In spite of the Lagos State Government’s directive to state-owned General Hospitals and Primary Health Centres not to collect antenatal and delivery service fees from pregnant women as part of efforts to cushion the impact of the fuel subsidy removal, PUNCH Healthwise investigation revealed that the order is being flouted with impunity by several healthcare facilities, CHIJIOKE IRMEKA reports.
When the Lagos State Government announced its plan to ameliorate the sufferings of pregnant women in the state by offering free antenatal and delivery services, many women were elated about the order, which they saw as a ‘sweet palliative’ in the face of the biting economic condition occasioned by the fuel subsidy removal.
However, PUNCH Healthwise discovered that pregnant women are being milked in several state-owned facilities meant to adhere strictly to this directive.
Mrs. Shola Adebowale, a petty trader was unaware of this free antenatal care and child delivery services when went to register at the General Hospital in Mushin.
The mother of two, while speaking with PUNCH Healthwise, claimed she was told to pay N27,200 for antenatal registration.
It was learnt that she made an initial payment of N7,700 as a pre-registration fee, which covered medical tests, examinations, a scan, and blood donation form meant for her husband.
The woman revealed that she made another payment of N19, 500, for antenatal registration, file, weekly antenatal consultation services and routine drugs that include folic acid, and B complex, among others.
Adebowale later made another payment of N5,000 in lieu of blood procurement during child delivery.
PUNCH Healwise learnt that she was mandated to make the payment due to her husband’s inability to donate blood, as his blood pressure was high on two different occasions when he came to donate blood.
Asked whether she is aware that antenatal care and delivery services are free for pregnant women in state-owned General Hospitals and PHCs, she said, “I am not aware and nobody told us anything about it.
“All the women you see here went through that same process. We go to Oliyide General Hospital for registration and are later transferred to this place. No one is exempted.”
“I am not surprised that they didn’t tell us. In every government’s policy, it is only the rich that benefit; the poor still suffer the most. Those women in rich areas are those enjoying the directive but we who should be the major beneficiaries, are paying. I thank God my husband was able to pay,” she lamented.
Adebowale, who is in her 30s told our correspondent that was told to bring items like disinfectants, detergents, drinks and biscuits when she comes to deliver her child.
Directive made in good fate
The Lagos State Governor, Babajide Sanwo-Olu, rising from the State’s Security Council meeting held on Monday, July 31, 2023, directed all general hospitals and primary healthcare centres to offer free antenatal care and child delivery services to expectant mothers as part of measures to cushion the effect of the fuel subsidy removal on Lagos residents.
In a statement obtained from the official website of the Lagos State Government, titled, ‘Fuel Subsidy Palliatives: Lagos Hospitals Offer Free Ante-Natal, Child Delivery Services,’ and also reported in the media, the medical intervention covers normal vaginal delivery and caesarean section services.
The governor said it was part of the rolled-out measures to ease off the burden of fuel subsidy removal on homes.
According to the Permanent Secretary, Lagos State Ministry of Health, Dr. Olusegun Ogboye, the implementation of free antenatal care and child delivery services would help improve maternal and child health indices in Lagos.
He said this in a statement by the Director of Public Affairs, State’s Ministry of Health, Tunbosun Ogunbanwo, during compliance monitoring visits to Ifako-Ijaiye and Isolo General Hospitals.
Posing as a would-be father
In the course of working on this report, our correspondent toured several health facilities meant to obey the state government directive with a pregnant woman who pretended to be his wife.
It was discovered that while few facilities openly collect money from pregnant women as antenatal fees, others complied fully.
Our correspondent gathered that pregnant women still pay as high as N80,000 for antenatal care and normal delivery services, while over N158,000 is paid for those scheduled for caesarean sections.
Huge ANC and C/S payments at Amuwo-Odofin Maternal and Childcare Centre, Festac
On Friday, at the Amuwo-Odofin Maternal and Childcare Centre, Festac, after informing a nurse that he wanted to register his wife for antenatal, he was referred to the account section, where he made a Point of Sale payment of N5,000 to a cashier.
Our correspondent later learnt from a pregnant woman, Mrs. Confidence Frank, who also came for the same purpose that the much-touted free antenatal care and delivery services in Lagos State-owned hospitals, are not anywhere near the truth.
According to her, she registered for antenatal on Wednesday, at the same facility with N29,500.
Confidence, who came in the company of her husband, Frank, said N28,000 was the actual price of antenatal care, while N1,500 was for a compulsory magazine purchase.
She noted that the N29,500 was different from the hospital delivery fee of N46,500, meant for normal vaginal delivery, while N151,500 is meant for those slated to undergo C/S.
“The N151,500 is for those women booked for surgery or a registered mother, and not for an emergency case,” she revealed.
Confidence insisted that there is no such thing as free antenatal care in the Amuwo Odofin MCC, noting that all the women who registered on the same day with her paid N29,500 in cash, through transfers or POS transactions.
“Pray for a safe delivery, if not, you will rob the bank to pay for caesarean section bills here. My neighbour gave birth through C/S and paid over N140,000. So, in Festac, it’s not free. Even after ANC registration, they will tell you to go and buy some drugs that they do not have. These are drugs they are meant to give you and which is part of your payment,” she added.
Going through her receipts, our correspondent noted that the breakdown of the N29,500 antenatal fee charged includes N2,000 for the EMR-Registration card; N1, 000 pre-registration fee; registration proper (N10,000); random blood sugar test (N1,000); Sitz bath (N3, 500); laboratory fee (N5, 000); Scan (N3, 000); Nutrition (N3, 000); alert (N500); mackintosh (N1, 000) and magazine (N1, 500).
PUNCH Healthwise was shocked to learn that an additional fee of N25,000 must be paid once the pregnancy exceeds 34 weeks, bringing the total amount to N54,500. This excludes the delivery fee.
Based on findings, the breakdown of the N46,500 meant for vaginal delivery at the Amuwo Odofin MCC are; N10, 000 delivery pack; N9, 000 for diet; accommodation (N10,000); admission pack (N5,000); gown (N4,000); miscellaneous (N2, 000); notification of birth (N1, 000); cervical screening (N5, 000) and circumcision/ear piercing (N5, 000).
However, the breakdown of the N151, 500 charged for C/S, include Anesthesia (N25, 000); operation fee (N40, 000); theatre pack (N28, 000); admission fee (N30, 000); unbooked fee (N20, 000); anesthesia consumables (N2, 000); cervical cancer screening (N500); notification of birth (N1, 000) and circumcision/ ear piercing (N5, 000).
N27,000/LASRRA for ANC at Asiwaju Bola Ahmed Tinubu Comprehensive Health Centre, Ifelodun, Alaba-Oro.
At the Asiwaju Bola Ahmed Tinubu Comprehensive Health Centre, Ifelodun, Alaba-Oro, Lagos, it was discovered that pregnant women who do not have the Lagos State Residents Registration Agency identification number were compelled to pay N27,000.
“With LASSRA-ID, the amount is reduced but antenatal care is not free in this facility. Though it is a palliative to cushion the effect of the fuel subsidy removal, it is not free,” one of the officers at the antenatal registration point told our correspondent during a visit to the facility.
Meanwhile, a mother of two, Mrs. Jessica Odum, who paid the mandatory N27,000, said she visited the PHC because she learnt of the free healthcare delivery for women.
PUNCH Healthwise discovered that the N27,000 was meant for registration, file opening and medical tests that include HIV, and blood sugar, among others.
“I may also pay the full amount during child delivery if I don’t get the LASSRA code before my due date,” Jessica told our correspondent
…More strict measures for ANC at Ajeromi General Hospital, Ajegunle
At the Ajeromi General Hospital in Ajegunle, a more stringent requirement was put in place for pregnant women registering for ANC. Aside from presenting the LASSRA certificate, they are also meant to produce the Lagos State Health Management Agency policy document.
When our correspondent inquired from a nurse with the name tag, Mrs. E. Adebayo, who was attending to some pregnant women what it would take to register his wife at the facility, she confirmed that ANC and delivery services are free for expectant mothers with LASSRA and LASHMA policy, but that they are still expected to pay a council revenue fee of N1, 000.
She noted that those without the two policies will pay N26,200, adding that this excludes delivery fees, if they are considered for registration.
Tonia Okaro, a pregnant woman seen at the facility, told our correspondent that she was allowed to register after producing her LASSRA and LASHMA but that she paid for ANC drugs.
“I didn’t pay for registration. They said delivery is free too but I wouldn’t know yet because I have not given birth here before,” she added.
LASHMA pay point inside Ojo PHC
PUNCH Wealthwise learnt that the Lagos State Health Management Agency, an initiative geared towards achieving universal health coverage, is meant to bring affordable healthcare to the populace.
However, it comes at no cheap rate and might be quite unaffordable for most residents who find it hard to make ends meet.
To register for the LASHMA policy, Ezekiel Ameh, who mans the office within the premises of Ojo Primary Healthcare Centre, said a pregnant woman is required to pay N40,000 to obtain the policy document in order to access the free antenatal care and delivery services.
Despite presenting the LASHMA policy, pregnant women are still expected to pay for all ANC services, as well as provide gloves, drinks, detergents and disinfectants among others for delivery.
Mrs. Rebecca Idris, who just gave birth at the centre, told our correspondent that she spent a total of N11,400 for tests and antenatal registration.
The woman, who spoke with our correspondent when she stepped out briefly to see her husband outside the ward, said paying for delivery and accommodation is a big problem they are faced with at the moment.
Meanwhile, a midwife at the PHC, who spoke on condition of anonymity said, “Before we register any woman for antenatal, she would have to go for a scan to know whether the baby is in good condition. If the scan shows a twin or triplet, the woman will be referred to a general hospital because we don’t have the capacity to handle such.
“For those who can register with us, we check the blood of the mother to be sure that the Packed Cell Volume is okay. If it is, we will register her with N3,800, but if it is not, she will pay N4,700 because we will be giving her some drugs and supplements to build her blood level. PCV is not normal when it is less than 30 per cent and we consider it normal when it is 30% and above.”
Alimosho General Hospital, Igando, ANC and delivery is not free
At Alimosho General Hospital, Igando, Lagos, perhaps the biggest in the state, the story remains the same.
Pregnant women pay N25,000 for antenatal registration and another N36,000, for normal vaginal delivery.
“You have to pay a total of N105,000 for caesarean section, which in most cases, is in upward review,” a POS operator within the premises, Bukola Ajanaku, told our correspondent.
According to Mr. Martins Osagie, who just welcomed his first son, payment for antenatal care and delivery services comes in two packages.
“If you have an account with the state insurance scheme, antenatal is free but normal delivery is N15,000. N41,000 is paid by other people without the LASHMA insurance scheme, and for them, antenatal registration is N25,000, C/S cost between N105,000 and N160,000,” he said.
His wife, Jane, said she was not aware that antenatal care services and delivery for women in Lagos State General Hospitals are free.
“I never knew; I don’t have an idea either. We just came with the mindset to pay for my registration, delivery and others. My husband has a policy that made him pay less but everything here is paid for,” said.
N5,000 ANC payment at Oluremi Tinubu Primary Health Centre, Festac,
At the Oluremi Tinubu Primary Health Centre, 41 Road, Festac, our correspondent was made to know that the facility does not collect money for ANC and delivery services from pregnant women.
He, however, discovered that the health officials ask for N5,000 from pregnant women as ANC registration.
While making inquiries from the Officer-in-Charge of the PHC, Mrs. T. Eso, she said with LASHMA, no payment is required apart from the N1,000 collected as revenue for the council.
“We don’t collect money for antenatal and delivery but you have to go for a scan and other tests, which you will pay for. It is through the scan result and physical examination that we will know whether to admit you here or refer you to the maternal and childcare centre.
“Again, once you have your LASHMA policy, antenatal and delivery are free but you still have to pay for your local government revenue of N1,000. If you don’t have the LASHMA policy, you will pay for lab and drugs too. If there is anything extra that you want to buy, then you will get that yourself,” she added.
Amuwo Odofin MCC’s MD reacts
Not knowing the extent of the investigation conducted already, the Managing Director, Chief Executive Officer, Amuwo Odofin MCC, Festac, Dr. Adeniyi Taiwo, claimed his facility offers free antenatal and delivery services to pregnant women.
According to him, “Though I am a civil servant and not supposed to talk to the press, beyond that, we offer free antenatal and delivery services in Amuwo-Odofin MCC.
“It’s one of the palliatives of the government. It has been on since August this year and we offer free services, especially to those indigent and vulnerable women.
“We also have people with LASHMA policy and when we treat them, we pass their bills to the health insurance organisation. The Governor is also supportive as he gave some of us initial takeoff grants to be able to do it. We have an agency to screen and register people under the LASHMA policy, and when we treat them and send their bills to LASHMA.
On what happens to pregnant women without LASHMA policy, he said, “No, everybody has to come through LASHMA.”
However, from PUNCH Healthwise’s investigations, almost 90 per cent of the registered pregnant women at Amuwo Odofin MCC paid out-of-pocket for antenatal registration and delivery.
This was evident with the huge number of pregnant women and men, waiting to make payments when our correspondent visited.