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The growing prevalence of chronic kidney disease presents a significant challenge to global health policy worldwide. In developing countries, it has severe impact on health and economic output.
Hospital social responsibility is of the utmost importance in the development of health systems. It could be considered as one of the solutions for kidney healthcare improvement, especially in African countries. The absence of African data on this subject, motivated us to carry out this study which aimed to assess social responsibility of African public hospitals in terms of kidney disease management, and to explore the factors that influence it based on the perceptions of patients and nephrologists, then suggest concrete solutions to improve it.
Our study included participants; nephrologists and patients, of public hospitals in ten African countries (Morocco, Tunisia, Egypt, Chad, Burundi, Senegal, Gabon, Mozambique, Mauritania and Cameroon), representing the five African regions: North Africa, West Africa, East Africa. Central Africa, and Southern Africa. Two structured questionnaires were used to measure the perceptions of patients and nephrologists regarding the hospital's performance based on four dimensions (quality, pertinence and equity of kidney care as well as accessibility in terms of providing access to kidney health services), Each of the above items was measured using a 5-point Likert scale. Besides, the participating doctors answered open-ended questions about the barriers to social responsibility in their institutions and were invited to propose practical solutions to improve the existing situation. Statistical analysis of the survey data included Student t-test, Chi-square test, and univariate and multivariate logistic regression methods on several levels.
Four hundred patients and fifty nephrologists from ten African countries were included. Only 26.95% of the patients believed that their hospitals were socially responsible. In fact, the participants were generally satisfied with the therapeutic management, especially with the involvement of caregivers in the care process. However, hospitals’ general conditions and the accessibility of care (waiting times, overall cost, unavailability of treatments) were generally perceived to be unsatisfactory. Also, patients generally believed that receiving treatment regardless of their ability to pay was not always possible. Moreover, correlation analysis of patients’ data and hospital social responsibility had shown that patients treated in large hospitals (p: 0.002) and those who had health coverage (p: 0.0448) were more satisfied. In addition, statistical analysis found a significant positive association between the country's income (p: 0,000), its public expenditure in health (p: 0.011) , education (p: 0.000), and the perception of hospital social responsibility.
As for nephrologists, 60% of the participants thought that their hospitals are not socially responsible. However, the statistical analysis did not note any significant associations between the socio-professional characteristics of physicians, the socioeconomic characteristics of their countries and their perceptions of hospitals’ social responsibility.
In addition, the participating nephrologists had raised, in addition to the social determinants of health, a number of factors hindering social respon of african hospitals, such as the lack of health professionals and brain drain. Other factors linked to the hospital structure (leadership and governance, inadequate and insufficient infrastructures, non-availability of drugs and diagnostic tools), as well as factors linked to the health system (limited resources, low national budgets allocated to health and lack of health coverage) were also discussed.
Finally, nephrologists had proposed solutions, mainly directed to hospital managers, encompassing the following three components: Recruitment and training of human resources, leadership and governance, as well as strengthening of infrastructures and logistics.
Our study highlighted the crucial role of hospital governance and management (by involving the various stakeholders) in improving hospitals’ social responsibility, and therefore the delivery of care.
In addition, perceptions and concerns of our participants provide information to health authorities regarding functioning and management of kidney disease in african hospitals. These results could be of great benefit to decision-makers and help influence health policies, in addition to improving the performance of our health systems to take the actions required to become socially responsible.