health, that outlines the roles and responsibilities of both the providers and patients within the context of healthcare delivery. It enlists various rights and responsibilities, alongside various codes of practice, amongst which include, the right to; quality healthcare, be treated with respect and dignity, privacy and confidentiality, information about their healthcare, and participation in decisions about their healthcare. They are intended to ensure patients receive quality medical care while fostering a healthy provider-patient relationship

The origin of the patient charter can be traced back to the early 60s and 70s and is deeply rooted in the patient rights movement around that period, in response to the growing concerns about the quality of healthcare and the treatment of patients. This movement birthed the creation and formalization of the Patients’ Bill of Rights in 1973 by the American Hospital Association. It highlighted the basic rights of hospital patients, including the right to; receive information about their diagnosis and treatment, refuse treatment, and privacy and confidentiality. Prior to this era, patients had little stake in their healthcare, and with limited access to information about their treatment and diagnosis, they were often subject to the whims of healthcare providers and institutions. Additionally, there were little or no formal means of addressing complaints or concerns and seeking redress. Overall, healthcare then was perceived as a paternalistic system with the doctor having totalitarian authority. Following the advent of the first patient charter in ’73, many other organizations and countries have gone on to develop their patient charter as part of other larger healthcare reforms. Today, patient charters are intended to ensure patientcentred care, improve patientprovider communication and relationship and ensure patients receive the highest quality of care, upholding ethics and safety.

Various patient charters and guidelines exist all over the world covering various regions and jurisdictions. However, despite their jurisdictional variance, there exist similarities between them in the sense that they are all looking to achieve a shared objective of upholding access to the highest quality of care.

Examining a few of the various charters, we notice the following;

PBoR is an important step towards promoting patient-centred care...

The European Patient charter emphasizes the importance of informed consent, patient safety, and patient empowerment, as well as the need for high-quality, evidence-based care.

The Patient Charter for the UK NHS emphasizes the importance of involving patients in decisions about their care and the need to provide clear information about treatments and procedures.

The WHO Patient Charter is designed to achieve the shared objective on a global scale. These principles include the right to; access healthcare services, be treated with respect and dignity, receive clear and accurate information about health issues, and participate in decisions about their care.

The US Patient’s Bill of Rights emphasizes patients’ right to; receive clear information about their care, receive safe and effective treatment, and participate in decisions about their care.

A recurrent theme amongst the reviewed patient charters is the importance of the inclusion of patients in their care process, providing clear information about treatment plans and ensuring patients are treated with respect and dignity.

Bringing this home, the Nigerian Patient Bill of Rights (PBoR) which was established in August 2018 is an aggregate of the existing rights of patients in the amended Constitution of the Federal Republic of Nigeria, Consumer Protection Act, Child Rights Act, Freedom of Information Act, National Health Act and other regulations, and professional ethical codes such as the Hippocratic Oath. Below are the Nigerian PBoR:

1. Right to relevant information in a language and manner the patient understands, including diagnosis, treatment, other procedures and possible outcomes.

2. Right to timely access to detailed and accurate medical records and available services.

3. Right to transparent billing and full disclosure of any cost, including recommended treatment plans.

4. Right to privacy, and confidentiality of medical records.

5. Right to a clean, safe and secure healthcare environment.

6. Right to be treated with respect, regardless of gender, race, religion, ethnicity, allegations of crime, disability or economic circumstance.

7. Right to receive urgent, immediate and sufficient intervention and care, in the event of emergency.

8. Right to reasonable visitation in accordance with prevailing rules and regulations.

9. Right to decline care, subject to prevailing law and upon full disclosure of the consequences of such a decision.

10. Right to decline or consent to participation in medical research, experimental procedures or clinical trials.

11. Right to quality care in accordance to prevailing standards.

12. Right to complain and express dissatisfaction regarding services rendered.

Our PBoR fairs well in comparison to other patient charters around the world, as it contains statutory provisions that align with the global objective of delivering the highest-quality care, protecting patient information and ensuring the patient is an active participant in their health. However, ours does have some quirks that reflect the uniqueness and specific challenges of the Nigerian health system. For instance, our PBoR places a strong emphasis on the need to address issues related to cultural beliefs and practices that may impact patients’ health, while acknowledging the need to address issues related to poverty and lack of access to healthcare services in some areas of the country.

The Nigerian PBoR is not legally binding, hence it can only be enforced within the existing legal frameworks from which they were aggregated. The legal status of patient charters varies depending on country and context. For instance, in the United Kingdom, patient charters are backed by law, and healthcare providers have a legal duty to uphold the rights and responsibilities enshrined in them. In countries such as the United States, while they may not be legally binding in the same way, they can still be used as a basis for holding healthcare providers accountable for their actions and decisions.

It is worth noting that even in countries where patient charters are legally binding, there may be limitations to their enforceability, and patients may face challenges in seeking legal remedies for violations of their rights. Despite the importance of patient charters, as a country, we still experience several shortfalls and challenges in its implementation, some of which include; a lack of awareness, limited enforcement mechanisms, poor access to healthcare services, limited resources, and cultural and social factors.

In all, while our PBoR is an important step towards promoting patient-centred care, these challenges need to be addressed and it will require a concerted effort from policymakers, healthcare providers, and other stakeholders to ensure that patients receive high-quality, equitable, and