How Lagos hospitals fleece pregnant women

For a long time, the Lagos State government has claimed to operate free maternal and childcare programme in the state, to make healthcare affordable among the vulnerable groups and reduce the tin evil of maternal and newborn death. But the reality appears different, as pregnant women in some sampled primary healthcare centres and general hospitals across the state are often forced to bear the financial cost of delivery and accessing antenatal services, even in the face of the policy.

The Lagos State government has always claimed to operate free antenatal care and delivery for pregnant women in the state.

But the reality on ground is showing otherwise, as various state-owned hospitals charges pregnant women for antenatal registration, drugs, investigations for tests and delivery.

Nigeria has one of the highest maternal mortality rates (MMR) and infant mortality rates in the world.

Out-of-pocket payments, along with other factors, have always been blamed for the phenomenon.

When The Guardian visited the Gbagada General Hospital, it was discovered that pregnant women were often made to pay for antenatal care, medical investigations and drugs, among other sundry financial costs.

Mrs. Bagadat Adeyemi, who has been attending antenatal care there, told The Guardian that she was made to register with N9, 000 for antenatal care.

Mrs. Adeyemi, who is in her early 30s, said she had spent a lot buying drugs in the hospital.

“When I came few months ago to register for antenatal, the nurses I met told me that I must register with N9, 000 for antenatal. I had no choice than to register with the money.

“I was told that the money was meant for investigations and drugs, but I know that I have spent some money for drugs since then. I am aware that I will also pay for delivery in due course.

So, I am not aware of any free antenatal care or free delivery here. If there is any, I have not benefited from it,” he stressed.

A midwife in the hospital, who refused to reveal her name, confirmed to The Guardian that pregnant women are expected to register with money for antenatal care and pay for delivery.

“A pregnant woman is required to pay N9, 500 for antenatal clinics on their first day of coming to the hospital.

“Out of the money, we shall take N500 for sending text messages to her to remind her of her antenatal days,” she explained.

She brought out a card the size of a school register, saying: “We shall also take N500 to open card for her. Then, N2, 500 will go for her tests and the rest N5, 500 will go as part payment for her normal delivery, which is about N35, 000.

“After delivery, the woman is expected to pay the remainder for delivery?”

By her explanation, pregnant women are expected to pay a minimum of N 49,500 for both registration and normal delivery.

When asked whether the amount for delivery would still remain the same if the delivery turned out to be through Caesarean Section (CS), the midwife said: “No! Caesarean Section is more expensive. But I can’t tell you how much it goes for now, because the cost has been reviewed and I just resumed today. So, I do not have the new price yet.”

Mr. Kute Fidelis, whose wife was delivered of a baby boy three months ago at the hospital, told The Guardian that he was made to pay the N35, 000 when he had the baby, and another N 1,000 each for three days as cost of hospital bed space.

At Igbobo/Bayeku Primary Healthcare Centre located at Bayeku at Igbogbo/Bayeku Local Council Development Area (LCDA) in Ikorodu, the story of antenatal payment and manipulation of women in the healthcare system in was obvious.

The PHC operates in a bushy and dirty compound. But that won’t deter women from attending the hospital, as some of them were seen bringing their children for immunisation.

One of the nurses attending to the new mothers said: “Pregnant women coming for the first time are expected to do screening in a private laboratory centre we use and bring the result on Tuesdays,” she explained.

Upon request, she pulled out a request form bearing Path Medic Diagnostic and wrote out the numerous tests.

She explained: “Pregnant women are expected to bring along N2, 500 for registration and N5, 000 for delivery packs.”

But she won’t disclose how much the hospital charges for delivery.

Since the new mothers who brought their children for immunisation were delivered babies in private hospitals, it was difficult to get information on the cost of delivery in the hospital.

But it costs about N140 to get to the diagnostic laboratory centre and get back to the PHC on taxi, as the distance is not what a pregnant woman can trek.

The next visit took The Guardian to Agbele PHC in Igbogbo, where the story was not different.

Built in 2013 under MDGs project, the centre looked new compared to the old abandoned centre at the compound.

When The Guardian visited the hospital recently, one of the staffers, popularly known as Alhaja, disclosed that each pregnant woman is expected to pay for antenatal services and delivery.

Alhaja said: “Pregnant women are expected to bring along N4, 000 as part of their registration requirements. Out of that money, she will use N2, 500 for registration and N1, 500 for her routine drugs for one month, after which she is expected to bring along N1, 500 for her routine drugs on each antenatal clinic days.”

When asked whether pregnant women are expected to pay to carry out investigations,” Alhaja replied in the affirmative.

At a time during the discussion, the health worker pulled out a request form bearing Path Medic Diagnostic and referred for “xyz and hepo. She refused to speak on further charges.

Puzzled and suspicious of the referral, The Guardian visited the laboratory located within the premises of the hospital, where the PHC medical laboratory scientist confirmed that the laboratory centre attends to pregnant women.

When shown the request form, the medical laboratory scientist gave the cost for doing the test for husbands as N500 and N2, 500 for the pregnant woman, making the cost of both tests at N3, 000.

Wondering why a public health worker would want to refer a pregnant woman to a private laboratory centre when there was a standard laboratory within hospital premises, The Guardian set out to trace the private laboratory centre.

It took about 30 minutes to locate the centre at Igbogbo. The attendant, who was on ground, told The Guardian that the cost of doing medical investigations for husbands was N3, 000 and N6, 500 for pregnant women, making the total cost for every pregnant test to escalate to N9, 500, an amount some of the women in the area cannot afford.

Few days later, the investigation continued at the Inland Maternity, one of the oldest hospitals in the state.

As the gynaecological arm of the General Hospital, Lagos, the Maternity attends to only children and pregnant women.

There, Mrs. Rebecca Adeyemi, who said she was delivered of a baby boy early this year, told The Guardian that antenatal services and deliveries were not free.

She disclosed: “I registered with N12, 500 for my antenatal clinics. The money was used for my antenatal bookings, registration, pregnancy screening and short message service (SMS).”

That was not all she paid. “When I wanted to be delivered of my baby, I paid N10, 000 for delivery packs and another N25, 000, which was for theatre operation for my CS.

“For the number of days we spent, we paid N1, 000 per day for bed space and N800 for food, which I did not even eat.

“We spent about N120, 000 altogether, because we had to settle the doctors and other health workers.”

Baffled by this revelation, The Guardian asked why she would settle doctors for services she already paid for.

She took a deep breath and said: “Health workers at the Inland Maternity tasked us for financial gratification as if it was their right. It got to a point we had to settle the consultant in charge of my case. It was that bad.”

At the premises, The Guardian was directed to the front desk officer, who stated that a pregnant women were expected to bring N100 along on the first day to a specific place in the hospital, after which she would be given two weeks to come back with other requirements.

Asked what the other requirements were, the officer refused to give further details.

Mrs. Helen Okoro, who had been attending antenatal services for two months, explained: “I registered for antenatal with N13, 500 for the cost of hospital cards, mosquito nets, scan and other medical investigations.

“But we were told that the cost of delivery is N16, 000 and CS goes for about 50,000.”

The story of payments was the same at Ikosi-Isheri PHC, which is shabbily located inside Ikosi-Isheri LCDA Secretariat at Ikosi, Ketu.

A nurse there, who does not want her name in print, told The Guardian: “A pregnant woman is expected to register with N2, 000 and equally undergo series of medical investigations at a private medical laboratory centre, after which she is expected to come to the PHC with the result.

“We will then give her list of things to buy. Delivery is free, but she is expected to appreciate the health workers who carried out the delivery with anything she has.

“And if there is no fuel in the generator or no electricity supply, she will be required to buy fuel.

“So, everything that the woman may spend at the end of the day may not be up to N10, 000.

“But also know that pregnant women have to buy their drugs, because our pharmacy is never stocked with drugs.”

A visit to the Badagry General Hospital on October 23 revealed that women pay as high as N30, 000 for normal delivery.

Mrs. Fadeyi Modupe, who was delivered of a baby few weeks earlier at the hospital told The Guardian: “Normal delivery goes for N30, 000 and CS goes for N45, 000.”

Regarding drugs, she said: “It is only once I was able to collect routine drugs at the hospital pharmacy, because the drugs are not usually available.

“At other times, we had to buy our drugs from private pharmacy shops.”

A visit to Afuye PHC in Epe on October 26 showed that women do not need to worry about paying for delivery services, because the centre does not take deliveries.

Although the centre looks modern, it was basically inaccessible, as the main entrance has been cut off by a major road construction going in Afuye area.

One of the three staffers, Mr. Raymond Ade (not his real name), who spoke to The Guardian, said: “We do not handle delivery cases in Afuye PHC, because we close by 4 pm daily.”

When asked about antenatal services, Ade said: “Yes, we attend to antenatal cases, but it is free. We do not collect money for registration, among others, but once it is getting to the due date, we often refer pregnant women under our care to Epe PHC/Maternity.”

At some, Ade referred The Guardian to Epe PHC/Maternity.

Inside the Epe PHC/Maternity hospital, Mrs. Rachael Akande (not her real name), a nurse, explained that antenatal and care for the newborn was not free.
“The cost of delivery and registration goes for N2, 000, but pregnant women are expected to bring N1, 000 to buy their routine drugs and N3, 000 for medical investigations, which are done inside the hospital,” Akande said.

When confronted with the fact on ground on October 28, Lagos State Commissioner for Health, Dr Jide Idris, insisted that the state was still offering free antenatal and delivery for pregnant women.

“We targeted basically the poor and said, ‘let antenatal care and delivery be free,’

“I am not unaware that some facilities are not implementing the policy, as we agreed. I am aware that there are sharp practices.

“That is why people in the Primary Healthcare Board have been going around to monitor what is happening,” Idris said.
The commissioner added that dwindling allocation to council from the federation account, the current economic recession and other issues have made it difficult to implement the policy.

“We know of situations where some people come from outside the state to get some of these things to sell. Those are the sharp practices we discovered when we went out for monitory.

“Because a lot of people come from outside the state, they put huge burden on these facilities. That might be the reason they (facilities) charge in excess, especially for those pregnant women that were not booked.

“But I am not making excuses for them.”

He assured that the state government would to correct the abnormally in the full implementation of free healthcare with health insurance.

Experts believe removing the burden of payment for antenatal care and delivery will not only help to increase the number of women attending antenatal care, but also go a long way to reduce maternal and infant mortality rates.