Nigerian healthcare providers can’t pay for own wellbeing
In 2006, Nubi (not real name) ran from pillar to post when she noticed a painless lump on her left breast. The matron-nurse at a government hospital in Lagos, Nigeria’s commercial capital, could not quell the torrents of fear that lanced through her. As a medical expert, she knew well her body had begun to dine with death. She had only six months to live. It was a stage-two cancer of the breast.
The 53-year-old mother of one shuffled between day and night shifts rehabilitating mentally strained patients. But her diligence and passion only earned her N80,000 monthly, while she needed at least N2.5 million to undergo procedures for removing cancerous cells.
Even as a healthcare provider, Nubi stood no chance of cover under the weak National Health Insurance Scheme (NHIS). The teaching hospital cooperative society could only loan her N400,000. The hospital management reluctantly offered N100,000 after she had made a compassionate plea for a N1.2 million loan. A non-governmental organisation disqualified her from accessing financial backing because her work profile as a top government staff didn’t match the profile of a destitute. In trauma, she combed odd sources, entreating until she pooled pockets of borrowings, just for a chance to live.
“It was not the kind of illness that could wait until I had money; by the time I have money, I would have been dead. So on my own, I saw a professor outside my hospital and did a mammogram,” Nubi narrated to BusinessDay in despondency.
“I had to use a 120-milligramme drug every two weeks which was then about N235,000, meaning I needed N470,000 for two doses and I had to complete. The first two injections administered were N300,000 and the last five doses were over a million naira,” she said.
Thirteen years after her ordeal, little or nothing has changed to better the wellbeing of healthcare providers in Nigeria.
In 2019, a junior staff whose contract is temporary in Nubi’s department cannot afford pills needed to manage her mental condition. She has not been paid for eight months. Ironically, she manages patients living with psychiatric problems. On bad days, she is forced to rely on leftover drugs of patients.
Nigeria’s healthcare roof is on fire and it appears nobody cares. From medical doctors to clinical psychologists, optometrists, physicians and nurses, the wellbeing of Nigerian healthcare providers, whom the government entrusts with management of the health of over 200 million citizens, is poor and getting worse. Yet, the country expects so much from caregivers whose health suffers due to non-supportive work structures and largely, poverty.
When the pangs of ill-health bash them in the duty of caring for others, many healthcare providers, like Nubi, can’t afford their own care. Yet, if a regular patient presents the same challenge they probably wrestle with and has the out-of-pocket power for the needed procedures, the care is expected to be delivered indeed.
This may well be a major factor responsible for why health workers in Nigerian hospitals are sometimes non-challant and lackadaisical in their attitude to patients brought before them, experts say.
“The productivity of healthcare providers will certainly slow if their working framework does not empower them to protect their personal wellbeing, does not provide machinery smart enough to enhance efficiency or overburdens them with tasks,” said Johnson Akomolafe, secretary of the National Association of Nigerian Nurses and Midwives (NANNM), Lagos University Teaching Hospital (LUTH) chapter.
In Nigerian hospitals, for instance, special priority does not often exist for medical staff, even when they sustain injuries during the discharge of care. When Nubi’s senior colleague sustained a severe finger injury caused by a patient plotting to escape from the psychiatry ward, it took the emergency unit of the same tertiary hospital 24 straight hours to attend to him.
Uninterestingly, the breakdown of salary shows that hazard allowance for Nigerian doctors dangles around a staggering N5,000 monthly, an amount about three times less than the allowance of professionals in non-clinical sectors.
“If we fall sick presently in Nigeria, there is no provision for sickbay or medical help or financial assistance for you as a staff. You have to go through the normal process that people go through as outpatient. You will wait until it gets to your turn, whether you are on duty or not,” Akomolafe said.
And while a doctor, nurse or surgeon queues behind a raft of squirming patients, staff strength is automatically shortened and available workers are overburdened, compounding an already worse situation where the density of human resource for health (HRH) stands at an alarmingly low ratio of 20 professionals per 10,000 Nigerians, according to the World Health Organisation (WHO).
Kayode Makinde, president, Association of Resident Doctors (ARD), LUTH chapter, said the ultimate danger from the poor practise of overburdening health workers is that the probability of introducing errors is higher. Some errors could be fatal or leave an irreparable scar on innocent patients.
“It is even beyond the issue of being well paid. If you look at other climes, there is a certain number of hours that you cannot go beyond and they don’t expect you to work continuously for 24 or 48 hours. Not only is it detrimental to your health and wellbeing, your chances of making mistakes will increase,” Makinde said.
As a result, there is a surge in voluntary resignation of nurses, occasioned by the pursuit of better working conditions that help skills to flourish and appreciate hard work, according to the NANNM. From 699 nurses handed over to Akomolafe’s administration in November 2018, 618 were left at the end of September 2019. The data does not cover for statutory retirements which, if included, speculations say overall number of nurses now available would be about 400. Meanwhile, the government is not proactive to renew this shrinking staff strength.
Across all specialities of nursing, staff strength is weakening as Nigeria loses specialists to countries like Canada, United Kingdom, United States and Australia, where an average nurse could potentially earn approximately N2 million monthly.
Contrastingly, the earning of an assistant director of nursing in Nigeria, for instance, hovers around N200,000. And it’s further crunched by deductions for tax and a health insurance scheme that does not provide life-saving medications.
As it stands, a nurse in LUTH is responsible for at least 14 patients when the World Health Organisation (WHO) pegs the standard at four patients per nurse. This unwholesome practise has consequences.
Most retiring Nigerian nurses constitute part of 1.5 million who suffer from ‘slipped disc’ yearly in Nigeria. The degenerative condition occurs when the soft centre of a spinal disc pushes through a crack in the tougher exterior casing.
Apart from the hospital workplace injuries caused by lifting, carrying, and transferring patients, there are other unique risks not found in other professions, including exposure to chemicals, needle sticks, and the potential for violence from patients and their families.
According to a survey on ‘Workplace Violence in Healthcare’ by Spok, a US-based firm specialised in clinical information, hospital staff suffered 51,380 work-related injuries and illnesses that caused employees to miss work. These injuries occurred at an incidence rate of 129.8 cases per 10,000 full-time workers, 45 percent higher than the rate for all occupations – 89.4 cases per 10,000 workers.
The most common injuries are caused by overexertion and bodily reactions, including motions of lifting, lowering, or repetitive motions. Sprains, strains, and tears are the most common symptoms that require time off from work.
Other research has shown the rate of violence suffered by those in healthcare is as much as 12 times higher than for those in other professions. A study in 2017 found that of all emergency department workers, nurses were the most likely to have been physically assaulted in the six months to the report and were less likely to feel safe. Nearly 60 percent reported verbal abuse and 12 percent were physically assaulted in the week prior to the survey.
For stakeholders, this data not only tells a story of hospitals as a risky workplace, it also shows Nigerian healthcare providers are potentially at greater risk. There is no regulatory requirement for healthcare workers to report incidents of violence, and each organisation has its own policies and procedures. There is also a culture within healthcare that workplace violence is a necessary part of the job.
Nubi’s experience with occupational hostility is also a pointer to why Nigeria’s stock of medical talent continues to deplete without abate, leaving direct adverse impact on the delivery of quality care to millions of Nigerians. Nigeria’s rich who constitute less than 30 percent of the population may have options to explore elsewhere, but certainly not the preponderant poor of an economy experiencing slow growth trajectory that is non-inclusive.
At 53, the mother of one still believes in a future outside Nigeria.
“I have written some exams. When I pass them, I plan to travel out as well. Ninety percent of nurses no longer have passion towards work. NHIS does not even give you malaria drugs,” Nubi told this reporter as she brightened the gloom that earlier gripped her countenance.