Editor’s Note: This week’s blog comes from a Nigeria Health Watch team member. She writes about coming head to head with the challenges facing Nigeria’s health system during her father’s recent health emergency. Her father is recuperating but the experience led her to think deeply about Nigeria’s emergency healthcare system and what must be done to improve it.
In two days, I learnt that you might never really understand the extent of Nigeria’s challenges until the Nigerian health system is all you have to rely on. My father fell ill suddenly and every step of his ‘care’ made more glaring the challenges that face us as a country.
My father is barely 60-years-old and has had a relatively healthy life, save for a sudden kidney failure followed by a transplant when he was 53. While that experience was excruciating for us, his management in a hospital in India made it all better for his caregivers – my mother especially. The system was smooth, we knew what we had to pay for and at what point. I recall my mother telling us that the doctors offered to record or live stream his transplant surgery so she could be part of the process. This was in December 2011.
Fast-forward to six and a half years later- we were all sound asleep when suddenly, my father had trouble breathing. And there we encountered our first challenge: We had to get him to a hospital. It was early in the morning, and we did not have access to any ambulance services. If any organized emergency ambulance service exist in Nigeria, then we must do better with sharing the information on how they can be reached. Maybe if we were in Lagos, we would have been able to access the state’s 112 service. Also, how many states in Nigeria have rapid response ambulance services for people? And how many of those services actually work optimally?
We decided to take my father to the closest hospital to us, given the emergency. However, we could not actually afford the services of the closest hospital and had to choose the “second closest”. In the past, we had used this hospital which has grown very quickly in the last two years to one of the most popular private hospitals in Nigeria— known to serve the wealthy. At our previous visit, we had gone in for a minor procedure and did not have to empty our bank accounts. Back then, we watched as hospital attendants refused to move an accident victim from the emergency ward to the Intensive Care Unit because he could not afford to pay for his care.
This got me thinking: How long do Nigerians have to depend on out of pocket payments for healthcare? How many Nigerians have health insurance to cater for their health needs, especially during emergencies? How many health insurance providers offer retail services where retired citizens like my father can get an individual plan? How well are these services publicised so the public is aware? How far has the campaign for Universal Health Coverage (UHC) gone in its implementation? The questions are plenty and I am hoping the answers will come soon.
We finally got to a government hospital about 10 minutes from where we live. This is one of the three tertiary healthcare facilities in the country’s capital. Thankfully, on arrival, we were provided with a wheelchair and a nurse to push my father into the emergency ward. It was at this point that what I thought would be the biggest shock came. The nurses would not check what the problem with him, a patient who could not breathe, was, until an initial deposit was made. Thankfully, my mother had just enough cash at hand to pay. Taking away compassion, aren’t there any laws or policies around providing emergency care in Nigeria? I recall a related story earlier this year, where it was reported that Lassa Fever patients had to pay for care. While the treatment drugs are free, they reportedly had to pay for the bed space, tests and other management provided to them. What happens to those who are unable to afford these? Are they rejected or left to add to the increasing mortality from diseases in Nigeria? Asides gunshot victims, shouldn’t a law also be in place for unconscious patients? Those infected with epidemic-prone diseases?
We were finally attended to by the doctors on duty, who looked like they could do with some rest. An oxygen tank was provided, and his breathing thankfully returned to normal. The next steps included the series of tests that had to be conducted. I recall a chest x-ray, an ECHO, urea test and a few others. I was given about five to six different sheets of paper. I asked the nurse if this was for only my dad, or if it included other people’s bills, but she snickered and said; “go and pay”. Well, I took the papers and went to what I understood was the cash point. However, I was given my papers back and in one minute, the cashier outlined all the places I had to go to “cost” the items.
Apparently, before you pay for any service – test, drugs, x-rays, you must take the paper to cost. As my father had a urine test, an x-ray and some drugs included, I had to go to at least three different places to cost the items. Each spot had its own queue and it did not matter if it was an emergency – you had to join a long queue to cost, another long queue to pay and the final long queue to collect your drugs, lab test bottle or whatever you needed at the time. Need I mention that none of the payment points had a Point of Sale machine (POS) throughout the period we were there. Clearly, we need a better-managed payment and drug purchase systems in our hospitals. While it may be argued that this redundant system of payment may reduce the so-called “risk” of theft in the hospital, it is definitely not the most effective solution for any patient or their caregivers.
In the eight days we spent at the hospital, there were continually more reasons for my family and I to lose faith in the healthcare system. At some point, the Consultant came in and made us realise the medical officers had not taken enough details of my father’s condition in his case notes. This meant she could not make an informed enough decision on whether to discharge him or not. In addition, the doctors did not communicate effectively with any of us about his illness and the treatment plan he was placed on. All we really wanted to know was the problem in clear simple terms. There was often a gap in communication. What this meant was sometimes, we had five different doctors or nurses writing those long lists of different items and we had to go to different points for costing, payment and collection, which, apart from prescription drugs, included miscellaneous items such as surgical gloves, a thermometer and syringes.
There are obviously so many problems with healthcare delivery in Nigeria. However, what is most irksome is that these problems have simple, solvable solutions; solutions that can easily be implemented but require proper leadership and management. I was at an event recently where it was once again emphasised that young people must begin to think of solutions to the problems in Nigeria. Therefore, I offer these to the leaders and players of our health sector:
- Stop the ambiguity – It is time to define the policy on providing emergency care in public hospitals in Nigeria. Do patients have to pay before treatment or not?
- To the health insurance providers, there are so many Nigerians in need of retail plans! Please provide easy options. How much does it cost? What does it cover?
- Let’s please move from paper-based to electronic patient information management systems. This is the age of technology! We all know that we cannot rely on doctors’ writing habits.
- There is strength in collaboration. Banks and financial houses can help our hospitals set up manageable financial management systems – how hard is it to provide POS, ATMs in hospitals etc
- Finally, our hospitals desperately need better managers. Even the best surgeon will not save a single life if he cannot manage the simplest of processes. Our hospitals need to be more user-friendly.
In line with the Patients’ Bill of Rights developed by the Consumer Protection Council and launched by the Vice President Prof. Yemi Osibanjo on Tuesday, July 31, 2018, healthcare providers must ensure that a patient’s right to seeking and obtaining quality healthcare is respected and protected. This includes the right to relevant information in an easily understandable manner, right to timely access to accurate medical records and right to decline care, subject to prevailing laws and upon full disclosure of the consequences of such a decision among other rights.
Have you had any experiences with Nigeria’s emergency care system? We would love for you to share your experiences with us.
Thank you for this article. The information within it will be very helpful for me as I negotiate with stakeholders and operators in my bid to build hospitals not only in Nigeria, but other African countries and beyond. At the moment I am in discussions with people in Nigeria, Cameroon, Ghana, Tanzania, Rwanda and Zambia to build hospitals for them. A major question that has to be answered is the viability to pay for the hospital, which of course relates to payment for services (this is not a free world.) Streamlining the management of the hospitals would go a long way to solve this problem as well as collaboration with other players such as health insurance companies to set rates for services. Fixing Africa’s health system is a challenge, but anything is possible if enough people are willing.
Dear Nigeria Health Watch, thank you for sharing this story. As Nigerians, nobody is immune from a health emergency. I certainly hope that your father has fully recuperated. No family should have to go through the pain and stress that your family endured. I agree with all the solutions you have offered, they are simple and should not be difficult to implement ASSUMING the right will and leadership is in place. I would like to add another situation that needs to be rectified. I fully understand that medical professionals at the hospitals are under a lot of pressure, however when faced with an emergency, where is that simple human instinct compassion? To the nurse who refused to attend to your Dad until the bill was paid, what if something adverse had happened? (let us leave that one to the pastors to deal with). You brought up the Consumer Protection Council, and the Patient’s Bill of Rights, the question needs to be asked, if not implemented, what are the repercussions? None from what I can see, therefore hospitals can do whatever they please. It is only until hospitals and medical professionals are held accountable for their actions, that things will change. Until then, we are at their mercy..unfortunately.
Healthcare services especially emergency care are unique because the timeliness and skill of their provision could be a life or death matter. There are no rights without responsibility. Money is needed for the service to be provided. If the government is so interested in the bill of rights you mentioned, it must ensure health insurance cover for all Nigerians at least for emergencies.
Literally everything narrated is a recurring decimal in the Nigerian healthcare system. The out-of0pocket expenses by most came about as result of the Yes Lack of Information on the health Insurance Scheme.
2. Retired Civil/Public servants face a wall of nonchalance when they try to register for a scheme after service. There is no proper arrangement to process and make the scheme available to the willing.
A prospective candidate is asked to log on to the government website, provide the required information, download and printout a result sheet. The go a bank t make payment and present the teller from the bank to another office for processing. This is user-hostile and too labourious for many.
Why not a simple access point at the office where the form is filled, downloaded and printed? This may then be processed through the bank of POS system there.
3. In any event most retiring civil servants have had their records with the NHIS. Why not contact them six-months before retirement informing of the options available such that those interested could actually update and buy a plan before retirement?
Perhaps the availability of ‘cheap money flowing-in from the treasury makes the organisation nonchalant on seeking for and encouraging new customers.
This sort of challenge faced in getting information about health insurance schemes and signing on is asking for a tech solution to facilitate the process for individuals. If banking transactions can be done on an app. no reason why health insurance cannot be purchased in the same way, via an app of similar tech solution.
Nigerian health care system is detrementous.. Wat is d function of so call govt wen Dey re those ready to save life at all costs sitting at home with no jobs those employed are those who know who.. D masses children are at home idle no job… Am a nurse graduate though it’s basic but y would d govt be so adamant by not employing the right people into the system… The main solution is to give jobs to those who deserve to provide it not just after the money… May Allah save Nigeria from these callous way … May he give ur pops lafia..
Welcome to the world of reality! This is an excellent piece of documentation based on experience.
I agree that the emergency response sector needs revamping and complete overhaul as suggested. However, permit to ask what is the role of the people? Health is a fundamental right of the citizens of Nigeria and therefore, should be provided especially in cases of emergencies. We are all guilty and responsible for what we get by being docile and not making demands of our leaders at every level of healthcare delivery. Let us document lessons learned from such experiences, publicise and share with relevant stakeholders that can effect desired changes, and collectively, insist on best practices. The change may not happen overnight but over time, we should record an improvement.
This is why health advocacy is very improvement and why citizens need to become more active in pushing for better healthcare. How? Start by holding the government to account, not standing by when failings are identified in healthcare delivery. Ask questions, stay informed. When failings are identified, report it, use whatever channels are widely available.