Deborah Ayobakin, a woman in her 40s battling a debilitating heart condition, was forced to leave a hospital bed in September 2024 after two days.
Her hospital bill was N112, 000 but she earned N80,000 as salary. If she remained in the hospital for another three days – as the doctor had recommended- the bill would rise to N305, 000.
Without funds for prolonged admission, she had no choice but to leave prematurely, highlighting the devastating impact of high healthcare costs on vulnerable Nigerians.
Cost of hospital bills has surpassed the incomes of several households. Malaria treatment for sick patients in several standard hospitals costs over N100,000, with the treatment of serious hepatitis patients exceeding N150,000, according to a BusinessDay survey. Treatment of more serious diseases such as pneumonia, ulcer, hypertension, diabetes can go higher.
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But incomes are not getting higher. A PiggyVest Savings Report 2023 showed that the majority of Nigerian workers earned below N100,000 monthly. Another 2023 report by Techpoint said the majority of workers earned N35,000 monthly.
Hospital bills are eclipsing incomes, pushing a large number of citizens into poverty.
The widespread economic challenges in Nigeria have not only escalated the cost of operation for healthcare institutions, it is confronting most Nigerians on every layer – whether in public or private hospitals.
Rising costs are affecting the depth and volume of medical diagnoses that patients can undertake, according to BusinessDay findings.
Patients’ wallets, rather than the appropriate standard of treatment, often determine whether they get surgery or manage medications.
Patients in emergency wards are refusing admission into wards because of financial constraints.
Several sick Nigerians like Mrs. Ayobakin have asked to be discharged against medical advice. Others are missing important clinic appointments because they can’t afford to cover the cost of commuting to the hospital.
Cost is crucial
Oyewole Kushimo, a consultant cardiologist at the Lagos University Teaching Hospital (LUTH), emphasised that cost is crucial for most patients seeking healthcare. However, with the current inflation rate significantly outpacing wage growth, accessing quality care has become increasingly challenging. While rising living costs have always presented difficulties, Kushimo observed that patients are facing unprecedented hardship in this period.
“If some patients are going to spend the money they require, they might have to sell their properties. It’s very tough. If a patient can’t afford a treatment, you can’t force it. You have to look for cheaper alternatives or some new procedures,” Kushimo explained.
“You probably want to write 10 tests as a doctor but you have to now select the most important ones because the patient cannot afford them.”
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Minister acknowledges impact of health costs
In a rare acknowledgment of the realities of medical hardship by the federal government, Muhammad Ali Pate, Nigeria’s minister for Health and Social Welfare, admitted that Nigerians face significant challenges in affording the cost of healthcare, which has pushed some deeper into poverty.
“We know that there are certain local governments where mothers don’t have access to the emergency services and they can lose their lives because they can’t afford caesarean sessions or manage complications,” Pate said.
Globally, half of all people impoverished by out-of-pocket payments live in Africa, according to a new report by the World Health Organisation WHO.
The report shows that Nigeria is one of only three countries where out-of-pocket health spending exceeds 70 percent of current health spending in the country. The country’s situation is deplorable because it has the largest fraction of people living in extreme poverty. About 133 million Nigerians are multidimensionally poor, according to the National Bureau of Statistics (NBS).
The report warns that out-of-pocket payments place a financial burden on over 200 million people, pushing over 150 million people deeper into poverty across the WHO Africa Region as of 2019.
“This exacts a heavy price on people’s health and hampers progress in attaining universal health coverage,” the report states.
Between 2003 and 2004, Nigeria failed to achieve any progress in terms of the percentage point change in the concentration of those further impoverished by personal health spending.
Despite an aggressive push to democratise universal health coverage and widen the safety net for more Nigerians, the number of those covered is still significantly low, excluding the majority of those who work in the informal sector.
Cancer patients turn to foundations
According to a trusted source at the LUTH’s cancer centre, many cancer patients have to turn to foundations and support groups to fund their treatment cycle, despite being significantly subsidised by the federal government.
The centre has supported about 138 patients since its inception and still has its support programme oversubscribed.
“People are actively applying to foundations that are willing to support their treatment,” the source said.
“The cost of treatment has increased. Radiotherapy is between N800,000 and about N1.9 million, depending on what the patient is doing specifically.
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“Chemotherapy is now about N200,000 to N400,000 for a cycle on average and we have patients going for four to eight cycles, depending on what is prescribed. We’ve adjusted our pricing modalities towards the number of fractions patients are receiving rather than the total cost. So, if our patients can’t afford it, they can at least access some level of treatment.”
Universal health coverage advocated
Kushimo believes universal health coverage can make a lot of difference in healthcare funding but wonders why the implementation is yet to become widespread.
According to him, most of the patients he has treated under the insurance coverage are federal civil servants or state officials.
“It is one thing to pass something and another thing is to see it in action. If you come to LUTH, go to the emergency and do your survey. You will see that 99 percent of patients are paying from their pockets. Nobody is under any insurance coverage. I’m not seeing any effect yet,” Kushimo told BusinessDay.
Pate, however, said the administration is focused on expanding health insurance, putting premiums on the vulnerable population, and providing other relief measures for Nigerians to afford the cost of drugs.
He said three out of six major cancer infrastructure and equipment investments approved by the president early last year will be ready by May for commissioning.
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