How High Cost of Medical Oxygen 'Kills' Patients in Nigerian Hospitals - DAILY TRUST
Many patients are losing their lives in hospitals because they cannot afford medical oxygen, investigation by Daily Trust Saturday revealed.
Taiwo Adeniyi, Ojoma Akor (Abuja), Victor Edozie (Port Harcourt), Hope Abah Emmanuel (Makurdi), Ibrahim Musa Giginyu (Kano), Usman A. Bello (Benin), Risikat Ramoni (Lagos), Mohammed I. Yaba (Kaduna), Eyo Charles (Calabar) & Mumini AbdulKareem (Ilorin)
Patients with certain complications like acute pneumonia, COVID--19, heart disease among others sometimes require the support of medical oxygen to survive.
Findings revealed that the COVID-19 pandemic which wreaked havoc around the world complicated the challenges associated with getting medical oxygen.
The development had also exposed the weaknesses of developing and third world countries in addressing health challenges.
Dire straits in Nigeria
Mr Simon Okonye lost his mother-in-law due to the inability of his family to pay N2,500 for medical oxygen that the deceased needed on daily basis at a private hospital in Aba, Abia State after a failed effort to resuscitate her at the public hospital in Port Harcourt.
He recalled that his mother-in-law slipped into a coma due to complicated cases of diabetes and high blood pressure. Consequently, she was placed on oxygen to support her poor breath at the hospital's intensive care unit. But when the family could not afford the accumulated hospital bills, the hospital removed the oxygen.
"When the oxygen was removed, we moved her to the house until she breathed her last. It was a terrible experience. The family is poor. We don't have money. That was the reason we lost the woman," Okonye said.
There are several families like Mr Okonye that are also battling for survival in several hospitals in the country that cannot get help to cushion the effect of their inability to access oxygen due to its high cost. Thousands of people in such condition have been left to die despite the National Policy on Medical Oxygen in Health Facilities by the Federal Ministry of Health.
The national policy's five-year strategic plan for medical oxygen-scale up has not lessened the plights of the Nigerians in accessing oxygen. The policy initiated during the tenure of former Minister of Health, Professor Isaac Adewole, had indicated that more than 625,000 deaths occur annually due to diseases associated with insufficient oxygen in the blood or low blood oxygen saturation.
Worryingly, the situation has not improved as patients suffer in states due to inaccessibility or exorbitant cost of medical oxygen. This has led to accumulated hospital bills and distress for the families and relatives of patients. Obviously, inadequate oxygen plants in the country and the state of the available plants aggravate the plights of patients.
Patients pay N25, 000 daily for oxygen
Another patient's relative in Abuja, Abdullahi, said that he paid over N200, 000 for three days when his wife was placed on oxygen for a heart-related condition at the Intensive Care Unit (ICU) of a public tertiary hospital in Abuja. According to him, the payment was, however, in addition to the cost of drugs, feeding and admission.
Checks across public hospitals in the Federal Capital Territory (FCT) revealed that the cost of oxygen ranges from N18, 000 to N25, 000 per day for adults while half of the amount goes for children.
The cost for oxygen in intensive care units of hospitals is higher than wards and other units because patients may need ventilators and drugs to aid breathing along with the oxygen.
Daily Trust Saturday learnt that oxygen is administered free for COVID-19 patients at the University Teaching Hospital, Gwagwalada, Abuja, but patients admitted in other wards have to pay for it.
In private hospitals, the cost of oxygen administration is double the cost administered in public hospitals.
Another source explained that oxygen is usually given free to patients that need resuscitation at emergency units in public hospitals but they usually pay daily fees for subsequent administration.
It costs between N3, 000 and N4,000 daily to manage a patient with oxygen at a government hospital in Port Harcourt, Rivers State. A resident doctor who spoke on condition of anonymity said that the cost of oxygen increase by the day. He urged government to set up oxygen plants to as a way out of the situation.
Checks at some private and public hospitals in Calabar showed that many patients who relied on oxygen to survive had died as they could not afford the gas.
One of the patients on oxygen at the University of Calabar Teaching Hospital, Mr Edem Umoh, said he spent a fortune to buy cylinders of oxygen daily.
"I was diagnosed of acute heart problems. The medics put me on oxygen. I spent 21 days on oxygen. I would buy the longest cylinder of oxygen which cost some times between N9, 000 and N11, 000 daily," he said. He added that he had been living on the generosity of his friends and colleagues.
A relative of another patient, Agbor James, said he had spent all he had on the health of his wife before they were referred to the University of Calabar Teaching Hospital (UCTH) from Ugep, which is a two-hour drive to Calabar. "We only spent a couple of days at UCTH when she gave up the ghost. I could not afford the cost of the oxygen. Please I don't want to talk about it," he said.
The UCTH Corporate Affairs Officer, Roselyn Ikpeme, said she needed time to respond but didn't as at press time.
In Benue State, a parent said they paid N7, 000 daily after their newborn baby had some health complications at the Benue State University Teaching Hospital (BSUTH), Makurdi. Though the baby died, the parent, who pleaded anonymity, decried the cost of getting the lifeline in a public facility.
There was no patient at the Intensive Care Unit of the hospital when our correspondent visited. But the hospital's consultant anaesthetist who is also consultant intensive care therapist and head of department at BSUTH, Dr. Enokela Efu, said the hospital charges patients N2,000 per day to be administered oxygen, while in some cases they give up because they can't afford the money.
In Kano State, relatives of patients that seek oxygen said the COVID-19 pandemic had eased the situation as oxygen is available in most of the health facilities. One of the relatives of a patient at Aminu Kano Teaching Hospital (AKTH), Umar Bello Maradun, said he paid N450 per hour for oxygen at the facility. He added that it was for a few hours that his relative was placed on oxygen.
According to the AKTH spokesperson, Hauwa Abdullahi, the hospital charges N800 per hour on adults and N400 per hour on children to get oxygen. She added that oxygen was required at theatres, Intensive Care Units (ICU), Special Baby Care Units as well as Accident and Emergency Units (A&E).
The charges at AKTH differ from Muhammadu Abdullahi Wase General Hospital owned by the state government. A relative of a patient that needed oxygen, Malam Umar Bukar, told our reporter that he was charged less than N500 per hour on his adult patient. He said he wouldn't have paid, if it had been extended to more than a day.
"It isn't expensive, but I would have defaulted, had it been extended to more than a day. I have seen people begging to save their relatives on oxygen," he said.
Charges for medical oxygen vary in Lagos State.
At Solace Hospital (private), patients pay for oxygen per bottle. A patient who needs a few hours of it pays N15, 000 for a bottle that weighs 12kg, while patients who need a longer time on it (oxygen) use two bottles at the rate of N30,000.
One of the staffers of the hospital who spoke on condition of anonymity said the prices were discounted for patients that spent days on oxygen.
At Randle Hospital (public) in Surulere, Lagos, some patients pay N4,000 for a small-size cylinder bottle, while others pay N8,000 for the big bottle if they stay for longer days.
A doctor in one of the general hospitals in Lagos, Dr Sulaiman Sarumi, said the hospital management use their discretion to charge patients on oxygen.
He added that general hospital generally charge per hour and not per bottle in the state.
However, oxygen is free at the public health facilities visited by our correspondent in Kaduna State. One of the relatives of a patient at Barau Dikko General Teaching Hospital, Mariya Dahiru, whose baby was placed on oxygen at the facility, said it was free, unlike the private facilities.
An elderly woman who preferred anonymity told our correspondent that she didn't pay for the oxygen and the bed space.
"We buy the prescribed drugs by doctors, but for the oxygen, we don't pay for anything and the bed space is as good as free," she said.
Efforts by our correspondent to get the response of the Chief Medical Director of Barau Dikko Teaching Hospital, Dr Abdulkadir Tabari, was to no avail as he didn't pick his calls.
A Kaduna-based medical practitioner, Doctor Usman Yelwa, lamented the shortage of oxygen in most of the hospitals within the state.
He called on the state government and philanthropists to assist patients.
In Edo State, the price of oxygen at the state hospitals has increased with the patients bearing the cost. At the Central Hospital, Benin, a small cylinder of oxygen that used to be N2,500 now costs N4,000, while the big size which cost N4,000 now goes for N8,000.
A patient's relative, Mr Johnson, said he paid N4,000 for a small cylinder of oxygen at the hospital. He added that a small cylinder could last for several days.
"It is on the high side because if it gets to a situation where one uses about three cylinders, the money would be much," Johnson said.
'Why we charge high prices'
The Consultant Intensive Care Therapist and Head of Department at BSUTH, Dr Enokela Efu, said the hospital management spent between N250, 000 and N300,000 on oxygen twice a month.
He explained that acquisition of oxygen posed a lot of challenges because the hospital does not have its own oxygen plant and needs it.
"For the past one and half years, we have been sourcing oxygen consistently from Abuja on a monthly basis sometimes, depending on our consumption capacity; sometimes twice a month or thrice," he said.
The anaesthetist consultant said the solution to the challenge is establishment of an oxygen plant for the hospital.
FG awards N5.6 billion for oxygen production plants
The Federal Government has awarded contracts for the construction and maintenance of oxygen production plants across the 36 states and the FCT. The Federal Executive Council (FEC), in a meeting chaired by President Muhammadu Buhari, approved the awards of the contract worth N5.6 billion.
The Minister of Information, Lai Mohammed, said it was aimed at tackling the challenges of the COVID-19 pandemic.
He said: "The Minister of Health, Lai Mohammed, presented a memo which was approved for the emergency supply, installation and maintenance of oxygen production plants and construction of plant houses in each of the 36 states of the federation and Abuja."
"The contract was approved in the sum of N5, 615, 127, 479, inclusive of 7.5 percent VAT, in favour of four different companies, with a completion period of 20 weeks."
This came after the government had, in January, approved the release of N6.45 billion to set up oxygen production plants at the peak of COVID-19 cases in the country.
Establish more oxygen plants - Experts tell FG
The Chairman of the Lagos Medical Guild, Dr Jimi Sodipo, said there was need for more investments in the sub-sector.
While emphasizing the need for investment, he disclosed that there had been a few main distributors of oxygen.
On how to proffer solution to scarcity and exorbitant price of oxygen, he said: "It will be good if there is an oxygen plant at every secondary and tertiary institution in Lagos State and the country at large. It may not be possible in every general hospital, but the government can focus on the big ones that have a large number of patients.
"Aside investing in an oxygen plant, there is need for investment in oxygen gauges. Piping oxygen to the various wards as carrying a cylinder of oxygen from one area to the other could be a challenge. While we sort out the issue of supply or the production of oxygen, supplying the oxygen to the people that need it directly to their bed is an important investment that should be considered to reduce the logistics of taking oxygen from one point to the other," Dr Sodipo said.
A Kaduna-based medical practitioner, Doctor Usman Yelwa, lamented the shortage of oxygen in most of the hospitals within the state.
He expressed the need for the state government and philanthropists to assist patients.
"Government needs to come in because most times, patients brought to the hospital may need oxygen but might not get it due to shortage," he said.
He urged government and non-governmental organizations to ensure that all hospitals have oxygen since they have trained personnel.
"It's very unfortunate that most general hospitals lack oxygen in their theatres and maternity rooms due to lack of supervision," he said.
A medical expert in Lagos State, Dr Tunji Akintade, has called on private investors to invest in companies that specialize in the production of medical oxygen in Nigeria because only one private company provides oxygen for many hospitals in the country.
This, he stressed, had been responsible for the scarcity and high cost of oxygen.
Akintade urged hospitals to book ahead for the oxygen.
"The oxygen plant by the state government will not be sufficient for the whole health facilities in the state. The government needs to increase the production of oxygen in its plants so that it can serve as a substitute for the private oxygen plant in existence," he said.
"Every time we go to get oxygen, we get a new price. That is even if it's available. Even if we booked for it ahead, we might not even get it. So, what we do now is to buy an extra cylinder and when it's available, we buy extra and keep."
Concerns about state of oxygen in states
Concerns on the availability of oxygen in hospitals have continued to rise in Nigeria. According to the National Policy on Medical Oxygen in Health Facilities, at least 30 public sector oxygen plants had been established in Nigeria, of which 21 are purportedly functioning; six are of unknown status and three are non-operational.
Among states that have oxygen plants is Kwara. The state's oxygen plant was refurbished at the height of the pandemic. But the state is still grappling with the problems of distribution and logistics to get required oxygen to patients in need in various hospitals.
The Kwara State Director-General, Hospital Management Bureau, Dr Sa'ad Aluko, told Daily Trust Saturday that the state had made appreciable progress in its efforts to see that the plant serves the entire citizens across the three senatorial districts.
He added that logistics, distribution and pricing had been their major problems.
Aluko said the state currently produced 40 ten cubic meters daily with its biggest cylinder.
He noted that the state had more than enough capacity to supply hospitals going by the current consumption pattern.
"As we are now, we have more than enough capacity to produce and supply hospitals in the state. Our primary assignment is to supply our own hospitals first. It's when we are able to meet the target that we can talk about private hospitals.
"Part of our challenges has been logistics which is one of the things we are looking at. Currently, we have procured over 150 10.5 litres of oxygen cylinders, making well over 250 oxygen cylinders that we intend to distribute across all our 45 hospitals. It's just like a person selling soft drinks and needs bottles or else even if he produces the content in large numbers, where will he put it?"
"Our next line of action is how do we formulate a strategy on distribution? But we are looking at various plans. The most tenable is to use it like a revolving drug scheme where you supply to the hospitals and whatever has been made through the Kwara Internal Revenue Services (KWIRS) will be taken out and ploughed back into paying the contractors, following application of the revenue sharing formula.
"So, it's not just the production of the oxygen. There are lots of things in the backend that will be put into consideration like pricing. We don't want a situation where it will look like the government wants to exploit people with the rate that will be agreed to be different from the commercial rate. It is really not a money-making thing for the state government.
There are two oxygen plants in Lagos State. One is at the Mainland general hospital in Yaba, while the other one is at Gbagada General Hospital.
The Mainland plant supplies 300 cylinders per day and six cylinders per hour for patients' use.
Both plants were built with the partnership of the private sector and Non-Governmental Organizations (NGO).
While the plant at Mainland was commissioned in January and built in partnership with Total, the Triage and Oxygen Centre as well as the Gbagada plant which was championed by Bill and Melinda Gates Foundation and Clinton Access Initiative was commissioned for use in April.
Due to the partnership with the private sector, the plants are functioning properly with minimal or no challenge.
The health Commissioner, Professor Akin Abayomi, said oxygen plants and industrial devices had been designed for regular supplies into healthcare facilities. He added that the plants separate oxygen from other air components by using pressure swing adsorption or membrane separation techniques.
Abayomi said that high purity oxygen was needed in healthcare facilities and essential for patients undergoing COVID-19 and other special treatments.
Dr Ayoola, the Director of Corporate Affairs of the medical centre disclosed that the Federal Medical Centre (FMC), Lagos, usually produce its own oxygen and also sent it to nearby hospitals at a considerable rate.
"Every patient's bed in FMC has its own oxygen in case a patient needs it and the price is at a reasonable fee," he said.