05/02/2015 08:13 GMT | Updated 07/04/2015 06:59 BST

Imprisoned in Hospital - The Story of Folake Oduyoye

In early November 2014, Wellbeing Foundation Africa (WBFA) and I assisted Mr. and Mrs. Ifeanyi Benjamin Amadu in Lagos State, Nigeria. A few months into Mrs. Amadu's pregnancy, she was told she was having triplets. The news came as a surprise and the family found themselves unprepared for the financial costs associated with having triplets. Upon giving birth, the family were not able to pay the hospital bill. Unable to leave the hospital until the bill was settled, the family appealed for urgent assistance from the general public.

Having had twins, I understand the additional costs that can accompany the blessing of a multiple birth. This is why I initiated the Twins and Multiple Births (TMB) Programme and the Indigent Medical Fund (IMedF) in 2004, which provided patients in need with financial assistance and guidance. As part of these programmes, WBFA supported the Amadus with their hospital bills and donated further funds for the feeding and care of the infants.

In the case of the Amadus, the story ended well, with the triplets and mother returning home, happy and healthy. However, for thousands of Nigerian families each year, the story ends similarly to Folake Oduyoye - a mother whose death at the Lagos University Teaching Hospital (LUTH), late last year, has instigated protests and ignited fierce debate about Nigeria's healthcare system and structures.

Folake Oduyoye, who delivered her child at a private hospital, was transferred to LUTH - a government medical facility - after developing post-delivery complications. Her treatments were successful and Mrs Oduyoye could have been officially discharged from the hospital. However, after being presented with a hospital bill of over N1.3million, her husband was unable to fully settle the bill. On this basis, the hospital allegedly refused to discharge his wife until a guarantor was provided to underwrite the debt. During her prolonged stay at LUTH, Mrs Oduyoye developed other health issues. The hospital could apparently not treat her due to the unsettled debt, nor would they transfer her to a different facility. Her condition worsened and unfortunately, she died on December 13th 2014. Her unnecessary death - and ensuing confusion due to an apparent lack of accurate patient custody records that detail her stay at the hospital - raises serious concerns about the conditions of Nigeria's public hospitals. Yet, wider questions must also be asked about how we fund healthcare as a whole.

Our public hospitals are woefully under-funded. It is not unheard of for pregnant women to have to buy candles and fuel in case their hospital suffers a power cut during delivery. The onus is placed on patients to plug the funding gaps for basic commodities like power and lighting in our neglected public hospitals. When government-funded hospitals are not receiving sufficient funds from the government, can we really blame the overstretched and under-funded hospitals? Despite a much-vaunted announcement of a presidential taskforce to improve Nigeria's public hospitals, we have yet to see the benefits translate to the daily lives of Nigerian families.

Therefore, the Nigerian government must make a clear commitment to improving our healthcare system, starting with a significant investment in our public hospitals as well as innovative financing for healthcare, including community-based health insurance. With the population set to boom by 62% by 2030, investments must be made now to ensure that we are prepared to meet the growing demand for healthcare from a growing population. Without an investment in the health of our citizens, our local, regional, and international development has the potential to be stalled. The recent outbreak of Ebola in the West African region has highlighted the importance of investing in healthcare systems to ensure they can handle the pressures of a crisis or growing population. Investing in our healthcare systems now will allow us to develop the structures that will make access to quality care, for even the most complex cases, an attainable possibility for all Nigerian citizens.

Despite the current administration's claim that Nigeria's maternal mortality ratio fell by 50% over the last 10 years, the National Demographic and Health Survey (NDHS) figures from 2003-2013 only show a fall of 27% in that same period. At the WBFA, we believe this reduction is largely due to increased advocacy and awareness of demand creation in healthcare services and commodities by organisations such as ours. Until the infrastructural and funding gaps within the health system are plugged, Nigeria will continue to suffer from the scourge of preventable mortality because facilities are not meeting demand, in the required quantity and quality.

For over 10 years, WBFA and I have intervened to assist with medical bills through our various community programmes like the TMB and IMedF. However, this model is ultimately unsustainable and as we move into the era of Sustainable Development Goals (SDGs), WBFA will be recalibrating its approach to ensure that Nigeria can meet international targets to reduce maternal, newborn and child mortality rates. Therefore, I am pleased to announce that, in a few weeks, we will be launching a Universal Health Coverage Birth Preparedness Fund, which will provide comprehensive health insurance for 5000 mothers, newborns and children, adolescent girls, and people living with HIV/AIDS, each year in participating communities.

I believe that universal access to innovative financing schemes like this and Kwara State's internationally celebrated Community Health Insurance Scheme could have prevented the death of Folake Oduyoye and many mothers like her. With annual minimum wage set at just N18000, spiralling hospital bills of over N1million are simply out of reach for ordinary Nigerians. In contrast, affordable health insurance schemes prepare families for the cost of childbirth, as well as the on going care of their children. With access to affordable health insurance, families can offset the costs of their medical bills over time and ensure that they are able to obtain the life-saving care they need, when they need it.

Beyond funding, there is the very salient challenge of a lack of respectful maternity care (RMC). Imprisoning a woman trapped in a cycle of poverty that is beyond her control and denying her liberty after childbirth in a public hospital is surely not fair or equitable in a sovereign democracy that claims to be implementing public health innovation? Working with the White Ribbon Alliance for Safe Motherhood, alongside Population Council, and the Kwara State Government, the WBFA have institutionalised RMC best practices in Kwara State as an example for the rest of Nigeria. Kwara State is the first area across the African continent to have a dedicated budget for respectful maternity care.

Therefore, substantial progress on reducing maternal, newborn and child mortality in Nigeria will not happen unless every Nigerian can access affordable health insurance and quality, respectful healthcare. Our government must put words into action and develop scalable, sustainable health insurance and savings schemes for all Nigerians, whilst addressing the systemic issues in pre-service training that can ensure quality across the entire spectrum of healthcare. This will ensure that families like the Amadus and Oduyoyes can spend the first few months after birth in joy, rather than economic peril or grief.