Access to healthcare in Lagos State, PwDs are largely left behind

According to Center for Citizen with Disabilities (CCD), Lagos state has more than 2million Persons with Disability(PwDs).  To avoid discrimination and exclusion of PwDs in Lagos state, Lagos State passed the   Lagos State Special People Law 2011 which provides for the right of   PwDs to heath, education, work and employment, freedom of communication and other human rights.

To ensure implementation of the above plus all-round adequate protection of PwDs, Lagos State had gone ahead with creation of Lagos State Office of Disability Affairs as well as a specialised Agency, LASODA for this.  12 years after the passage of the bill, do people with disability have easier access to healthcare in Lagos State?

A visit to hospitals in Lagos revealed trauma and lack of proper attention to PwDs health concern across the state. In Gbagada General Lagos State we assessed the implementation of Disability Acts with regards to health care as well as how much the law has translated into better healthcare for PwDs in Lagos.

Our findings show there is a gap between what was promised and what is available. The question is how long should PwDs continue to suffer despite all the noise in Lagos about a sustainable and smart city while many are still being left behind?

In terms of physical access, the hospital buildings have ramps, there were maps for directions, the hospital reception was accessible and large enough. However, the health care facilities were grossly inefficient and were not able to erase barriers that can make PwDs health care service effective. This is not peculiar to Gbagada General hospital but many others.

For instance, in the area of information and communications, there is a need for information and communication materials. Health professionals including social workers in the hospital do not have adequate knowledge of sign language interpreters. Also no provision was made for physically impaired. There are no materials in braille, neither was there a provision for alternative channels, such as virtual visits.

Hospital officials concern, Government and LASODA attitude

Mrs Aderibigbe (not real name) a nurse at the hospital when asked what was her experience treating PwDs in the hospital said, “we don’t make them wait longer than necessary before attending to them, but we are short staff ourselves. Lack of adequate and qualified human resources has affected our prompt service”.

Aderibigbe also said “Generally we try our best to give attention to PwDs but you know when the pressure is much, the health worker might not have the patience to attend to them”.  Aderibigbe continued, “I have a particular deaf couple patient, at first, it was difficult to communicate with them but they were able to communicate through writing.  In a particular instance, the wife had visited the hospital and she was attended to by another nurse who probably was not patient enough. Immediately, she saw me passing by, she pulled my dress for attention and wrote some instruction in a paper for me. I had to stop and take her to the doctor.  Thank God, she can write legibly. Communication with some of them are very difficult because you can’t even understand their handwriting”.

I visited the social welfare office of the hospital. Mr Salimonu(not real name) was a staff in that office when asked if the office has been able to accommodate the healthcare needs of the hospital PwD patients. Salimonu said “Social welfare unit has fairly been able to accommodate PwDs needs because when many of them come they are able to pay for their health bill. As long as this is done, the hospital must accommodate them. Though in our hospital destitute fund we categorize PwDs as indigents”.

Sometime, from the hospital’s destitute fund, we pay for some PwDs. Salimonu mentioned a case of PwD, Kehinde (who is visually impaired and is suffering from Diabetes and renal issues. The hospital had to caterer for some of his bills with the destitute fund arrangement”.

When asked about the Lagos state Health scheme which made some provisions for PwDs, Salimonu said “the provision is there but the hospital continue to experience difficulty in getting a refund from the Government.   LASODA had a scheme with a health certificate for PwDs but getting refund is like passing through a needle’s eye, if we are successful at it at all”. This is the reason the hospital is sometime reluctant to treat those with the LASODA Certificate. But out of pity we often go the extra mile”. Salimonu Concluded.

PwDs cry for help, illiterate PwDs are the most excluded from the health Care

I interviewed Some PwD in Lagos State. I asked if and how they receive health care; and challenges associated with accessing healthcare in public hospital.

Many of the illiterate PwDs I talked to were not aware of the provision to healthcare services for them by the insurance scheme. Mr Faitai Salami (a 49 year old illiterate PwD ) said, “I don’t visit any hospital in Lagos, the last time I visited the hospital, I used  a private health facility because they will attend to me fast. I don’t use public hospital even though I know their service might be better”.

                                                      Fatai Salami, A PWD, PC- Busola Oladunjoye

“I settled for the private hospital over the public health services because the times I used to wait for treatment was longer. Sometime one has to wait the whole day to get below the standard attention required” Salami claimed. “I still need medical attention and will like the government to come to my aid” Salami cried out.

When asked if he was aware of the Lagos state health insurance scheme for PwDs? Salami said “I am not aware but will be happy if enrolled in the health Insurance Scheme”.

Aminat another PwD (visually impaired) when asked to assess how she was treated at the hospital whenever she visits? Amìna said, “I seldom visit hospital because It is difficult to access.  I need an aide, which is not always available”.

“Whenever I visit, I pay for the service received and I am not aware of the Lagos State Insurance that cover PwDs”. Aminat said.

This is the sad reality of exclusion from health service of PwDs, not only in Lagos State but in Nigeria in general. A sizeable number of people are being left behind.

Iyiola, a PwD graduate civil servant when asked about his experience using the Public health facility said “Though there seems to be an improvement on what it used to be but there is still room for Improvement”. Iyiola said, “I am aware of the Lagos State Health Insurance scheme and had benefited from it, but I think in its operation it is still not the best and there is still room for improvement”.

According to Iyiola, “Each category of disability: physical, hearing, visual, mental, psychosocial disability has its own peculiar needs which one would have thought will be captured in the health insurance but unfortunately, that is not the case”.

Tade (not real name) one of the leaders of PwD cluster said “We were all hoping that the insurance will take care of the peculiar needs of each cluster members. For instance, our Albinism Cluster members have skin conditions and are predisposed to skin cancer when exposed to sun because of their lack of melanin, we were thinking that the health insurance scheme will cover sun screen lotion for them but unfortunately the health insurance only covers common illness as persons without Disability”.

When I personally checked, the most unfortunate thing about the purported health care scheme for PwDs in Lagos is that the scheme is an annual subscription and it ends after one year.  After one year what happened?

The Lagos State Office for Disability Affairs (LASODA), the agency which is saddled with the responsibility of upholding the rights of PwD and   ensuring enrolment of PwD into the scheme seems to be unconcerned. Though its website published an article encouraging members to use the scheme. In order to get first-hand view of the situation, I personally visited the Agency’s office twice. The General Manager, Mr. Dare Dairo and other management team refused to speak to me.

According to LASODA website, Lagos State Government through its Health insurance scheme made provision for 2500 free slots for PwDs. This is a welcomed development, however, it is infinitesimal to the number of PwDs in Lagos State.

Addressing the challenges of Healthcare Service for PwD in Lagos State and solutions.

In the cause of the report, I discovered despite the effort made by Lagos State Government, access to health facility status of PwDs is still very poor as they lack physical access in terms of transportation, especially persons with physical Disability such as visually impaired. There is still more to be done to allow for proper information, communication and integration between PwDs and their caregivers.  Information materials should be made available in braille, and sign language. There is need for professional standby interpreters in hospitals.

The brain drain in the Nigeria health sector has limited professional human resources supply of medical professional for all and not just the PwDs. But generally if the concerns of PwDs are not prioritized or given extra attention, Nigeria may lose more valuable potentials among PwDs to death.

More health workers need to be employed and if possible PwDs should have specialized and trained health care providers attending to them. Health workers in Lagos State need to be trained to understand the need of PwD patients.

PwDs in Lagos need special attention than people without disability due to various forms of barriers: Physical, financial, communication, illiteracy barrier. Healthcare insurance for persons with Disability should cover their peculiar health needs and stretch beyond one-year limit.