Ayobakin, a woman in her 60s battling a debilitating heart condition, faced a stark choice to either continue battling her illness in a hospital she couldn’t afford, or return home to her struggling children.
Despite repeated hospital visits and a dire need for comprehensive treatment, including crucial investigations and admission, Mrs Ayobakin was forced to discharge herself.
Her children, themselves grappling with poverty, could only afford to send between N5,000 and N10,000—barely enough to scratch the surface of the exorbitant medical bills.
Without the funds for proper tests or prolonged admission, she had no choice but to insist on leaving, highlighting the devastating impact of high healthcare costs on vulnerable Nigerians, tipping them further into the abyss of 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 involved in accessing care 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’ pocket, rather than the appropriate standard of treatment more than often determines whether a patient gets surgery or manages medications.
Patients in emergency wards are refusing admission into wards because of financial constraints.
Sick Nigerians like MMrsAyobakin are asking 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.
Oyewole Kushimo, a consultant cardiologist at the Lagos University Teaching Hospital (LUTH), emphasized 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 proprieties. 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.”
In a rare acknowledgement 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 caesarian 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 exceeded 70 per cent 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.
The report found warns that the practice of out-of-pocket payments, placed 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 hamper 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.
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 subsidized 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, it’s between N800,000 and about N1.9 million, depending on what the patient is doing specifically.
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.”
Kushimo believes a 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 insurance coverage are with 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.
He also noted that the government has also flagged off 10 new major diagnostic centres across the country for about five months through NSIA.
“For a very long time, the capacity we had when we were 150 million people is what we still have when now that we are over 230 million,” Pate said.
“It’s challenging. We have intervened from a policy perspective to see how we can begin to relieve some of those constraints over time. It’s an integrated system where primary healthcare is at the base where every Nigerian should be guaranteed the basic minimum while complicated cases go to a higher level.
“There is rapid progress in infrastructural development. Beyond infrastructure and equipment, we are beginning to focus on the quality of care.”
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