Nigeria Lagos states healthcare ‘mission impossible’
The Nigerian government is constantly criticised by citizens for its lack of action in fixing the country’s healthcare system. Millions do not have access to adequate healthcare, with public hospitals at substandard levels and private healthcare too expensive for most to afford in a country with a high poverty rate.
However, Nigeria was widely commended for its fast response to Ebola, which stopped the deadly disease from becoming widespread across the country.
The coronavirus pandemic has brought healthcare problems to light again, with angry citizens taking to social media to suggest that government officials who contract the virus should stay in their own states and be treated by the public healthcare systems they have refused to fix.
Dr Ade Alakija is the chairman of the Lagos State Health Management Agency (LASHMA), a board tasked with ensuring the success of the Lagos State Health Scheme launched in December 2018.
Alakija spoke to The Africa Report at the beginning of this month. Presented here is a transcript, with light editing for clarity.
TAR: When did you become chairman?
Ade Alakija: I was appointed on 17 January, but my official letter came on 22 February.
The Lagos State Health Scheme was launched over a year ago now. It is described as a mandatory health insurance scheme. What does this mean? What does that involve?
The Lagos State Health Scheme is a scheme proposed by the Lagos State government to ensure that all Lagosians are registered with the Lagos State Residents Registration Agency (LASSRA) so they can get compulsory health insurance.
The aim is to ensure that all Lagosians are covered by a basic health scheme.
The population of Lagos is estimated to be around 23 million. If accurate data on the number of residents does not exist, how did the government think it would be possible to “bring quality health to all residents”?
The government is trying to make the scheme mandatory and so laws will be passed to that effect.
It is a national health insurance scheme, so we must all follow the federal government’s proposals, but Lagos State will have its own unique way of implementing it.
We have to convince people to key into the programme. To do this, we will need to have meetings with the governor and other key stakeholders such as businesses, multinationals, banks, civil society, the Nigeria Employers’ Consultative Association, and other such groups. We must convince them to get onto the plan.
Although we are to make it mandatory, we know Nigerians are sceptical. So they will still need persuading.
Ideally, businesses will register to the scheme. Most have some sort of insurance, and the aim is to key into that pre-existing insurance.
The basic insurance for the state will cost N8,500 ($21.9) per person, and N40,000 per household, annually.
Once all these stakeholders key into the scheme, they will pay into the fund, which guarantees everybody healthcare in the state. For those who want additional insurance, for example for surgery, and other such procedures outside basic healthcare, a premium kicks in.
The 2017 statistics from the Healthcare Facilities Monitoring and Accreditation Agency show that Lagos has 26 registered general hospitals, 256 public healthcare centres, 2,886 private hospitals/specialist clinics/labs/diagnostic centres, and 160 tradomedical centres. However, I was unable to find data on how many doctors are in the state, are there enough?
For the number of people in Lagos, we have a moderate number of doctors and healthcare centres. The real problem is the quality of the facilities.
This programme aims to merge both the public and private sector. The public sector has a lot of hospitals and community healthcare centres, but they are not well stocked, not well managed and they have staff shortages. Many are run down.
The government wants to create a standard model where all of the hospitals and healthcare centres will be worked on and refurbished, and some demolished and rebuilt, to build them up to a minimum standard.
The aim is that everybody should be able to use the healthcare centre in their locality and also be able to use private facilities around. So healthcare is closer home to citizens.
LASHMA aims to be able to fund this scheme adequately, so people will be confident that they will get adequate care when they go to these hospitals.
How many people have this health insurance now?
Right now, there are about 300,000 people registered, but only about 15,000 are actually benefiting from it.
The scheme started in mid-2019, but it has not really taken off. The board was just formed early this year, but the coronavirus pandemic has frozen a lot of things.
The aim is to register up to 2.5 million people by the end of this year. So there will be two million or more people benefiting from the program.
I call this a ‘mission impossible’ that has to be made possible.
How is awareness of this scheme spread?
There are two ways. The government says that every resident must register with LASRRA before they can benefit. If you do not, you cannot [benefit]. There will be penalties if you fail to register, but I cannot discuss those at this time.
It is an authoritarian/punitive style of bringing people on board.
But we are also human beings, so we will use the persuasive style.
We will try to convince people to come on board by showing them the benefits both for them and for the state. The scheme will benefit the providers (doctors), intermediaries and the users (patients that are clients of the scheme).
We will use radio jingles, go on television and lean on the government. Hopefully, after the coronavirus pandemic, the governor will lead a charge to increase public awareness.
Once people trust it, there will be no problem, but we have to first get people to trust it and buy into it.
What do you think about Lagos State’s response to COVID-19?
Lagos State has done a perfect job. Based on the resources we have here, I will score Lagos State top marks. I could not have done it any better.
Perhaps they should have instructed people to wear masks earlier, but there is a shortage of masks and so they had to be left for medical people. As more masks are produced, they can become available for the general population. However, for now, only those who might be at risk should wear them – doctors and those who think they might have the virus.
Apart from that, Lagos has done a perfect job, under the circumstances of what we have on ground.
Do you believe the number of cases reflects the reality?
It is a possibility that they do not, but testing kits are not easy to come by, and the results take about two days.
Then again, with the aggressive stance Lagos State has taken – the search and find, tracing all people that have come into contact with the infected, and the isolation and watching – it has probably been working quite well, although a few might have slipped through.
If they say we have 174 cases, the number could be double or triple that, but we do not know.
If people had been honest and adhered to state instructions to isolate, we would have been fully under control. However, some refused – from the top members of the government, to ordinary citizens. Some people insisted that they did not have it and ended up spreading it, which made things a bit more complex. But Lagos State has done a good job.
Do you know the whereabouts of the supplies sent by Chinese billionaire Jack Ma?
As I am not on the first line of action, I am totally blank on that. I might be called to the first line as the need rises, but I pray that does not happen.
Does Lagos have enough healthcare workers to stop the virus if it spreads?
Absolutely no way. That is why we started the fight early. I urge citizens to practise social distancing even at home and stay at home! Then we will beat this thing. We don’t want it in the camps and slums, in places like Mushin and Ajegunle, as that will be a horrible situation.
For now, let’s not have these kind of hypotheses. We don’t want to go down that line. People should stay at home for the next two weeks to one month, then things will be okay.
Thank you for your time!
I want to say one final thing: This is a wake-up call for us in Nigeria. We have seen medicine and healthcare neglected.
The World Health Organisation says that a minimum of 10% of a country’s GDP should be spent on health. However, over the years, the federal and state governments have been horrible at funding this sector.
Lagos State perhaps spent 3% on health in the last few years, but out of that, only 50% is actually dispersed. The current government is trying to raise it to 10%, and they are well on their way to that, and hopefully all will be dispersed.
Coronavirus has shown us that we need healthcare. You can be the richest man, but you will be the richest dead man without sufficient healthcare.
Health is wealth. People do not understand what that means, but they need to understand it better. For me, even if you are the richest man in the world, you can have one condition that finishes all your money. Bad health situations can turn millionaires into paupers and affect the whole family.
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If one has health insurance, and health is well funded, all of us are less likely to go down that path.
I appeal to all Nigerians to realise that health is the best way forward. We need to teach people how to get healthy and avoid diseases, especially social diseases such as diabetes and hypertension, which can be avoided by improving lifestyles.