The difficulty in accessing medical services by enrollees of the Kano State Contributory Health Management Agency (KSCHMA) at private health institutions has been attributed to the delay in reviewing capitation fees paid to the service providers.
Launched in 2016, the State Contributory Healthcare Management Scheme stipulates that the state government will review the capitation fees every four years.
The scheme was designed to protect families from the financial hardship of huge medical bills, limit the rise in healthcare services, improve access to quality healthcare, and maintain high standards of healthcare delivery services within the scheme.
The scheme was also designed to provide registered government workers and their families with quality medical services, including free or subsidized medications at accredited hospitals.
However, eight years later, the government has yet to review the agreement despite the present economic realities in the country, a situation that led to shortages of drugs in KSCHMA’s accredited hospitals, hence leading to frustration amongst beneficiaries.
A Kano civil servant, Malam Dan Asabe is among the frustrated beneficiaries.
Dan Asabe could not hide his frustration when a nurse working with Soft Care Hospital, a KSCHMA-accredited hospital in Sharada insisted that he must pay for the treatment of his wife, who collapsed after a chronic ulcer attack.
“She had an ulcer, and she collapsed before we got to the hospital. They said she needs a drip, but the nurse there says we have to pay because it is not in KSCHMA’s scheme. We had to call a doctor who instructed them to attend to us before they put the drip,” he said.
Another enrollee simply identified as Garba was denied his prescription drugs at the hospital he selected after he was diagnosed with malaria.
“I was in the hospital recently and the doctor prescribed drugs for me. I took it to the pharmacy but they said there were no drugs and that I should come the following day.
"The funny thing is that once they start saying that, just go and get the drugs at a pharmacy outside the hospital to save your energy.”
These stories are not peculiar to Dan Asabe and Garba alone, as another enrollee leaves the hospital he selected lamenting his difficulty in accessing drugs and other medical consumables.
“If they prescribed six different drugs for you, you can only get two in the hospital. And the funny thing is the missing drugs are the expensive ones.
"My question is, is it that they can't provide the expensive drugs despite deducting our money every month?” he asked.
A visit to several KSCHMA-accredited private hospitals in Kano revealed a troubling pattern despite the monthly deductions in the name of contributory healthcare.
However, amid these complaints, another enrollee at the Soft Care Hospital, Ahmad Akilu insists that he and his family have been enjoying quality health care.
Akilu was referred to Murtala Muhammad Hospital by Soft Care Hospital as they do not have a
He said, “Honestly I’m enjoying their service. Right now I need a dental service but they don’t do it here. So they directed me to Murtala Muhammad Specialist Hospital. I lost the referral note given to me and I’m back to get another one.
"And the hospital I was referred to charges me N15,000, but the Soft Care Hospital will be the one to pay,” he said.
Akilu’s submission suggests that some facilities are still holding up to their part of the bargain despite the challenges.
A recent investigation by Nigeria Info uncovered that the rising cost of drugs is the major reason behind persistent shortages in KSCHMA’s accredited hospitals.
Taking a close look at the scheme, it was discovered that N4,000 is deducted from Directors' monthly salaries in levels 14, 15 and 16 as their contribution to the scheme.
However, civil servants from grade level 1 to 13 see N1,400 to N2,800 monthly deductions from their monthly salaries. Therefore, N400 is being paid to accredited hospitals per patient for healthcare services.
For instance, if an enrollee registers 5 dependents, N4,00 each will be paid to KSCHMA’s accredited hospitals, making it a total of N2,400 monthly.
Speaking on condition of anonymity, a manager of one of the hospitals in Kano disclosed that the N400 capitation per head is no longer sustainable.
Also speaking, one of the Directors of Soft Care Hospital, Musa Ibrahim Kurawa refuted allegations made by Mallam Dan Asabe, describing it as “baseless.”
He said, “We wish to clarify that Dan Asabe is not an enrollee of Soft Care Hospital. Our records show no prior registration or medical history for him at our facility.
"As a private hospital, we operate on a structured system that prioritizes registered patients and emergency cases according to established medical protocols."
Kurawa further clarifies that the hospital receives N2,400 for an enrollee with his/her five dependents, denies the lack of drugs in the facility.
“We wish to inform the public that Soft Care Hospital is a primary healthcare facility. Our mandate is to provide essential medical services such as routine check-ups, treatment of common illnesses, and preventive care,” he said.
“For specialized treatments, we refer patients to appropriate secondary or tertiary hospitals equipped to handle such cases,” he added.
Responding, the Director of Standard Quality Assurance at KSCHMA, Dr. Nuraddeen Sani Ibrahim says “The agency has already reviewed the capitation fees and is awaiting the final approval by the government.”
In addition, he said the agency has recently introduced an exercise it tagged “Door to door exercise” where prescribed medications are delivered to enrollees who have not been able to have access to them while in the hospital.
“We started this in Murtala Muhammad Specialist Hospital, Muhammad Abdullahi Wase Teaching Hospitals, Khalifa Sheikh Isyaku Rabiu Paediatric Hospital, Waziri Shehu Gidado General Hospital and Imamu Wali General Hospital. Our plan now is to expand it to other hospitals in the State.”
According to him, “such actions violate the agreement between the agency and healthcare providers." He said the agency recently found public and private facilities in the State for violating its agreement.
Dr. Nuraddeen, who further urged hospitals to comply with the scheme’s guidelines or risk losing their accreditation, reiterated that KSCHMA has a robust monitoring system in place and will not hesitate to sanction defaulters.
On concerns from enrollees over the circulation of substandard drugs, the Director General of Kano State Drugs and Medical Supply Consumables Agency, Pharm. Gali Sule said confirmatory tests are conducted on drugs before they are supplied to the hospitals.
“We make sure we confirm basic confirmatory tests on the drugs we are getting from manufacturers and importers. And we also conduct these tests on the drugs we are producing locally to ensure that we supply drugs that fulfil the requirements of the regulatory agencies in Nigeria.”
However, Pharm. Sule revealed that the agency only supplies drugs to government-owned hospitals, saying they cannot supply drugs to all the hospitals in Kano.
“This agency was established by the Kano State House of Assembly in 2009 to source and supply drugs to Kano State government-owned hospitals.
"And even though we have over 1,000 facilities in the State, we only supply drugs and consumables to 901 facilities as we can’t supply drugs to all the facilities.”
He further said, “It’s not the mandate of the agency to supply drugs to private hospitals, but they can buy the drugs from approved government sources.”
Pharm. Sule said the state government is currently upgrading its “manufacturing unit” to accommodate private hospitals.
Adds that once completed, “the agency would produce drugs for all the facilities across the state.”
As private hospitals continue to struggle with drug shortages, enrollees are calling on the State Government to improve the efficiency of the scheme by reviewing the capitation fees with immediate effect.
