NHIS debacle: How citizens are condemned to death in Nigerian hospitals

FOUR-YEAR-OLD, Sophia (not real name) had been complaining of cold for about two days but her father gave her Paracetamol tablets expecting the fever to subside.

When her condition grew worse,  he took her to the hospital and she was admitted to the pediatric unit of the Lagos University Teaching Hospital, (LUTH).

After diagnosis,  he was told his daughter had an infection and would need blood transfusion immediately.

The news was a big blow to Sheriff Atoyebi, Sophia’s father.  His wife who was involved in an accident several months earlier, and was also admitted in the Accident and Emergency ward of LUTH, and the outstanding financial bills were yet to be completely paid. And now, his daughter.

The poor girl has been lying in the Intensive Care Unit (ICU) without medical attention given to her because he couldn’t pay the bill.

“It has been tough getting money to pay for the prescribed drugs because they are very expensive. I was recently laid off the engineering firm where I worked, attending to my wife in the hospital and taking care of the children have been physically exhausting and financially demanding,” he said to The ICIR.

Before he was laid off, Atoyebi worked for  Cobel Contracting Ltd, a construction engineering firm based in Victoria Island, Lagos. As a staff, he was compulsorily enrolled by the firm on the National Health Insurance Scheme, choosing UCH as his Health Management Office. The insurance scheme took care of the medical expenses of his family while he worked with the firm but when he lost the job his family was stripped off of all the benefits of the program.

Atoyebi eventually decided to take Sophia out of the hospital so that he could care for her at home.  He would buy over-the-counter drugs from a local drug store where drugs are sold cheaper.

But luck came his way before he left the hospital with his sick daughter.

The nurse he met at the children ward introduced him to a Health Emergency Initiative, HEI. The volunteering organisation that renders financial assistance to indigent Nigerians who cannot afford to pay for their emergency healthcare service. And Sophia’s case got to them on time.

“They took over the hospital bills and paid for all the drugs prescribed by the doctor. I was really happy someone could stand by me at a time I needed help so desperately,” he said.

When asked, why he could not get his family insured by the National Health Insurance Scheme (NHIS) to ease the financial burden on him.

Atoyebi responded: “Where do I get money to pay for health insurance when I don’t have a job? My wife has been the major breadwinner of the family since I lost my job but after her accident, the financial burden was on me without support.”

Like Atoyebi, many Nigerians still pay huge “out of pocket expenses” for their health care needs or resort to assistance from friends, relatives or donor organisations despite the establishment of the National Health Insurance Scheme in 2005 with its objective to subsidize the medical expenses of Nigerian citizens.

The limited reach of NHIS

The NHIS was established under the National Health Insurance Scheme Act, Cap N42, and Laws of the Federation of Nigeria, 2004, to provide easy access to health care for all Nigerians at an affordable cost.

Act 35 of the 1999 constitution that set up the National Health Insurance Scheme did not make health insurance compulsory for all Nigerians, as is expected in a social welfare scheme.

The NHIS is saddled with the mission to ensure the financing of health care costs through the gathering of financial resources to provide financial risk protection and cost-sharing for people against the high cost of health care, through various programmes, before falling ill.

However, a huge population classified in the vulnerable group that includes older citizens, disabled persons, under – five children and pregnant women are majorly not covered by the scheme.

About 90 per cent of federal government employees are covered by the NHIS compulsorily,  in a customized health care package developed based on 10 per cent contribution of their annual income by the government and five per cent contribution by individual enrolee making 15 per cent, according to a study carried out by David Adewole and Kayode Osungbade which was published in the International Journal of Tropical Disease and Health in 2016.

However, private organisations have different arrangements with their chosen Health Management Offices.

According to the World Health Organisation, WHO, Nigeria’s health insurance coverage is pegged at less than 4 per cent of the total estimated population of 190 million people compared to Rwanda’s 91 per cent of the country’s 12.21 million people who are covered by the government’s health insurance according to a report by US-based newspaper Financial Times.

The budgetary allocation for health from 2010 to 2018 has been below 15 per cent. This is far below the benchmark prescribed by  Abuja declaration to which Nigeria is a signatory.



Following the trail to a narrow health coverage

The World Health Organization, WHO defines out-of-pocket expenses as direct payments made by individuals to healthcare providers at the time of service use.

WHO puts the total out of pocket expenditure at 71.7 per cent of the total health expenditure in Nigeria, experts attribute this to the poor management of the health sector.

The Chairman, Pharmaceutical Society of Nigeria, (PSN), Abuja chapter, Jelili  Kilani blamed the situation on the government for not giving priority to the health sector by increasing funding to the sector.

“The health sector has not been funded properly by this present government even the preceding ones. Adequate funding will go a long way to subsidize the health care needs of vulnerable Nigerians and provide affordable healthcare. The current NHIS programme needs to be reviewed, and increasing the health budget will mean that more money is available to subsidize these expensive drugs to meet up with the changing economy,” he said.

In a bid to extend the reach of government-sponsored health insurance to Nigerians across all sectors, the NHIS introduced the Vital Contributor Social Health Insurance Programme (VCSHIP) especially for people in the informal sectors who are not employed by the government.

The community-based health insurance programme requires the enrollee to pay ₦15, 000 annually for every person registered on the program. This means that a family of four will have to pay ₦60, 000 annually according to records obtained from the NHIS website, which is reasonably high for the majority of Nigerians who earn less than $2 per day according to a World Bank report.

Fausat Afolabi is one of those people.

The 32-year-old mother of two is engaged in petty trading in Ifako – Ijaiye local government area of Lagos State.

Two months, after giving birth to her second child through a caesarian operation in a private hospital, she starts feeling intense pains in her stomach.

Her husband, Adebowale, a long-distance driver was away on a business trip when the pangs of pain became unbearable for her.

Her neighbours took her to the General hospital in Ifako – Ijaiye where she was admitted but treatment was not administered until the drugs were paid for.

Adebowale got the news and returned home immediately to attend to his wife after some of his friends contributed money to purchase drugs before doctors’ commenced treatment for her.

The diagnosis revealed that a “foreign body” (large pieces of wool) was left in her body during the caesarian session that took place in a private hospital.

Adebowale Afolabi had a difficult time meeting the financial demands of paying the medical bills for his wife and buying the drugs needed for her treatment.

He sold some of his properties to raise money for the medical bills yet it was not enough to cater for the expenses.

Finally, he was able to offset the medical bills through assistance from friends, relatives and donor agencies. Joy is currently recuperating at home but the medical expenses put a hole in the finances of the family.

Speaking to The ICIR, Joy said being alive was attributed to the financial relief that came from the savings of her husband, voluntary contributions from relatives, friends and donor agencies that assisted her.

“My family, especially my husband and some of our friends helped me to scale through because the drugs were very expensive. I was to take astimin a drug that costs about ₦15, 000 per tablet and I was to take two daily which makes it N30, ooo per day, there was also a drip that costs about ₦50, 000. Everything spent on the medical bills should be between ₦500, 000 to ₦600, 000. I am happy to be alive,” she said.

Findings by The ICIR shows that many households in Abuja also face a similar situation, causing many to solicit funds from family and friends during an emergency medical situation.

The United Nations is pursuing  a sustainable development goal to ensure access to affordable medicines, safe and universal health coverage for all by 2030, but with the state of healthcare system in Nigeria, and  with the growing population of Nigeria, now estimated at 195 million people,   it is unlikely that Nigeria would achieve the goal.

Poor service delivery with “Insurance Scheme.”

In Giri, a rural community located in Gwagwalada Area Council of the FCT, the only semblance of a health facility in this community is the Giri health centre that offers free primary medical services.

The building is sited close to the community’s LEA Primary school, with three rooms, and a large room that serves as a reception. A female nurse was attending to an aged man, while over ten patients were waiting for their turns.

The ICIR reporter spoke to a middle-aged woman who didn’t disclose her name, how her treatment went, after her appointment with the nurse.

Speaking in Pidgin English, “Treatment ke,” she said.

“This one na clinic. Wey even common drugs for stomach pain dem say dey no get. Rubbish”, she replied angrily.

In a recent report by the World Health Organisation, Nigeria is rated 187th out of 191 countries in the area of healthcare delivery.

Irene, a programme officer at the Surgical Aid Foundation, Abuja, explains that most government hospitals are not equipped to provide modern solutions to medical health challenges.

“Most people would prefer government hospitals because they believe it’s cheaper than private ones but the problem is the kind of service they offer because they don’t have the equipment. For example, they still cut people open from the stomach to the back to remove kidney stones whereas, in most private hospitals, it is laser surgeries. You might complain about the cost but people want to live,” she said.

“I think the NHIS programme was a noble programme but it has failed to live to its expectations. Currently, it is good for administering effective primary care like malaria treatment, headaches, and other illness. When it comes to terminal or serious diseases you have to look away from the scheme,” she said.

She also complained of the long waiting time and the poor attitude of health service providers in government hospitals.

“Before you get the NHIS authorisation code before you can treat a patient is a huge challenge because sometimes it might take two days and if it is an emergency situation you can imagine what will happen,” she said.

    A handful of Nigerian non – profit organisations like HEI are attempting to provide free emergency medical assistance to indigent and vulnerable people in public hospitals and communities by stepping in to pay their medical bills within the first 24 hours, especially accident victims.

    Pascal Achunine, the Executive Director of HEI decried the way health service providers’ demand for an initial deposit from emergency patients, especially accident victims before administering treatment when that time difference could determine if the patient lives or dies

    “When hospitals demand an initial deposit from a patient in an emergency condition and stall treatment until it is paid. That time difference could determine the chances of survival of the patient and that’s where we come in,” he said.

    “Accident does not know age, we bridge that unique gap by paying their bills free of charge to make sure that lives that would have been lost or fatalities that would have resulted from the first ten hours of an accident or an emergency situation is minimal because our aim is to save lives,” he concluded.

    Amos Abba is a journalist with the International Center for Investigative Reporting, ICIR, who believes that courageous investigative reporting is the key to social justice and accountability in the society.

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