A gazelle has to run twice as faster as any lion to survive and a lion has to double its pace to out run a gazelle if it wants to feed. This is the basic law of survival in the food chain. Keep this in mind as I take you through my observations as I visited this prestigious hospital, named after one of the country’s greatest leader. One would be strike by the fancy new structure elected here and there. Inside it were very hard working staff, busy with routine of which the primary assignment is to save life, prevent an occurrence of disease and promote recovery.
I was disgusted at the sight and it tingled my ear. A doctor told a mother of a new born baby that if she doesn’t pay for a pint of blood which cost about four to eleven thousand naira her baby would die. A new born baby rushed from Afikpo to Abakaliki would die because the mother had no money. Her husband is on the way to Abakaliki for the singular reason of saving his first child.
The next one is a man who came all the way from Taraba state to be treated of diabetes. The man came bearing in mind that his brothers who are medical doctors would take care of him. On getting to AE-FETHA, the staff on call ignored the man despites the signs. The sister of the man came all the way from Onitsha to look after her brother. She nearly fought with the doctor on duty. The demand were that certain amount must be paid before a dying man, a diabetic patient was to be treated. The sister called her brothers, narrating the situation over there, blaming her brothers if the patient was to die. The doctors, one who was representing WHO in Abakaliki told her to put a cube of sugar in the man’s mouth which she did and revived the man. When the doctor eventually came, hell broke loss, apologies became much, threats of losing jobs abounded. But this was needless, now the diabetic patient had a sister and brothers that could rescue him what of the new born who had nobody but trusted in the efficiency of inadequate public service. These are for people that were not insured by NHIS, how public medical system treats them.
The NHIS system is one of the best idea in this country but unfortunately the hospitals are ripping the system off, systematically. It simple, they can’t turn down an insured patient but when it comes to drug prescription. They simply tell the patient that they don’t have the drugs. While the patient fumed and curse for this and eventually goes outside to buy the drug. It turned out that it’s expensive. The hospital would now include drugs that they didn’t offer to the insured patients in the costing of the patient’s bill.
What they inadvertently or systematically doing is making insured patients bear some of the cost with NHIS despite that such drugs were covered by the scheme. Before you say something, you know they are drugs covered by NHIS and others that are not. They are others that are partially covered too. The issue is in most of these cases these drugs they claimed they don’t have is covered by NHIS. NHIS pays them monthly including the cost of services they didn’t provide in respect to drug provision. I took the liberty of discussing this with one of the HMO, then with NHIS department at Imo state teaching Hospital Orlu. IMSUTH is NHIS friendly, probably one of the few. They both confirmed that if the drugs prescribed were not available in the hospital, the hospital should give the patient the money to purchase the drugs. This is what is on paper but never in practice. No hospital does that.
My suggested solution to this is simple: NHIS should liaise with pharmaceutical company or stores retailing drugs close to the hospital or close to any hospital licensed by NHIS to be supplying drugs to patients insured under NHIS. The NHIS unit of hospital should issue clearance which the patient would use to get drugs the hospital doesn’t have. If it’s on weekend the chief or examining doctor should give a written authority to the patient who goes and pick the drug from the pharmacy. This would be documented by the pharmacy and NHIS pays him the same way they pay the hospitals. Nine out of ten patients insured by NHIS in AE-FETHA buys their drugs outside while the hospital pockets the money from the drug prescription claim.
In fact the more pharmacy stores licensed by NHIS the better. HMOs would then have a modality for their users to access drugs from outside pharmacy stores that actually have those drugs instead of from hospitals that rarely do. This would break the monopoly most hospitals have on drug prescriptions and in fact, it would force them to starts doing the right thing.
Still on AE-FETHA, I saw some of the places their doctors and nurses were sleeping in between work and it was nice, including the places for post natal mothers on VIP at the complex. Besides these, the post natal general ward, waiting mother whose newborn are getting treatment is terrible, smells like where urine and feces were dumped and left for days. It’s possible that sometimes a patients leaves the hospital happy that he or she is recovering from treated illness only to go home having contracted an unknown ailment. The toilets and bathroom is too unhealthy for mothers, not to talk of the distance they had to go to fetch water to take their bath or flush toilets.
Finally at the complex I saw a giant rat running from floor to floor, from one unit to the other and here is a state that Lassa fever was reported to have killed before. And of all places a national hospital. Not to talk of the post natal ward which is a breeding ground for mosquitos and giant rats. None of the mothers or their babies had mosquito treated net except those who brought one from their homes.
So our hospitals are they here to generate revenue or cure patient first. The answer would be both but priority would be given to the second. It is the reason government established this in the first place. We are crying about infant and maternal mortality and here were are….struggling to adequately align to sustainable development goal having failed in the MDG’s.
Another rip off they do is gate pass fee for patients from newborn ward. The fee is up to a thousand two hundred naira. And they issue the patient who is already a victim of malpractice a receipt to suggest legality. NHIS patients cried foul play and they told them it is equipment maintenance fee. So is this money going to government account or to the bank account of the CMD whom they said is aware of this. So patients are now maintaining equipment for AE-FETHA. What is government allocation, over heads and imprest they receive for?
What about the compulsory meal that looks like a road side meal? In fact they sell two hundred naira meal at five hundred naira to patients or post-natal mothers. Whether they eat it or not they must pay. Anyway it’s a part of generating revenue for the hospital after all a minister claimed he used billions of naira to cut glasses in IDP
Back to the drug issue my question is, is NHIS sharing the drug money with this hospital or is it just the hospital’s head? To survive, meet up with ration, offset bills some of the hospitals in Nigeria have become a lion. They are there for the pound of flesh. The gazelle being the patients has failed to out run them, in fact they needed them and it is this existential affinity that makes it even more dangerous.
Written by Igwe Ejikeme