Abuja, Nigeria — Halima Galadima wheels herself into the Dialysis Unit of Garki Hospital with the support of her teenage daughter on September 11.  She is too weak to walk as she is overwhelmed by dizziness. 

In preparation for the day’s dialysis session, she came for some tests, including her packed cell volume (PCV) and to take injections. Being an End Stage Renal Disease (ESRD) patient, she needs to undergo a renal replacement therapy.

ESRD, otherwise known as kidney failure, is the last stage of chronic kidney disease. When the kidneys fail, it means they have stopped working well enough for patients to survive without dialysis or a kidney transplant.

Halima, who has not done kidney transplant because of her poor financial condition, takes hemodialysis three times a week as her only lifeline. Since she was diagnosed in October 2017, she has undergone about 45 sessions of dialysis.

“Without a renal transplant, ESRD patients do dialysis for the rest of their lives to stay alive,” said Aderemi Adelaja, a consultant nephrologist who works at Garki hospital. “And 36 sessions of dialysis will establish an individual who has kidney failure as an end-stage renal disease patient.”

Halima is a National Health Insurance Scheme (NHIS) beneficiary. Her health insurance scheme covered six out of 45 sessions of her dialysis procedure, excluding the injections and drugs she had taken since the inception of the disease.

“The injection costs N12,000 per dose and I have to take two doses in a week,” Halima told The ICIR.

At the cost of N26,700 per session, she has spent N1,201,500 on the dialysis sessions done so far. Her insurance scheme coverage paid N160,200 for the six sessions — the period covered by the scheme. She had not stopped receiving the periodic treatment as at the time The ICIR interviewed her. Without the kidney transplant, the patient would have to continue undergoing a regular dialysis procedure.

“NHIS to some extent supports hemodialysis. The number of sessions that are supported by the scheme is the question. That is where the problem is,” Dr Adelaja noted.

In between an intermittent cough and overload of fluid in her body, Halima lamented: “If the NHIS has supported me more, I would have been healthier as I struggle to meet up with even one session of dialysis per week.”

She said that, at several times, she had done emergency dialysis because some of her critical conditions warranted such.

Adequate dialysis and cost

“An ESRD patient has to dialyze three times in a week and to take two doses of injection in a week,” says Bulus Goni, a nephrology nurse who is also the dialysis unit head at Garki Hospital Abuja.

A dialysis session costs N26,700 in Garki hospital Abuja. In addition to that, some injections, which constitute Recormon and iron sucrose cost N10,000 and N2,000 respectively, bring the sum of the injection per dose to N12000.

Therefore in a week, N104,100 (N80,100 for dialysis and N24,000 on injection) are spent by the kidney failure patients to stay healthy. In a month, the money spent by these patients sums up to N416,400 while annually, N5 million naira is spent.

“The financial burden for the treatment of kidney failure mostly rests on the patient, the patient’s relatives or guarantors,” Adelaja said.

With the financial responsibility, Goni said a lot of patients could not afford regular dialysis.

The importance of the kidney to the proper body function cannot be overemphasised. Its functions include the removal of toxins from the body through the urine, said Akinremi Omotayo, a nephrology nurse at Garki Hospital and founder of the Omotayo Kidney Care Foundation.

The human kidneys, she explained, regulate the body fluids and the blood pressure, helping to stimulate Erythropoietin, a hormone that assists in the production of red blood cell in order to increase the blood volume. Omotayo said that in a situation when someone’s kidney is not properly working, those functions performed by the kidneys have shut down. Hence the reason for a renal replacement therapy which could be through a renal transplant, hemodialysis or peritoneal dialysis.

She said inadequate dialysis causes the urea and creatinine (i.e. some of the wastes in the blood removed by kidneys) to be high.  As a result, patients are bound to experience diarrhoea, loss of appetites and vomiting. And the blood volume is drastically reduced because the erythropoietin would not reproduce.

Nephrologists voice to the government

Adelaja told The ICIR that the Nigeria Association of Nephrology (NAN) has made a proposal through the Vice President and the Minister of Health for a more effective participation of the Nigerian government in either subsidizing or make the NHIS take over the management of dialysis.

A speech delivered by Babatunde Salako, the association’s president, and contained in a 2017 publication of NAN reveals that the government agreed to the proposal of increasing the number of dialyses to be covered by NHIS from 6 to 36 sessions.

NHIS speaks

In a phone interview, The ICIR spoke with an NHIS officer, who declined to be identified, she, however, confirmed that the insurance scheme only covers a maximum of six sessions of dialysis. When asked if there is any other plan to give more support to the kidney failure patients who chose NHIS as their health insurance scheme, she replied that the scheme is currently working on some benefit packages for the patients who are beneficiaries of NHIS but did not give further information.

Similarly, the NHIS Media Head told The ICIR the cost of dialysis restricted the NHIS to provide more benefit package for the patients.  “You know dialysis is a big amount of money?” He also hinted that the pool of funds accrued is insufficient.

Meanwhile, he directed The ICIR reporter to the Informal Sector head through the executive secretary, Usman Yusuf, saying that he would not give any information without the consent of the NHIS boss.

However, five weeks after Halima spoke with The ICIR, she died.

According to a nurse at the hospital where she was receiving treatment, her death was caused by the high creatinine and Urea in her body which was a result of the inconsistent dialysis.