Illicit fees common in Abuja hospitals — Report

National Hospital, Abuja
National Hospital, Abuja

Illegal fees and transactions are amongst the most popular forms of corruption in public hospitals in Abuja, a survey has found, describing the trend as the lubricant that helps ease access to care.

The recently released researched by Tap Initiative for Citizens Development in collaboration with Dataphyte found that health administrators in hospitals in the Federal Capital Territory (FCT) collect payments for services that are ordinarily meant to be free as well as tips for special favours from patients who are trying to speed up access to care.

The research listed the illegal transactions to include payments for bed space, consultancy fee, laboratory fees and tips for the “movement of files”.

Payments for such services are considered illegal because they are meant to be free and or are made mostly without issuance of receipts, the survey found.

It also identified what was driving the corrupt practices in health facilities and offered ideas on how to address them.

But health authorities in the FCT kicked against the findings of the survey, describing it as a false representation of the actual state of things at public hospitals in Abuja.

The Survey

The study was conducted among 300 randomly selected adult residents in the six local councils of the FCT.

An average of 50 respondents were selected in each of the area councils. The respondents are outpatients who had accessed care within two months prior to the survey.

They are old residents with outpatient cards for more than three years receiving care in public hospitals in Abuja.

Their responses were reviewed by health workers and tested on a small sample for reliability, according to the survey.

The research was focused on investigating how the four components of access to healthcare: coverage, services, timeliness, and the workforce are affected by corruption.

Survey questions focused on uncovering what extent patients tip healthcare workers to access health care services and whether patients are deprived of health services due to corrupt officials in the healthcare facilities among others.

According to the result of the survey released on May 10, none of the respondents indicated they have been deprived of healthcare for not paying financial tips.

But they said since most of the other patients “that paid the tips are usually attended to first”, the time it takes them (respondents) to access the facilities has increased.

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The study found that in 449 transactions involving the services of paying for bed space, consultancy fee, HIV fee, tuberculosis fee, Hepatitis fee, and movement of files, receipts were barely issued.

Almost half of the respondents, 134, attested to paying for consultation fees between N200 to N21,000. About 76 per cent of the times these payments were made, there were no records kept or a receipt to serve as payment evidence.

On 120 occasions, such payment was made to the cashier in cash while it was paid to a doctor and a nurse on eight and two occasions.

Nine respondents attested they paid N500 in cash for HIV fees. Six of them confirmed they were not issued a receipt for this payment.

Nine persons also paid between N200 to N2000 for the treatment of tuberculosis with a receipt issued to only seven of them.

Similarly, 35 respondents paid for hepatitis treatment with only 14 of them issued a receipt; 21 of them were not issued any receipt.

The study also revealed that often, patients are denied access to health care facilities due to the unavailability of adequate healthcare facilities especially doctors, bed space, and drugs.

In summary, the majority of the respondents were unable to access healthcare timely because most of the healthcare centres they visited lacked the facilities to treat the health condition of the patient.

Respondents, however, did not mention the name of the facility or the health official they engaged with in the survey.

Kickbacks?

“It is not true. The findings of the survey are inaccurate,” said Francis Alu, the Director of Clinical and Diagnostic Services of the FCTA.

Mr Alu said the researchers did not gather enough data and interviews to arrive at the findings. “You cannot interview only a few people and come out with such finding. What they found is not true,” he explained.

However, Roland Aigbovo, the president of the Association of Resident Doctors (ARD), Abuja chapter alluded to the possibility of recurring corrupt practices in public health facilities in the FCT.

He, however, said the bulk of the blame should not be pushed on health officials, maintaining that patients in most cases initiate the illegal transactions.

Mr Aigbovo also agreed with the researchers on the existence of corruption in the health sector when presented with findings of this survey.

He downplayed the prevalence of such practices, dismissing them as a “mutual transaction between health officers and patients”.

“In all public hospitals in the FCT, there are bold inscriptions on the walls that any payment should be made at designated areas and patients should request for receipts”, he said. “Yes, there are one or two sharp practices but most times those sharp practices are negotiations between any of the doctor or healthcare worker and the patients paying the fee”.

On bed space fee, Mr Aigbovo said the scarcity of bed spaces in many hospitals in the FCT has made it difficult for patients, even those that need emergency treatment get a space. He disagreed that patients are made to pay for beds, “unless they are paying for V.I.P slots”.

The ARD chief noted that HIV and tuberculosis treatments are free and should not be paid for. “Anybody paying for such treatments should come forward with details of where it happened so we can take action”.

On the movement of files, the medical doctor said the illegal transaction is between record keepers and the patients.

Not true

But Martins Obono, the Executive Director, Tap Initiative disagreed with the officials, especially the union leader, insisting that the onus lies on the health official to ensure no illegal transactions occur by refusing such offer from a patient.

The fact that a patient initiated an illegal transaction does not exonerate health officials from blame, he argued.

“A person who has a health challenge is already desperate and can do anything”, he said. “It is the duty of a health official to avoid, reject, and refuse any illegal payment and advice patients to do the right thing”, he explained.

“But instead, health officials are taking advantage of the vulnerabilities of patients. In some of these public hospitals, administrators intentionally create a lot of bottlenecks that will make these illicit payments inevitable. They also collude within themselves to upturn things.”

Recommendations

The study recommended that the federal ministry of health, the national primary health care development agency (NHPCDA) and chief medical directors of various health facilities should base on the findings of the survey, issue appropriate sanctions and disciplinary actions to healthcare workers that enforce patients to make irregular payments before they access health care facilities.

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“This study also recommends that the federal Ministry of Health in collaboration with the media should encourage extensive sensitization of citizens of their right to report any fraudulent or unruly behavior of health workers in their course of accessing health care facilities,” the report noted.

Mr Aigbovo said the major solution for corruption in hospitals is for patients to “stop initiating illegal financial transactions with health officials”.

“Patients should demand receipts too in order to help us. They should do the right thing.”

For Abiodun Essiet, a public health expert, the findings of the survey calls for further probe into such activities in the public health space.

“Even when you bring emergency cases such as rape, some hospitals will not treat the patient until payments are made for card and other things”, she explained.

Knotty problem

Besides illegal financial tips, several sharp practices occur in Nigeria’s health facilities.

A PREMIUM TIMES investigation last June found how a network of corrupt officials of different cadres perfected means of issuing all sorts of reports to willing patients at negotiated prices in Lagos.

The Nigerian Medical Association (NMA), considered the largest medical association in the West African sub-region with over 40,000 members, has laid down ethical guidelines on how to check medical malpractices.



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