…Say it is fuelling maternal mortality rates

By Chioma Obinna

Lagos is one of the states  where free health services are considered priority for women and children, according to the homepage of the website of the State Ministry of Economic Planning and Budget, where health care is 5th on the list.

There, it is stated that the State government will provide free healthcare including free pre-natal and ante-natal care for pregnant women.  But the idea of free health services for this vulnerable group may be just on paper as findings show that women are currently paying through their nose to get ante natal services.

Pregnant women.

Public health facilities

Findings at various public health facilities visited in Lagos revealed that the cost of delivery is out of the reach of the poor and middle class who seek the services.

One striking thing is that the charges in these hospitals are not uniform even though they are all run by the Lagos State Ministry of Health.  The policy of compulsory blood donation is also a source of worry.

At the General Hospitals in Isolo, Shomolu, Gbagada, Igando, to the  Amuwo Odofin Maternity and Child Centre, the story is the same.  Pregnant women are complaining of high cost of ante- natal and delivery services.

An encounter with Basirat, who patronises one of the public health institutions, was instructive. She was by the entrance of the Mother & Child Centre, Isolo General Hospital when Good Health Weekly encountered her. Obviously, she wasn’t in a good frame of mind and attempts to cheer her up failed.

Donate blood or pay N10,000: A mild drama ensued after her phone rang and she screamed  at the caller. “Stop calling me.  I have told you everything they said we should do.  Leave me alone!”

When she calmed down, Basirat, a petty hawker popularly known as Alaate  in Yoruba language recounted her ordeal.

“ I came for ante-natal but I was asked to bring my husband to donate blood or pay N10, 000.  I have been speaking to his relations to arrange someone since the hospital explained to us that all they need is blood but no one is doing anything,” she said amidst tears.

Price list at Isolo General Hospital, Lagos.

Basirat, who was about seven months pregnant, said she was asked to pay N12, 500 for registration and that her husband should donate a pint of blood, or pay N10, 000 for the blood.

“I cannot afford these charges. All they care about is collecting blood. Many women whose husbands are not around and the unmmarried ladies usually bring their brothers or pay people to donate blood.

“My husband lives in Kano.  I just called him now and he said he cannot come to Lagos to donate blood.  I was booked today. I have called my sister-in-law but she said with the situation of the country, people are not eating well; that she would rather look for money to pay for the blood rather than bring somebody whose health status cannot be guaranteed.

“Right now, the challenge is to raise this N10, 000 plus the booking fee of N20, 800.  I have paid the initial fee of N12, 500.”

A number of women are  convinced that  government hospitals are more expensive now.

According to Philomena, another pregnant woman:“Some private hospitals will not charge as high as this.   The only thing you benefit from all these charges is that you pay gradually until you deliver but the total sum put together is over N60, 000 excluding the money for your drugs and other laboratory tests.

“If you undergo Caesarean Section, CS, it will amount to over N100, 000. That’s too much for most of us.   Not everyone can afford it.  Just last week, my neighbour who was meant to register here decided to patronise a nurse close to my house.   She said she could not afford to pay all the fees.

“I came all the way from Ikotun to Isolo because the belief is that deliveries are better handled.  That is why you see many of us here,” she observed.

Exhorbitant charges: Women attending the Isolo Primary Health Centre, PHC, for immunisation appointments, told Good Health Weekly about the high charges.

It was gathered that in 2015, registration for antenatal care at the Isolo General Hospital was N3,500 including compulsory donation of a pint of blood by their spouses.

The second payment, usually referred as “booking”, was N9, 000 and safe delivery was N25, 500 respectively.  “Those who gave birth through CS also paid N56, 000 or more, but this year the story has changed as the fees have been raised,” it was gathered.

Another expectant mother at Igando General Hospital, Olamide, corroborated the complaints of excessive and multiple charges.

She said sometimes patients were charged differentially. Some pay N16,200, others  N16, 700 or more for registration.

She hinted that the hospital management claimed that the registration fee which is part of the first instalment would cover the delivery pack, laboratory investigation, scan and notification of birth, while the second payment of another N16, 500 wiould cover items such as underlay, admission gown, baby olive oil, bed pampers, sanitary pad, pharmacy pack etc.

“After delivery, the patient is expected to pay another N16, 500 for normal delivery excluding other little charges. If you deliver through  CS, you are expected to pay N66, 500.”

According to Yusuf whose wife just put to bed through CS last week,  the high cost of services was unexpected in a government hospital.

“I had already deposited N50, 000  and was going to pay a balance of N70, 000 before my wife would be discharged. One thing I will tell you is that the services here are commendable but costly. Nothing is free. Yet we were told that most  services are free in General Hospitals but the  contrary is the reality. The charges are high.”

Disparity incharges

The situation  at Gbagada General Hospital, was no different. Findings revealed that  registration is N5, 000 with compulsory blood donation by the spouse, normal delivery N38, 000 while the CS is N44, 000 only.

At Amuwo Odofin Maternity and Child Centre, registration fee is N23, 000 with compulsory blood donation from the spouse; normal delivery is N28, 500 and CS N74, 500.

At the Isolo General Hospital, registration is N12, 500 including compulsory blood donation by the spouse; booking is N20, 800; normal delivery N15, 000, CS N58, 200 and admission for other clinics is N12, 850.

At Igando General Hospital, the registration fee ranges from N16, 200 -N16, 700 with compulsory blood donation by the spouse; booking    is N16, 000, delivery: N16, 500 and Caesarean Section (CS): N66, 500.

Following the disparity in the hospital charges, one question that is on the lips of health watchers is that, what is the role of hospital service commission? How are these charges fixed?  They believed that if these prices are not fixed by the government agency who then monitors what happens in these hospitals?

Response by LASG: When contacted and fully briefed about the conflicting charges in the various hospitals, the Director, Lagos State Hospital Services, asked for details of the findings as well as the charges by each hospital. He declined to comment and referred enquiries to the State Commissioner for health.

“I have ordered each of the Chief Medical Directors to send in their charges.  With regards to the policy on free health, that is the Ministry of Health’s responsibility. You may wish to call the Permanent Secretary or the Commissioner for Health,” he responded.

But the Commissioner could not be reached. Messages sent to his phone lines were not replied.

Good Health Weekly went back to the Director  but he said, as a civil servant, he wasn’t cleared to comment.   “I’m still waiting for the Commissioner’s approval. Please give me a few more minutes and also send another text or call the Commissioner again,” he replied.

Maternal mortality

in Lagos:  The maternal, perinatal and under five health indices for Lagos State, though improved over previous years, are far from cheering.

Data from the 2013 National Demographic Survey, show that the Maternal Mortality Ratio, MMR, of 576/100,000 live births is higher than national average 243 per 100,000 live births.

At a recent meeting of the National Centre for Women Development, NCWD,  the Acting Director, Sadeeq Omar  said  while it is difficult to collect data in Nigeria because most significant births and deaths occurred at home or outside health centres, a lot of factors still hinder women from accessing care.

“The barriers to accessing quality maternal health services are created by many factors including poverty, women’s limited access to education and income, nutritional problems and poor or non-existent transport, road and communications infrastructure in conflict or post- conflict situations.”

Although there has been progress, the pace still remains too slow.

Lagos State has one of the unacceptably high maternal mortality ratios in the country.

More than half of deliveries still take place at home without the support of certified medical professionals due to poor access to care, cost of hospital services and age long customs and confidence in Traditional Birth Attendants.

Only recently, the Lagos State House of Assembly  put machinery in motion towards investigating alleged unabated maternal mortality ratio in the state, especially as caused by personnel negligence and other factors beyond medical reasons.

A case in point is a three-page petition by Women Advocates Research and Documentation Centre, WARDC  signed by Dr. Abiola Akiyode-Afolabi on poor infrastructure, ineffective health services, high user fees and cases of women who die due to alleged negligence by medical personnel.

Call on LASG: Critical observers are of the view that with the unusual increase in hospital services as regarding pre-antenatal and post natal services, there are fears that the mortality and morbidity rates for women and their babies may go up as many may opt to patronise quacks.

Hence, the Lagos State Government is urged to match its promise of free health for women and children with action.

The Sustainable Development Goal 3: Ending Preventable Maternal Mortality, stipulates that by 2030, all countries should reduce MMR by at least two thirds of their 2010 baseline level, the supplementary national target is that no country should have an MMR greater than 140/100 000 live births.

To achieve this targeted Action Plan for ending preventable deaths among newborns, it is expected  the target of 10 or less newborn deaths per 1000 live births should be attained by 2035.

To achieve these in Lagos and Nigeria at large, Prof. Oladapo Shittu, a Professor of Obstetrics & Gynaecology, Ahmadu Bello University Teaching Hospital, Zaria, stressed the need for governments to be more strategic and to double their efforts.