A N26.3 billion fund for medical emergency care in Africa’s most populous nation is falling through the cracks and cannot be tapped by most frontline hospitals confronted with patients who need it the most.
The fund, the equivalent of five percent of the Basic Health Care Provision Fund (BHCPF), is missing in action years after the National Health Act established it to cover essential medical services during emergencies.
Between 2020 and 2024, N526.9 billion was approved for the BHCPF, five percent of which is over N26.3 billion.
“We need to find where this five percent is hiding. It is a very serious discussion because five percent has been accumulating and there is a lot this can do,” Njide Ndili, vice president of the Healthcare Federation of Nigeria (HFN) and country director, PharmAccess said while moderating a session during the week-long Medic West Africa Exhibition of local and multinational healthcare companies in Lagos.
Samaila Kaila, deputy chairman of the Senate Committee on Health, comparing the emergency response to a part of a dysfunctional system, said legislative reinforcement is weak despite being a critical issue.
“This money was approved by the National Council on Health in 2020 and since that time, the money is still not seen. A committee was approved by the Ministry of Health to administer it,” Kaila said.
In 2022, the federal government kicked off the implementation of the National Emergency Medical Service and Ambulance System in a pilot phase that provided ambulance transport to hospitals and covered hospital costs for the first 48 hours in Abuja, the Federal Capital Territory.
One of the objectives was to establish effective emergency medical response services in 36 states and the Federal Capital Territory (FCT) in five years, including a national ambulance service.
Most hospital executives expected that a funding vehicle would be put up across the country to empower them to cover the cost incurred in providing such critical care, whether as a private or public hospital.
However, such mechanisms do not exist. Most emergency cases pressure patients’ relatives into raising huge amounts out of their pocket or relying on the scarce goodwill of hospitals for help.
Over 80 percent of Nigeria’s population is not covered under any insurance scheme, despite a law that makes it mandatory. This means more than 100 million people who recently fell into poverty can hardly get help when emergency calls.
Abiola Fashina-Ayoola, medical director and head of Emergency and Critical Care at R-Jolad Hospital said emergency costs are too expensive for hospitals to absorb alone. The challenge often compromises the quality and promptness of intervention required by many patients, she noted speaking during a panel session of HFN’s leadership conference that gathered key stakeholders in Nigeria’s emergency care.
If the lack of funding or mechanism to offset whatever cost incurred by hospitals persists, Fashina-Ayoola said equity in access to emergency services could be unattainable.
“Emergencies are frequently unexpected and very expensive to treat. Emergency patients need investigation. They need imaging, they frequently need ICU and critical care. They need multi-emergency specialists involved. As a private provider, we try our best to be ethical in our approach but we can’t give charity care 100 percent to all who come. Nevertheless, we do it and many hospitals lose a lot of money monthly on charity care,” the medical director said, analysing the ordeal.
“For instance, R-Jolad is right in front of a highway and we get young men all the time. We spend over N5 million naira on emergency care, without a chance of ever recouping the cost. There is no way we can continue without some sort of financial mechanism.”
“There are regulations that say you have to provide emergency care. But there’s nothing following that saying how you can access funding to pay for it. We need to have ideas on how we want to access this 5 percent of one percent of consolidated revenue that should be available to us.”
According to Kay Adesola, national president of the Association of Nigerian Private and Medical Practitioners (ANPMP), the emergency fund has been deployed to purchase ambulances, without rolling out concrete plans to ensure funding reaches the hospital taking in emergency patients.
Adesola, like many health providers, is worried that the investments needed in training of skilled paramedics that man prehospital care and even doctors and nurses specialised in emergency care risk being overlooked for the optics of ambulance services.
Leke Oshuniyi, chairman of HMCAN, believes Nigeria can ensure comprehensive health insurance packages that include emergency care for all, if government expenditure on health is scaled up to the 15 percent agreed in the Abuja Declaration, about N3 trillion.
Highlighting how the Presidential Unlocking Healthcare-Value Chain Initiative is improving emergency care, Abdu Mukhtar, the national coordinator said his team is working to ensure essential drugs required for critical care can be produced locally.
He explained that the initiative aims to increase domestic manufacturing by reversing 70 percent of imports to 70 percent of production by 2030.
His team is also driving pro-manufacturing policies, collaboration in research and development partnerships, and working with financial institutions to co-create financial mechanisms.
“I was in the UK and spoke with the CEO of the world’s largest producer of bed nets and they are willing to come and invest. A lot of policies and regulations are anti-business. In the last two months, we have worked with the Africa Export and Import (Afrexim) Bank. We signed an agreement of $ 1 billion facility. We are talking with AFDB and EIB to put together similar facilities,” Mukhtar said.
Pamela Ajayi, President of the Healthcare Federation of Nigeria emphasised the importance of innovative solutions in addressing emergency healthcare challenges.
She stressed the critical importance of efficient emergency care systems in saving lives and enhancing overall healthcare outcomes, charging participants to unite in advocating for comprehensive reforms that prioritise the development and implementation of robust emergency response protocols nationwide.
