On Ante-Natal Fee In Lagos Hospitals

ON account of the fact that medical care is an essential  service that  the majority of the citizens who are poor cannot afford on their own, it is necessary for the Lagos State government to review the fee it charges for ante-natal services.  The cost of medical treatment, equipment and personnel might have made the state government to increase the fee to N18,000 from what it used to be. But the need to make the citizens, especially the poor,  have access to ante-natal services should  be the prime consideration in the review of the fee.

Already, most of the pregnant women who use public hospitals are  complaining that the new fee is too much for them.  Before the increase, pregnant women reportedly paid very little sums for ante-natal care. But with the increase, most of these women who cannot afford  private hospitals would be shut out of care as  most  are not gainfully employed.

Antenatal Care (ANC) is the care a woman receives during pregnancy, the purpose of which is to monitor her health and the baby’s health. Contrary to reports that most state governments including Lagos State offer free medical services to pregnant women, even before this new administration, while government hospitals charged between N11,000 and N40,000 for ante-natal, private hospitals charged between N25,000 and N100,000 excluding charges for birth either through normal delivery or by Caesarean Section (CS) and post natal care including the use of phototherapy and incubator for babies with jaundice and prematures respectively.

In public hospitals in Lagos State, pregnant women paid N9,500 deposit on registration for ANC and another N650 for folder/file. They were also made to pay N200 on every visit to the hospital to see a doctor, which was the cost of routine urine test for glucose.

However, this cost of registration for ANC in Lagos public hospitals reportedly doubled from the previous N9,500 to N18,000 just a few weeks ago, leading pregnant women in the state to reject the hike in the registration fee for ante-natal services in some public hospitals, describing it as unaffordable.

Meanwhile, according to a new study published in The Pan African Medical Journal, despite high coverage of ANC, Nigeria still remains a major contributor to under-five mortality, contributing about 13 per cent, 9.4 per cent and 14 per cent of global under-five, neonatal and maternal deaths respectively.

The study titled “Determinants of antenatal care, institutional delivery and postnatal care services utilization in Nigeria,” noted that expectedly, the neonatal, post-neonatal, infant, child and under-five mortality rates remain high at 37, 31, 69, 64 and 128 per 1000 live births respectively; and maternal deaths at 576 per 100,000 live births. These figures show a reduction of between 20 per cent and 31 per cent in the past decade but not enough to achieve Millennium Development Goals (MDGs) 4 and 5.

Also, recent estimates show that the overall ante-natal care (ANC) coverage in Nigeria stood at 61 per cent which is an abysmal three percentage points increase from 58 per cent a decade ago; 36 per cent of deliveries were delivered in a health facility while only 14 per cent of newborns received postnatal care within two months of delivery.

The Pan African Medical Journal noted that the ANC coverage of 61 per cent falls short of the recommended 90 per cent of ANC coverage required to reduce most deaths among mothers and their newborn.

In  a country like  Nigeria where  the rate of  poverty  is  high, women go through harrowing experiences at childbirth. Because they cannot afford the high cost of  orthodox hospital, they eventually patronise  quack orthodox  medical practitioners  or traditional ones. The result is that many pregnant women in Nigeria, especially the poor die in pregnancy.

Even before  delivery, the  unborn  baby  needs  so much care and a pregnant woman needs to be properly advised on the kind of diet  and drugs  she  should  take. But  when  the high cost  of  such ante-natal services pushes  pregnant women from  hospitals, the result is  children  dying  at  birth  or when they survive, they become  liabilities  to the society as some of them are afflicted with such disabilities as could have been avoided had there been proper care. In this case, a vicious cycle continues in which the resources  that ought to have been used  to  develop  these children while  they were still in the wombs of their mothers  are now  needed to salvage them.

A grim picture of the plight of  poor pregnant women who are not given the right ante-natal services is shown by the fact that in Nigeria each year, 2.9 million newborns unnecessarily die within their first month and an additional 2.6 million are still-born. The World Health Organisation (WHO) positions Nigeria 163rd of 191 countries in terms of Disability Adjusted Life Expectancy (DALE).

The new government in Lagos State promised positive  change and one major way it can improve  the  lives of the poor  is  to allow them access to basic medical services. If  the cost  of providing the services  makes it impossible for the government to render  them free, the least it can do for the people is  to alleviate the situation by allowing the existing fee to stay while it works to create the environment  for  the  people who need  these medical services  to be able  to afford them. It is understandable that too many needs are chasing very little resources available to the government. But compassion is also a key element of governance.