Language policy for healthcare services: Special Consideration needed for Universal Health Coverage

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By Balungile Shandu

Effective communication is crucial in healthcare to ensure accurate diagnosis and appropriate treatment of patients. It is imperative that healthcare providers are able to fully relay information to their patients and vice versa. Language barriers between healthcare providers and patients translate to miscommunication that can be detrimental to the patients’ health and the provider’s career. Miscommunication is, to some extent, a result of linguistic differences between healthcare providers and patients. This then creates a demand for language interpreters so as to ensure successful and positive outcomes from consultations. Patient-healthcare provider rapport is created through effective communication – extensive communication where these stakeholders fully understand each other. Such rapport also translates to the building of trust which is important for healthcare services particularly because the absence of effective communication could have life-threatening consequences.

Language barriers compromise one of the main objectives of the Universal Health Coverage (UHC) namely the ‘access to quality essential healthcare services’. While the 2009 Ugandan Patients’ Charter describes a set of rights, responsibilities and duties which a person can pursue to receive healthcare services, the Charter further empowers patients to demand quality health care and actively participate in decisions that affect their health and treatment. The issue of language barriers could then compromise the patient’s active participation in the decisions related to their health due to the failure to understand each other during consultation.

When it comes to the hard of hearing and speech, matters are even more complicated. Trouble starts at home where the patient’s relatives or guardians may not be able to tell when this individual is not well and the individual is unable to communicate the feeling of ill-health.

To address the language challenge, some studies recommend the use of professional interpreters. A study conducted by Kariliner et al revealed that when speaking the patients’ native language, interpreters can assist in decreasing communication errors, increase patient comprehension, improve health outcomes and increase patient satisfaction with communication. Interpreters create an environment for a trustful relationship and comprehensible communication between the healthcare provider and the patient.

However, while interpreters help in facilitating communication, there is also a view that they are insufficient for overcoming language barriers because of other important factors such as trust, accessibility and the quality of translation. Sobane’s study revealed that some clinics  in Lesotho used untrained interpreters such as administrative personnel, bilingual nurses and bilingual high school graduates employed from the community to interpret for patients in consultation rooms. While the interpreters were eloquent in both the patients’ and the medical practitioners’ languages, their understanding and ability to convey the meaning of medical concepts in the patients’ native language was weak. For this reason, Sobane recommends that interpreting should be an accredited medical profession so that interpreters can be competent enough to transfer information and mediate between the healthcare provider and the patient.

The other downside to the use of interpreters is compromised confidentiality. Ethical guidelines of the Health Professions Council of South Africa (HPCSA) and Uganda Medical and Dental Practitioners Council (UMDPC) indicate that the patients’ medical information should be treated confidentially by the healthcare practitioner. The presence of an interpreter in the consultation room is an infringement on this requirement, more so because interpreters do not take the Hippocratic Oath.

For a setting like Uganda, with over 50 dialectics the venture can be chaotic and quite costly for individuals and the government.

These phenomena depict the language policy predicament in the health care services. Overcoming the language barriers in the health sector requires language policies that will address the language barriers experienced during consultations. A policy of this nature requires commitment to the development of languages for use in the health sector because significant financial, material and human resources have to be apportioned to this cause. Balancing language services and healthcare provision requires fluency in the patients’ language by all relevant healthcare providers which is a challenge in light of globalisation and the high rate of people movement around the world. However, the multiple concerted efforts in this regard would be helpful instead of leaving the issue to chance.

Balungile Shandu is a Junior Researcher at the Human Sciences Research Council (HSRC) in South Africa.

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