Emergency healthcare in Nigeria faces critical challenges due to inadequate infrastructure, limited ambulance availability, and a missing emergency fund of N26.3 billion, impacting frontline hospitals’ ability to provide essential care.
LEADERSHIP checks reveal that a N26.3 billion fund for medical emergency care cannot be tapped by most frontline hospitals confronted with patients who need it the most.
The fund, the equivalent of five percent of the Basic Health Care Provision Fund (BHCPF), is missing in action years after the National Health Act established it to cover essential medical services during emergencies.
Between 2020 and 2024, N526.9 billion was approved for the BHCPF, five per cent of which is over N26.3 billion.
This is as the cost of treating emergency cases in Nigeria has accrued to N200 billion in the past 10 years, even as the Nigerian private medical practitioners have called on the government to release the 2.5 per cent of the Basic Health Care Provision Fund (BHCPF) for emergency medical treatment.
Emergency incidents, no doubt, present a huge medical burden on the healthcare system in Nigeria. According to a 2019 Emergency Response Africa (ERA) survey, three out of four Nigerians had experienced at least one medical emergency in the last five years, with over a quarter of Nigerians having more than four emergencies.
Medical conditions (acute and chronic) and road traffic accidents contributed significantly to the number of emergencies. For instance, a total number of road traffic crashes in Q4 2022 was 3,617, indicating an increase of 6.01 per cent from the previous quarter which recorded 3,412 and a 6.16 per cent rise from 3,407 in Q4 2021, the National Bureau of Statistics (NBS) disclosed.
Statista report revealed that over 11,800 road traffic accidents were reported in Nigeria between October and December of 2021; of those, approximately 10,200 were injuries and about 1,700 were registered deaths.
A study titled: “Mortality patterns in the accident and emergency department of an urban hospital in Nigeria”, averred that some of the deaths occurred within six hours of arrival at the emergency department of a major urban hospital in Nigeria.
To reverse this trend, the former president of Nigeria, Muhammadu Buhari launched the BHCPF appropriated by the National Assembly for the first time in the 2018 budget since the National Health Act (NHAct) was enacted in 2014.
In accordance with the NHAct 2014, the BHCPF is derived from an annual grant from the federal government of Nigeria of not less than one percent of the Consolidated Revenue Fund (CRF); grants by international donor partners and funds from any other source, inclusive of the private sector.
The NHAct sets out the important drivers to guide disbursement of the BHCPF. These “Payment Gateways” are in three-fold and the Act states that 50 per cent (one half) of the Fund shall be disbursed through the National Health Insurance Scheme (NHIS) and deployed towards the provision of the Basic Minimum Package Health Scheme (BMPHS) in eligible primary or secondary health care facilities.
Forty-five per cent of the Fund is meant to be disbursed through the National Primary Health Care Development Agency (NPHCDA) and deployed to strengthening Primary Healthcare Centres (PHCs) in eligible PHC facilities for the provision of essential drugs, vaccines and consumables; provision and maintenance of facilities, equipment and transport; and development of human resources: 2.5 per cent shall be disbursed through a committee appointed by the National Council on Health (NCH) and deployed towards emergency medical treatment and 2.5 per cent goes to the Nigeria Centre for Disease Control and Prevention (NCDC).
Current contributions into the basket fund of the BHCPF includes N88,993,570,146.91of which N59,203,966,455.42 has been disbursed to states as at June 2022, (with balance of N30,120,321,166.18), according to document obtained by LEADERSHIP Weekend.
National president, Association of Nigerian Private Medical Practitioners (ANPMP) Dr. Kayode Adesola told LEADERSHIP Weekend that section 20(1) of the NHAct (2014) provides that “a health care provider, health worker or health establishment shall not refuse a person emergency medical treatment for any reason.
“Since 2014, we, the private medical practitioners, have been treating emergency cases, as stipulated by the law, without being paid a dime. From our calculation, the cost of treating emergency cases across the over 11,000 private health facilities in Nigeria, has surpassed N200 billion from 2014 till date,” Adesola revealed.
Speaking on the efforts to recoup their money, the national president said, “We know that 2.5 per cent of the BHCPF is meant for emergency medical treatment. We have confronted the National Assembly appealing to them to investigate where the money is. Private hospitals across Nigeria are receiving emergency cases, without being paid. Anybody can be a victim of any form of emergency.”
If government refuses to pay the money, Adesola posited that they will not continue this charity care forever, as they set up their clinics to make money, adding that it does not make sense if government decided to enforce the penalty for not adhering to section 20(1) of the NHAct (2014).
He called on Nigerians to appeal to the government to release the fund. “We need the senate to help us look for that money. Any of us can be a victim,” Adesola affirmed.
Country director, PharmAccess Nigeria, Njide Ndili, told LEADERSHIP Weekend at the sideline of the 2024 Medic West Africa Conference, that a lot of Nigerians are being turned away, adding that, “When you get to the hospital, in an emergency, you may be turned away. The first thing they will ask you is who is going to pay. The private hospitals don’t want to admit that, that is why they are turning people away, because they provide services and at the end of the day, nobody pays for the treatment. We need to find the 2.5 per cent of the PHCPF. Government needs to provide that fund for private hospitals to be able to fully enforce the NHAct 2024.”
The medical director, Head of Emergency Care, R-Jolad Hospital, Dr. Abiola Fasina Ayoola, explained that most of the public health engagements are focused on malaria, HIV and achieving Universal Health Coverage (UHC). However, there is need to flesh out these engagements/discussions in terms of incorporating emergency, critical and operative care, she said, adding that, “We don’t give attention to acute emergency care, yet, trauma and emergency affect almost all Nigerians, surpassing malaria, TB and HIV combined.
“For instance, road accident kills more Nigerians than anything. R-Jolad is right on the highway and we are getting young victims all the time. We are spending like N7 million in a month, with zero chance of recouping these funds. While we try to treat as many survivors that come to the hospital, we should not forget that we established the hospital to make money. We can’t give charity care 100 per cent all the time. We cannot continue this charity care for ever, without some sort of financing mechanism. To achieve equity in emergency care services, we must tackle the issue of healthcare financing. Someone has to foot the emergency bill,” she asserted.
The deputy chairman of the Senate Committee on Health, Sen. Samaila Kaila, affirmed that the health system in Nigeria is not working and as such, one should not expect a component of the system to work.
Speaking on the emergency fund, Kaila said that National Council on Health approved a committee in the ministry of health, headed by a director to administer the fund.
On the need to formulate a law to improve emergency funding, Kaila stated that there are only two medical personnel in the Senate Committee on Health, adding that it is not easy to convince the rest of the committee members when it comes to critical matters like this. He therefore called on Nigerians to take the issue of politics seriously. “If we really want to change the way we are doing things, we have to get the right people to man critical positions,” he stated.
The chief medical director of the University of Uyo Teaching Hospital, Emem Bassey, further affirmed that the 2.5 per cent for emergency treatment is with the Ministry of Health. “Sadly, the money is what is being used for the national emergency medical service and ambulance system. That is where your 2.5 per cent is. So, I am afraid it may not be given to private medical practitioners, unless they fight for it,” he stated.