The Burden Of Healthcare On Vulnerable Populations And The Duties Of The Nigerian Government
By M.O. Hussein
About two months ago, I had a discussion with Aisha, a nurse who works in the Intensive Care Unit of a public hospital in Abuja. Her disclosures about the plight of critically ill Nigerians were deeply disturbing.
She told me that at that stage of medical care, patients are often required to deposit not less than ₦450,000 before they can be admitted or before treatment can commence.
Then, daily each patient will pay a fee of ₦150,000. This does not include tests, drugs or operation costs. Those ones run into millions of Naira.
My thoughts immediately ran wild. How many Nigerians can readily produce between ₦5 million and ₦10 million simply to begin treatment?
Aisha told me that a significant number of patients; perhaps as many as 80 per cent, are unable to cope with such costs. They simply pack their bags and leave the hospital premises, knowing they have nowhere else to turn. In many cases, they return home only to die. What a tragedy!
Generally, we never fully appreciate the ordeals of seriously ill people until a close relative or friend is caught in such circumstances and we experience the anguish firsthand.
Recently, a friend developed a severe kidney condition. He was required to raise about ₦5 million for medical tests in a government hospital in preparation for surgery. Before the operation could be performed, however, the hospital demanded a deposit of another ₦9 million for the surgery.
I witnessed the desperate, rather frustrating efforts of family members and friends as they struggled to raise the required amount.
While the painful search for the money continued, our friend died.
Perhaps the operation could have saved his life. Perhaps it could not. But he never had the opportunity because the money could not be found.
We buried him last Saturday.
What, then, is the government’s responsibility in all this? Shouldn’t the government be deeply concerned about the plight of its most vulnerable citizens, especially when their lives depend on access to healthcare?
The constitutional principle that the primary purpose of government is the security and welfare of the people surely includes their healthcare. Yet, when the majority of citizens are forced to leave public hospitals because they cannot afford the cost of tests, medicines or life-saving operations, it is difficult to avoid one painful conclusion: the government has failed in one of its most fundamental responsibilities.
Is this the reality faced by poor citizens in every country of the world?
The answer is no.
Many countries have developed systems that ensure people who cannot afford medical treatment still receive essential care.
In Germany, nearly everyone is covered by compulsory health insurance. People on low incomes receive government support, ensuring that inability to pay does not usually prevent access to essential healthcare.
In Australia, citizens and permanent residents benefit from the publicly funded Medicare system.
Sweden, Norway, Denmark, Finland and the other Nordic countries finance healthcare primarily through taxation, allowing residents to receive most essential health services at little or no direct cost.
In Brazil, healthcare is provided free of charge through the Sistema Único de Saúde (SUS), covering consultations, hospital treatment and many essential medicines.
Rwanda, despite being a lower-income country, has established a community-based health insurance scheme that has significantly expanded access to healthcare. The poorest households receive government subsidies, ensuring that poverty is not an automatic death sentence.
Muammar Gaddafi’s Libya provided free treatment for all Libyan citizens. In cases where specialised treatment was unavailable in Libya, the government sponsored patients to receive treatment abroad, covering all the costs, most of the time.
Saudi Arabia has one of the largest publicly funded healthcare systems in the Middle East. For Saudi citizens, healthcare in government hospitals is generally free while emergency care is available regardless of ability to pay. The government finances treatment from oil revenues and taxation. When specialised treatment is unavailable locally, eligible patients may be referred abroad at government expense.
The situation of relief is the same in the United Arab Emirate, Qatar, Kuwait, Oman, Bahrain and Jordan.
Across Africa, healthcare systems vary widely. However, many countries have adopted policies to ensure that poverty does not deny access to essential medical care.
South Africa, for instance has one of Africa’s most developed public healthcare systems. The government provides free primary healthcare at public clinics for all citizens. There is free maternal and child healthcare in public facilities. In public hospitals, patients pay according to their income. Those who are unemployed or extremely poor often pay little or nothing.
In Ghana, vulnerable groups, such as children, the elderly, pregnant women and many indigent citizens enjoy free or heavily subsidised coverage.
Mauritius operates a tax-funded universal healthcare system. Citizens receive free consultations, free hospital care, free surgery in public hospitals and many medicines without charge.
Whether in South Africa, Ghana, Rwanda or Mauritius, the guiding principle is essentially the same: no citizen should be denied essential healthcare solely because they are poor.
What, then, is Nigeria lacking? Is it community participation? Is it the professionals capable of designing a truly universal health insurance programme? Or is it the political will to prioritise the lives of ordinary Nigerians despite the enormous oil revenues being generated daily and taxes the citizens already pay?
In a country where billions of dollars and trillions of naira have reportedly been stolen or misappropriated over the years by single individuals, it is morally indefensible that millions of poor citizens continue to die from treatable medical conditions simply because they cannot afford basic healthcare.
Despite the failures of some public officials, Nigeria still has men and women of integrity who are capable of managing public resources responsibly and implementing reforms that genuinely serve the people.
The government at every level bears a solemn responsibility to lift the crushing burden of healthcare from the shoulders of poor and ordinary Nigerians. Failure to do so carries not only political consequences but also a profound moral burden. Those entrusted with public authority will one day have to answer for how faithfully they discharged that sacred duty.
M.O. Hussein is a writer and public affairs commentator based in Abuja, Nigeria.