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.

[Leadership]

The recent report by the International Rescue Committee, IRC, that an estimated 16 percent of Nigerians will face severe food insecurity and extreme hunger between June and August 2024 is a big source of concern to many Nigerians.

According to the report, the 2024 figure is higher than that of 2023- a clear indication of the increasing spate of hunger and the worsening living conditions, not only in Nigeria, but also across the West and Central Africa regions.

The report further revealed that the total number of people across West and Central Africa, who are likely to face food insecurity during the period, popularly referred to as the lean season, stands at a staggering 52 million, which is about 12 percent of the analysed population.

However, in Nigeria, the report said about 32 million people, representing about 16 percent of the country’s population, would face severe hunger, a development that is considered to be at a crisis level or emergency food insecurity.

The report said: “Looking ahead, the projected outlook for the period June-August 2024 appears even more severe.

“Nearly 52 million people across the 17 analysed countries are anticipated to face phases three to five during the lean season of June-August. This translates to 12 percent of the analysed population struggling to meet their basic food and nutrition requirements.

“These countries include Mauritania (656 652, 14 percent), Burkina Faso (2 734 196, 12 percent), Niger (3 436,892, 13 percent), Chad (3,364,453, 20 percent), Sierra Leone (1,569,895, 20 percent), and Nigeria (31,758,164, 16 percent).”

The report went further to state that the situation would be more severe in the northern states of Sokoto and Zamfara, where the IRC analysis described the situation as critical, with over 15 percent of the children in the states experiencing acute malnutrition.

According to the report, the major contributory factors to the severe food insecurity across the Sahel region include insecurity, climate change, and worsening macroeconomic conditions, especially on the inflationary front.

DAILY POST recalls that in January 2024, the average inflation rate in the region stood at 21 percent, which is an increase from the 18 percent that was recorded in the same period in 2023.

Earlier in the year, the World Bank, in its food security report for Nigeria, projected that seven states in the North would face severe food security problems with the spate of food inflation and insecurity across the food-producing states.

While the Boko Haram insurgency greatly affected food production in the North East, leading to the destruction of farmlands, the farmer-herder crisis and banditry have significantly affected food production across the North West and North Central regions of Nigeria.

Reports show that insecurity, coupled with disruptions in global food supply chains has pushed food inflation in Nigeria to about 40.01 percent in March.

Nigeria has an estimated population of over 200 million people, making it the most populous country in Africa, and the sixth in the world. It is also believed to be the 10th largest producer of oil in the world, but ironically, about 84 million Nigerians, representing about 37 percent of the population live below poverty line, according to the World Food Programme, WFP, report.

The WFP also agreed with the IRC report that insurgent activities in the north, have added to a fragile resource environment, deepened insecurity, hampered development and heightened the food and nutrition insecurity of vulnerable women and children

However, with the recent report, Nigerians have expressed fear that the prediction might come to pass.

Some observers, however, agreed that Sokoto and Zamfara states may not be the worst hit states when the time comes, looking at the level of havoc that kidnappers and militant herdsmen are wreaking in the North central states of Nigeria.

They, however, called on the government to sit up and ensure that Nigerians were not thrown into such a precarious situation.

One of those urging the government to take decisive action against banditry, kidnapping and all forms of criminalities is the president of the Middle Belt Forum, MBF, Dr. Pogu Bitrus.

He believes that only the government has the powers to prevent the IRC’s projection from manifesting, by tackling insecurity headlong.

He emphasised that Nigeria does not need any international body to give her the report of an impending hunger between June and August because the reality is staring everybody in the face.

“We know it is a reality because banditry has reached a stage where farmers can’t go to farm, and if farmers can’t go to farm, naturally, there won’t be food to eat.

“Besides, that time is a period when crops like maize are expected to mature, and if there is no maize to complement or supplement whatever that is out there, then there will be trouble, and hunger will definitely set in, unless the government rises up and does something to address the insecurity situation.

“So, their report is in order because it is in line with what is on ground. Unfortunately, it will not be worse in only Sokoto and Zamfara as the report stated, because there are so many other areas where bandits do not allow farmers to go to farm.

“And in such situations, you will agree with me that there will be a devastating hunger unless the government takes a proactive action to address the issue of banditry, so that farmers can return to farm in peace,” he told DAILY POST.

Also aligning with the IRC’s report is a former lawmaker in the Katsina State House of Assembly, Hon Yusuf Shehu.

He believes that traditionally, the people in Zamfara, Sokoto and Katsina axis experience shortage of food between June and August every year but lamented that the insecurity in those areas would worsen the situation this year.

The ex-lawmaker told DAILY POST that, “Ordinarily, Zamfara, Katsina, Sokoto and other states on that axis receive their first rains around May/June; so it is the beginning of the harvesting season.

“And every year, we, in the north, normally experience food shortage around June/July because most people would have brought out the remaining food in stock at that period to plant for the next season. And there is nothing more for the peasant farmers to do than to go to farm during the period.

“Now, considering the insecurity situation in the country today, where bandits and kidnappers are riding roughshod on the people, coupled with the high cost of living, obviously, there will be acute food shortage.

“The period is the beginning of the harvesting season and the bandits and kidnappers don’t allow people to go to farm; so what do you expect? Added to that is the removal of fuel subsidy which has heightened the cost of living.

“So, for me, I think the report is a wake-up call to the government to take steps in advance so that unavoidable deaths that could result from known calamity could be avoided.

“It is for the government to take the war to the bandits and kidnappers, clear them from our forests and bushes, and allow the farmers to go back to the farm.

“That is the only way to avert the IRC’s prediction, otherwise the percentage of Nigerians that would face severe hunger during the period could even be far more than the predicted 16 percent,” he stated.

A lawyer and public affairs commentator, Nnamani C.I, said there was no hard and fast rule to making food available, apart from creating an enabling environment for farmers to do their farm work without fear of being attacked, kidnapped or even killed.

He stressed that it would be a surprise and one of the greatest miracles of the century if, between June and July, Nigerians don’t experience a biting food crisis.

The lawyer said bandits and kidnappers had taken over the farms and forests, forcing the farmers to stay permanently at home.

“It is when farmers go to farm that they can produce. A situation where bandits, kidnappers, herdsmen and Boko Haram Islamist insurgents have driven farmers away from the farm, without any reaction from any quarter, what do you expect? Do you expect manna to fall from heaven in this 21 century? No, that won’t happen.

“The report by the IRC is just stating the obvious. We know that we are in big trouble. And unless the government takes the report seriously and rises to its responsibility, Nigeria may experience civil unrest of unprecedented proportions, and it will start from the north.

“There is a saying that a hungry man is an angry man; and an angry man is violent, while a violent man is an unreasonable man that is capable of doing anything, should not be disputed by any reasonable human.

“The report has just warned the government of a danger lurking around the corner. And I believe the government will not just fold its arms and allow the prediction to come to reality.

“I expect the government to declare a total war against those enemies of the state, rout them out once and for all and allow the farmers to return to farm in peace.

“That way, what the IRC said in its report may not be as adverse as it would have been, but if the government fails to act, the prediction might just be a child’s play to the kind of hunger that will envelop the country, particularly those on the fringes of Sahel during the period,” he told DAILY POST.

[DailyPost]