How poverty compounds poor medical treatment

It is no longer news that many Nigerians who are not able of pay their hospital bill after treatment are being detained in the hospitals.

It is no longer news that many Nigerians who are not able of pay their hospital bill after treatment are being detained in the hospitals. The most affected group are women, pregnant women in particular, who are delivered of their babies but could not pay. The hospitals are forced to detain both the mother and baby until the bill is paid. At the moment, nothing is being said about the legality or otherwise of the detention; the main issue is how to get a discharged patient out of the hospital. There are many reports of this growing trend in Nigeria.

Last June, for instance, seven weeks after she was delivered of a set of triplets – two girls and a boy, a housewife by name Gloria Okore, was detained by the management of a private hospital in Surulere Lagos over her inability to settle outstanding medical bill of N35, 000 out of N120, 000 incurred at the hospital. The woman reportedly was begging for help to raise the balance and also cater for her babies. One of the babies, a girl, later died because there was no incubator to use for the babies.

Mrs. Okore told reporters that due to the harsh economic situation in the country, her family needed the goodwill of Nigerians to survive. The nursing mother, who reportedly looked pale and unable to breastfeed the babies, was put in an unkempt ward without medical facilities. She appealed to government and good spirited Nigerians to help her pay the bill and also get basic necessities for her babies.
Okore is just one out of millions of indigent Nigerians who are held up in abject poverty to the extent that they could hardly eat one good meal a day talk less being able to pay medical bills when they are sick.

The inability of most Nigerians to pay for simple treatment in hospitals has certainly compounded the precarious human development situation in the country. A healthy population is an asset, but a sickly populace is a burden. Most rural dwellers and the urban poor are among the group that can’t afford to pay for hospital treatment. Government should promote free and affordable massive primary healthcare in the country.

Nigerians should be able to afford treatment in hospitals either on their own or through a well-structured and functional national health insurance scheme. Otherwise most plans of government anchored on the population would fail. There can be no national aspirations without a vibrant population. It is high time that government took the issue of public health serious in the interest of the country.

Speaker, House of Representatives, Yakubu Dogara recently lamented that over 100 million Nigerians cannot afford treatment in hospitals. This category of Nigerians can’t afford to pay bills for treatment of illnesses in public health facilities, talk less private hospitals. Dogara’s figure must be underestimated. The number of indigent Nigerians is mind boggling.

The Speaker spoke in Abuja while declaring open an investigative hearing by the House of Representatives committee probing into the compliance rate of Health Maintenance Organisations (HMOs) to the National Health Insurance Scheme (NHIS) contributions and utilisation of funds by the healthcare providers and the inhuman treatment meted to enrollees.

He decried the lack of mechanism to protect vulnerable families from the catastrophic effects of the exorbitant cost of healthcare services in Nigeria. The Speaker contended that poor families, who constitute 67 per cent of our population, cannot pay for treatment of malaria in public health facilities or for routine ante-natal services.

Consequently, he said there is compelling need to expand the coverage level of the NHIS currently estimated to be about 5 per cent of Nigerians who are mainly in paid employment and other forms of formal sector.

Dogara noted that the NHIS and the delivery partners have been subjected to various criticisms, challenges and complaints ranging from untimely payment by healthcare providers from the HMOs to unsatisfactory health services to enrollers. There is need for repositioning of the scheme to make it more effective.

The probe of the NHIS by a committee of the House of Representatives might help in repositioning the scheme. The about 450 petitions the committee received on the shoddy implementation of the NHIS scheme shows the failure and dissatisfaction of Nigerians.

For instance, the disclosure by the Executive Secretary, Prof. Yusuf Usman, that a whopping N381 billion was disbursed under the NHIS within the past 12 years, out of which administration fee alone got N60 billion, is worrisome considering that a mere 450,000 people are enrolled in the scheme out of 170 million Nigerians.

How was the money spent? Who got what and for what purpose? Corruption in the scheme must be curbed before it can be effective. No doubt, the NHIS has failed, which explains why most Nigerians can’t afford to pay for medical treatment. The NHIS ought to cover the medical treatment of Nigerians.

There is need to expand the coverage of the scheme to include both formal and informal sectors. The seeming focus of the NHIS on the formal sector comprising mainly people in paid employment is flawed. Even at that, the income is poor and can hardly afford decent medicare. We cannot ignore the rural poor.

The importance of primary healthcare cannot be over-emphasised. Rural public health could be achieved through personal hygiene and provision of potable water.

Unfortunately, reports indicate that some 63 million Nigerians lack access to safe water, which is a recipe for disease epidemics. A staggering 60,000 children reportedly die of diarrhea annually due to lack of water. Primary healthcare, which ought to be promoted, is utterly neglected.
For instance, apart from the periodic child immunisation shots carried out across the country under the Expanded Programme on Immunisation (EPI) campaign of the Federal and State Governments, nothing in recent times, shows that government is concerned about the deplorable state of primary healthcare delivery in the country. Even the tempo of the immunisation campaign as well as participation of members of the public seems to be slowing down by reason of reduced focus.

Gone were the days when free hospitals, including dispensaries, existed in parts of the country. Quality drugs were available. Sanitary inspectors did their job. Churches and faith organisations owned health facilities. Local governments played prominent role in promoting rural healthcare. Today, hospitals charge exorbitant fees when a lot of people are not on salary.

Given the ugly state of affairs, Dogara should not just lament the anomaly in the NHIS healthcare system. He should use his privileged position to sponsor a bill that would help to correct some of the anomalies. That is the least that Nigerians can expect from him.
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