Gaining access to Nigeria’s public health facilities is now like passing through the Nigerian Police checkpoint. While ₦50 might see you through a police checkpoint on a bright day, Dataphyte research has shown that ₦100 is the least you can pay for easy access to a health facility. In both cases, either you pay or you are delayed while those after you gain access once they comply.
Although the level of corruption in the health sector is still not known to many, its existence cannot be denied.
In recognition of the gap in ascertaining the extent of corruption in the health care sector, Datapyhte in collaboration with TAPInitiative conducted a corruption victimization survey in the primary health sector.
The survey examined how four key components of access to health care – coverage, service delivery, timeliness, and personnel – are affected by corruption.
One question in the survey is the extent health workers extort patients accessing care. The research revealed a high degree of extortion from health workers.
Analysis from the survey showed that patients paid for services such as bed space, consultancy, HIV test, tuberculosis test, and file movement in 449 different transactions.
To show the abnormality of the transactions, receipts were issued in only 83 of these transactions. In 360 cases, receipts were not issued. This was most likely to avoid future trace or forensics of such transactions.
Ideally, services such as the movement of files from the nurse to the doctor or HIV test are meant to be free of charge.
Further investigation showed that 147 patients attested to paying between ₦100 to ₦5000 naira for movement of their medical files from the nurse’s desk to the doctor’s office.
One hundred and forty-five (145) of these respondents noted that there were not issued receipts. Only two of the respondents claimed they were issued a receipt. The two respondents claimed to have been issued a receipt for movement of file but could not lay hands on the receipt as it was misplaced.
Respondents who refused to comply noted that their non-compliance increased the time it took them to access the facilities. Most of the other patients that paid the tips are usually attended to first. The question remains, what must have been written on such a receipt? Is there any legitimate service like the movement of files in the hospital?
Results from the survey further showed that between ₦300 and ₦37,000 nairas were paid by respondents in one-hundred and fifteen (115) cases. Although in 85% of the cases, payment was made to the cashier, only in 30 cases were receipts issued.
Leaving 85 different cases where bed space service was paid for without the issue of a receipt.
Normally, a patient who is admitted to the hospital is supposed to pay for a bed space. This service is official and is usually recorded in hospital transactions. It is, therefore, an act close to theft to make a patient pay for a bed space. Especially without the hospital having a record of payment for the service.
This level of incomplete remittance of revenue generated from health care facilities contributes to the underdevelopment of the sector. Health facility management depends on internally generated revenue to run health care facilities.
While a lot could be blamed on the government for the underdevelopment of the health sector, patients, health care workers and hospital management also share in the blame.
If patients learn their rights in accessing health care and always report unruly behaviour of health workers to the right authority it could help checkmate corrupt practices. However, for this to happen, hospital management will need to issue appropriate sanctions and disciplinary actions to health care workers that enforce patients to make irregular payments before they access health care facilities.
As recommended in the survey, media and civil society organizations need to carry out further investigations to expose the ways corruption manifests in the health care system.