National Health Insurance Scheme was set up with the aim of making healthcare more accessible, and affordable to Nigerians, but in many cases, the reverse is the case. Many have died, and many are still dying due to the inefficiency in the system and the people that are meant to carry out their responsibilities at the right time. The scheme was meant to reduce out-of-pocket expenditures amongst the enrollees.
Unfortunately, the majority of the enrollees are still paying out-of-pocket expenditures due to inefficient services of the health sector practitioners, with the deliberate act of impoverishing the populace. These stories will be strange in the ears of the rich ones that can pay for a higher health package to afford higher hospitals or those that can fly themselves outside the country, or at the expense of the government.
A true-life story of one particular woman made me understand what many suffered, and it is a reflection of the typical scenarios of what happens in many hospitals. A particular woman that was not feeling fine walked into a particular hospital with her health insurance, explained all her troubles to the consultants or medical doctors, and presented herself for treatment. The doctor ended up giving her prescriptions after a few questions, and she left. But her condition could not improve after some days. It was suspected that it is either the symptoms were not cleared enough to the doctor, improper diagnosis or prescriptions were not the right ones, or inefficient drugs were administered to her with less potency (less expensive). According to her, her encounters with that doctor have been like that, if she is not lucky enough to meet other doctors on duty. She also observed that other people hold similar views. In this case, the woman came back three days later, with the same troubles to meet the same doctor. The first thing the doctor could say is, “Madam, you are here again, is it because you are using HMO? And the woman was humiliated. Story of privileged few that are enrolled. What of those without the means to even enrol?
When I had this, so many thoughts were rolling out of my mind. Probably, the doctor acted this way because it was funny for the same hospital to present the same bill or higher, for the same treatment, for the same patient in the space of one week to the same HMO. It is not adding up, and it will raise a red flag for more questioning. So, he reacts, I guess.
So, some of them know exactly what they are doing, and this particular doctor in question used tactics by distressing the patient to get her intimidated not to come back again, even if she is dying in silence. It will interest you to know that the same hospital provides quality healthcare services for some private individuals who can afford their bills, but HMO patients are treated differently. So, the story continues. After he reluctantly prescribed, and she reluctantly received the substandard treatment, as usual, she walks away, and that was the last time the woman visited that particular healthcare center.
Many people have abandoned their health insurance for out-of-pocket expenses for similar reasons. The thinking of many people out there that are not seriously sick is that it is better to get quality drugs or better treatment from a qualified pharmacy than to waste the transportation, energy, and time to go and queue to get poor service from a ‘medical doctor’ at the end of the day. To many people, that ends it. Don’t forget, whether you go or not, the health insurance or maintenance organizations will not refund the money collected on your behalf. Suffering and smiling continue. The story of our healthcare sector.
There are prevalent cases and allegations that most hospitals will tell the patients to go and buy the drugs from outside (stores) that they don’t have in their stock, even if they have since the patient is an NHIS/HMOs patient. Twenty people walk in a day; the stories are the same thing. That the government has not funded them enough to store medicines or NHIS money was not enough to buy the medicine. But they will not disclose that to the patients. Sometimes, some of them even refer a patient to their own private hospitals, pharmacy, or clinics to purchase or for further treatments, and that happens mostly in the public hospitals. Whereas, some hospitals will prescribe the medicines for you to go and buy from any available pharmacy of your choice (out-of-pocket expenses). Going to some private hospitals, you pray and fast to meet the good doctors on duty if not, you take whatever service you get, provided you are using health insurance because low experience doctors are placed on the night, and weekend duties. Then I ask, what is the value of the health insurance scheme, when it cannot cover drugs for basic treatment, without going for out-of-pocket expenses?
The typical Nigerians will not complain, and some who complain will not direct their complaints to the right sources. Some walk away to carter for themselves and their families in places they can get better services. Those that cannot afford are dying in silence. Then I wonder, whose duty it is to supervise the Nigerian hospitals and the activities of doctors in Nigeria? These took me to the National Health Act, 2014.
Many Nigerians are not even aware that they have the right to complain if they are not satisfied with the service they received. This is stipulated in the National Health Act, 2014, Section 30(1), which says “A person may lay a complaint about the manner in which he or she was treated at a health establishment and have the complaint investigated”. Again, many Nigerians are skeptical if actually the complaint will be investigated. Again I ask. Even if, will justice prevail?
To have a better system, the people in the position of authority should not wait until they received a complaint before they carry out their constitutional functions, especially the highest policy-making body in Nigeria on matters relating to health.
The National Council on Health comprises the minister of health, who is the chairman; minister of state for health, commissioners for health; and the FCT health secretary and the permanent decretary of the Federal Ministry of Health, who is the secretary to the council, should wake up to their responsibilities. It is important to highlight some of their functions, as stipulated in the National Health Act, 2014. Section 5(1)(a) said they “have responsibility for the protection, promotion, improvement, and maintenance of the health of the citizens of Nigeria, and the formulation of policies and prescription of measures necessary for achieving the responsibilities specified under this paragraph;”. Section 5(1)(c) also said they “ensure the delivery of basic health services to the people of Nigeria and prioritize other health services that may be provided within available resources;”. They are also meant to “issue, and promote adherence to, norms and standards, and provide guidelines on health matters, and any other matter that affects the health status of people” – Section 5(1)(e).
How will Nigerians know that they hold these powers if there are no actions? Section 5(1)(j) also stated that they “coordinate health services rendered by the Federal Ministry with health services rendered by the States, Local Governments, Wards, and private health care providers and provide such additional health services as may be necessary to establish a comprehensive national health system”
Many Nigerians lick their wounds and prefer to die in silence rather than complain and take action. Some believed that the system is not working, complaining will be a waste of time, while it is obvious that some don’t even know their rights. It is our collective responsibility to make them know their rights, especially with the use of the patient bill of rights.
Nigerians, it is high time we know our rights and demand for our rights, especially as it concerns our health.
Finally, the system can only work, if we hold the people in charge to account for their actions.
Samuel writes from Centre for Social Justice, Abuja via
