By Chioma Obinna
Grappling with economic turmoil, the Nigerian healthcare system is bearing the brunt. As the cost of living skyrockets, the prices of essential medications, medical laboratory tests, and other health services have surged, making access to treatment a luxury for many.
Even before now, the story of healthcare in Nigeria has remained a stark contrast between the privileged and the marginalised. For those who can afford it, world-class medical facilities and treatments are a mere taxi ride away.
Sadly, the current situation has further worsened the plight of the majority of Nigerians, navigating the complex and often exorbitant healthcare system has become worse than a daily struggle. The costs of basic medical care beginning from obtaining a hospital card and consultations, getting routine tests such as malaria, urine tests, consumables and drugs have gone up even 10 times higher in some instances, leaving sick Nigerians stranded.
The rising costs in healthcare generally have particularly impacted vulnerable populations, including pregnant women, children, and those with chronic illnesses. Many families are forced to choose between food and medicine, while others are resorting to traditional healers or self-medication. The stories of Nigerians slumping and dying have become commonplace.
The situation is dire and experts say it requires urgent comprehensive action to address the crisis and ensure that all Nigerians have access to affordable and quality care.
Financial ruin
Olayinka Ade, a mother of three, recently, was turned back from hospital. She was not turned back because the doctors or other health workers were on strike. Rather, the turning back was because she could not afford to pay N3, 000 Hospital Card in one of the Lagos State government-owned hospitals. Her two children were down with high fever while one suffered from chronic asthma, a condition that required regular medication and occasional hospital visits. The cost of the child’s treatment, combined with the rising prices of food and other essentials, has pushed Olayinka to the brink of financial ruin. “Sometimes, I have to choose between buying food for my children and getting their medicine,” Olayinka told Sunday Vanguard amid tears.
“It’s a heartbreaking decision to make. This is one of the reasons why I decided to come to the General Hospital.” Like many other Nigerians, Olayinka could not see the doctor not to talk of completing the healthcare process. “If I pay N3, 000 for just a card, how much will I pay for drugs?” she asked rhetorically. But she is not alone. Faziyat, a school teacher who has been on diabetes medication for years, told Sunday Vanguard she could no longer cope with her treatment. Faziyat, a widow, said with a monthly pay of N30, 000, her salary could not meet up with her family feeding not to talk of buying her routine drugs. “I was told about a miracle plant. Every morning I eat it”, she said.
Joseph Eke, on his part, has been on hypertension drugs for over six years. Joseph, who works in a shopping mall in Lagos, said the increasing cost of his medication has forced him to go on drug holiday. “My salary can no longer cover my drugs plus feeding. Over the past year, I have been managing my condition with support from friends, but these days, things are tough. Even those friends are now in a financial mess. I have decided to hand over my case to God”, he lamented. Today, many hypertensive and diabetic patients have gone on drug holidays which experts say could increase the rate of heart diseases including heart attack and even death.
Pregnant women
The health crisis in the country does not spare even pregnant women. The family of Mrs Faustina Imeh almost lost their twins. This is because the family could not afford the cost of CS. “It was like a film. I fell into labour three weeks before my delivery date. Getting to the hospital, I had other complications and the doctors said the only option was a caesarean section”, Mrs Imeh said. Unfortunately, the family of four could not afford it. They were asked to pay N650, 000 but a deposit of N500, 000 was required. Sadly, they wasted a lot of time to raise the money. Although Faustina and her children survived, the family was thrown into debt. At the Outpatient Department of a General Hospital in Lagos was Bola Ojerinde.
He had been down with a high fever and her doctor recommended she run some laboratory tests. Bola made her way to the laboratory. In the company of her husband, she was handed over a bill of N23, 500 for just four tests. Bola husband’s countenance changed all of a sudden.
“The prices had gone up by over 200 per cent. It was an unexpected increase. If tests cost N23, 500, how much are we going to pay for treatments?” Bola queried. Also, Aisha Azeez almost lost her life because of complications of pregnancy. But thanks to her doctors, Aisha is alive today but luck was not on the side of her child. Aisha, whose husband is a labourer at a construction site in Lagos, never thought her delivery was going to be through CS, but, unfortunately, she fell into labour unexpectedly with complications.
Upon examination, Aisha was booked for CS. Meanwhile, the family could not afford to pay the required N320, 000 for the CS. “I lost my baby due to the high cost of CS. I and my husband could not even raise the deposit. If we had money, my baby would have been alive today”, Aisha lamented.
The stories of these Nigerians are not unique. Millions of Nigerians are now prioritising immediate needs over long-term health. The high costs of medical care, coupled with limited access to quality healthcare facilities, particularly in rural areas, have led to a public health crisis. T r e a t m e n t abandonment has become the order of the day. In most hospitals surveyed by Sunday Vanguard, many patients who needed specialised treatments could not afford them.
Top among patients hit are those needing surgery, those suffering from asthma, diabetes, hypertension and even patients needing treatment for malaria and typhoid.
Prohibitive costs
Also, the prices of all routine drugs in Nigeria have gone up. And branded and unbranded antibiotics, analgesics, antimalarials, and specialised drugs are not spared. Some of the malaria drugs now cost as high as N3, 500 to N7, 000 depending on the area of purchase. About one year ago, the cost was below N1, 000 Malaria tests, which costs used to be in the neighbourhood of N1, 000 to N1, 500, have risen to between N4, 000 and N5, 000 depending on the facility and where it is located.
The devaluation of the Naira has apparently caused the prices of drugs, diagnostic kits, and medical consumables to increase by several hundred percent in the past year. For example, a popular antibiotic that sold for under N4, 000 now costs over N50, 000.
Medical tests like urinary analysis in public lab facilities now go for N2, 000 to N6, 000 while fasting cholesterol tests cost N16, 000 in private hospitals etc. The cost of CS, which used to be around N50, 000 in public hospitals, has gone up to N250, 000 and N300, 000. In private hospitals, it now goes for over N500, 000 depending on the facility. Surgeries are not spared. The cost, depending on the type of surgeries, has risen due to the high cost of consumables like gloves, drips and operational costs. If the situation continues, experts are warning that more women may die during childbirth while infant mortality rate will rise. The situation in hospitals, according to medical practitioners, has worsened, coupled with the hike in electricity tariff. Operational costs are forcing private hospitals, battered by low patronage, out of business as Nigerians prioritise food over health.
Quackery
Sunday Vanguard c a n authoritatively report that quacks, meanwhile, are having a field day as the social media are awash with the marketing of all manner of medications, including those that are not registered by the National Agency for Food and Drug Administration and Control (NAFDAC). These ‘social media professionals’ falsely claim they have affordable alternatives to conventional medical care.
Implications
Consequently, experts are warning that more Nigerians, especially women and children, are going to die if the situation is not tackled urgently.
They also fear it may negatively impact the country’s health indices. Right now, the experts say the occupancy rate at big hospitals is decreasing. Sick people, according to them, Pray you don’t fall ill as costs of drugs, healthcare surge don’t go to hospital anymore; instead they go to pharmacists, churches and traditional healers to seek any treatment they can get.
Treatment abandonment
The Chairman of the Medical Guild, Dr Moruf Abdulsalam, who spoke on the scenario, said treatment abandonment has become the order of the day in hospitals. Abdulsalam said the situation has resulted in an increased rate of antibiotic resistance, treatment failures and sometimes outright refusal of treatment protocols. He said sick Nigerians are facing a myriad of problems including psychological trauma from the effect of ailments to the harsh economic realities.
According to him, though medical treatment in any part of the world is not cheap, the woes of the Nigerian patient have been compounded more by the out-ofpocket system. Abdulsalam highlighted that Nigerians have been thrown into multidimensional poverty from the harsh economic policies of government, which has greatly reduced the purchasing power of patients.
“Things have just been on a negative trend since this government came on board with their poorly managed economic policies of subsidy removal, floating of the exchange rates, increased taxation, dollarisation of the economy worsened by the opulent lifestyle of our rulers”, the Chairman of the Medical Guild told Sunday Vanguard. He said Nigeria’s overdependence on importation has caused more harm to the healthcare sector, adding that government must wake up to its responsibilities and partner the private sector to ensure a holistic multi-stakeholder approach to address the situation. Abdulsalam said government should encourage local production, implement price control and regulations, subsidize all variables that increase the cost of essential medicines, as well as promote the use of generic brands as alternatives. The Guild Chairman said there was a need to remove out-ofpocket payment by making health insurance policy mandatory.
Increased morbidity, mortality looming
On his part, the National Chairman of the Association of Medical Laboratory Scientists of Nigeria, AMLSN, Dr Casmier Ifeanyi, said the devaluation of the Naira against the US dollar has sent healthcare costs in Nigeria skyrocketing, making essential medical services increasingly inaccessible to ordinary citizens. Ifeanyi said the situation is exacerbated by the country’s heavy reliance on imported medical supplies, warning that the astronomical rise in prices was putting severe strain on the healthcare system and endangering public health. He regretted that all medical-related materials, be they drugs, consumables, kits, diagnostics, and point of care testing tools are all imported.
“In Nigeria, we run a medical care that is over 98 percent dependent on imported products holistically and it puts pressure on our FX, and any time the FX becomes volatile, reciprocally, the costs of medical care will increase,” he argued. The expert told Sunday Vanguard that, between last year and now, costs of treatments have increased astronomically and have continued to take health care further away from the reach of the average Nigerian. ”We are worried that even when the present government has come with an Executive Order to promote local production, not much is happening in that regard”, he said.
“If you wanted to buy the Augmentin brand of Clavoneteramoxicillin, you could buy it for less than N4,000. That was June 2022. Today, if you find it to buy, you may be parting with over N50,000 to buy the one-gram-a-day pack of Augmentin. “That gives you an idea of the very galloping increase in price for that particular drug and the same would go for all other drugs, even for unbranded drugs imported from India and China. “The same would go for all kinds of testing kits.
“That which you could buy a pack before now for less than N10, 000, today, most of the rapid test kits are in the border of N20, 000 and N25, 000, or even a lot more. “And that is just the rapid test kit, not the consumables and other accessory products that you utilize in the course of performing a test using that kit.” Stating that the precarious situation is affecting life, longevity, and life expectancy, he said many patients in Nigeria who are hypertensive can no longer afford their routine drugs.
According to him, Nigeria is getting to a point where the subsidy that was removed from petrol should be spent on healthcare as a way of ameliorating the suffering of Nigerians. “Most families cannot afford antenatal and post-antenatal care”, Ifeanyi said. “You find out that more people, more pregnant women are likely now to die because they are going to resort to very unethical things, resorting to traditional birth attendants, resorting to all manner of concoctions and local remedies that may make their condition worse.” He said it was time for the Coordinating Minister of Health, Professor Ali Pate, to convoke a conference on how some measures and strategies must be put in place to bring down the cost of medicare, both in the public and private sectors. Ifeanyi lamented that in most of the public health institutions and facilities, out-of-stock syndrome has fully returned.
“Our facilities are becoming mere consulting clinics where these drugs are no longer affordable”, the expert said.
Price control
He called for the introduction of price control in the healthcare system, saying the different healthcare professional associations need to begin to introduce some kind of price or cost or bill moderation and have benchmarks that can be acceptable and violations should address some form of sanction as a way of being alive to various professional goods to care for humanity.
Corroborating his views, a Medical Laboratory Scientist at the Mopex Medical Laboratories, Festac, Lagos, Mr Chukwuemeka Ihezue, said the costs of medical care in Nigeria in the past four years have recorded a significant chain of increase but cannot be compared with the astronomical increase in the last one year. Ihezue said: “A few years ago, the costs of diagnosis of malaria parasite, and Widal test for typhoid were about N1, 500 depending on the area and facility where you went for the tests. “But in the last two years, there has been an increase because of the exchange rate which has affected all imported things. “Last year the tests went up to N3, 500; but since then they have increased by over 150 percent. In most centres, they go for N5, 000. “I am involved in the importation of diagnostic machines, reagents and other consumables. The costs of these items have tripled. “Patients patronage is going down and it is not that they no longer need laboratory services but many can no longer pay.”
The former Public Relations Officer at AMLSN, Lagos State Chapter, lamented that the hike in electricity tariff has not helped health facilities nationwide. “If you go to a lab, there are equipment and reagents that cannot survive without electricity. Some are cold chains and refrigerators”, Ihezue said. According to him, the costs of scans and x-rays have also hit the rooftop. The expert advised Nigerians to take their hygiene seriously despite the situation, adding that there was a need for government to come up with policies that would bring down the exchange rate. Also speaking to Sunday Vanguard, the first Vice President, of the Nigerian Medical Association (NMA), Dr. Benjamin Olowojebutu, urged government to take immediate action to address the crisis. According to Olowojebutu, the rising cost of medications, coupled with economic hardship, has made access to healthcare a luxury for many Nigerians.
“The cost of medicines has gone up and has caused more morbidity”, he said. “We need to start testing what we call generics and the doctors have started doing that.” Advocating for increased investment in local pharmaceutical production and the strengthening of the national health insurance system, Olowojebutu emphasised the need for government intervention to ensure that healthcare remains accessible to all citizens. “Access to healthcare and funding has reduced”, the NMA official said. “We are glad that government has started talking about the National Health Insurance Authority that has given everybody in Nigeria access to insurance. “If we strengthen insurance in healthcare, it will help access the pool of funds for other people to get access to healthcare in our country.
“We hope that this inflation, the economic challenge will be resolved very soon. “There are cases where patients can no longer pay their bills. “Like people on high blood pressure medicine, it’s not palatable because the average people that have this problem can’t see doctors again because of lack of funding.
“For example, somebody who earns N50, 000 and his drugs per month cost about N25, 000 for hypertension, he won’t take it regularly.
“There’ll be loss of lives, there’ll be a lack of manpower, and the economy and economic power of the nation and GDP will reduce”. Olowojebutu posited that local drug manufacturing should be driven by government. He said: “Right now, the occupancy rate of big hospitals is even decreasing. People don’t go to hospital anymore, instead they go to pharmacists. They go to herbal homes and it’s causing more morbidity.” According to him, to support government, the NMA was working to adopt one primary healthcare centre in each of the geopolitical zones in Nigeria to offer free services to patients. “It is our CSR to cushion the effects on sick Nigerians”, the NMA official stressed.
