By Opeyemi Adelakun
Lagos State’s public hospitals have experienced a significant rise in patient attendance, with outpatient patronage doubling in the past six months amid growing pressure on healthcare workers and a shortage of professionals linked partly to brain drain.
The state Commissioner for Health, Prof Akin Abayomi, disclosed this during an interview with ARISE NEWS on Friday, saying the surge had left doctors and other healthcare professionals under considerable strain.
“In the last six months, our outpatient patronage has doubled in our public health facilities, Lasuthi, Korodu, Lagos Island.”
“I’ve seen thousands of patients a day. Now, you can’t imagine that kind of patronage in a private hospital.”
Abayomi linked the rising patronage partly to the increasing cost of healthcare, which he said was making private medical services unaffordable for many residents.
“While the cost of care is going up, the ability to buy that care is relatively stagnant.”
He said the situation was pushing residents from private hospitals into public facilities, while some were turning to informal providers, including roadside drug sellers and pharmacists, to obtain treatment without going through the conventional healthcare system.
“So the public are shifting from the private sector to the public sector and from the public sector to the informal sector, where they can walk into a pharmacist or stop the hawker on the road and tell them, I have a headache or I have a fever, and they get access to medication without going through the orthodox system.”
The commissioner said the growing number of patients was worsening pressure on healthcare workers already affected by the migration of medical professionals abroad.
“Our doctors and our healthcare professionals are under a lot of stress. You can imagine with the brain drain, with this influx of patients.”
Using the demands placed on medical workers to illustrate the situation, Abayomi said, “You know, if you work from 8 till 12, I don’t know what your time on stage is, but in the medical facility, can you imagine if they asked you to work from 6 in the morning to tomorrow 6 in the morning? It would be crazy,” he added.
Lagos Moves To Enforce Health Insurance
Against the backdrop of the growing pressure on public hospitals, Abayomi said Lagos would soon begin enforcing compulsory health insurance as part of efforts to strengthen healthcare financing.
“Now we’re moving into enforcement. So very soon, it’s just like if you have a car. You need three things. You need a licence, you need an MOT, and you need insurance. If you don’t have it, somewhere along the line, someone will enforce it,” he noted.
He said Lagos had domesticated the National Health Insurance Authority Act through an executive order issued in July 2024, making health insurance compulsory for people living and working in the state.
“Lagos was quick because of what you just described. Within a year or two, we had domesticated that law in July of 2024. That’s two years ago, in Mr. Governor’s executive order, essentially enforcing compulsory insurance on negotiations,” he said.
According to the commissioner, the state is restructuring its health insurance system while increasing public awareness about the benefits of insurance.
“We’re restructuring. We’re doing a lot of enforcement. We’re doing a lot of public health awareness. We’re doing a lot of educating the public around the need for insurance,” he added.
He said the government wanted every resident to have access to a basic social health insurance package, while private insurance would be incorporated into the broader system.
“So everybody should have at least a social health insurance basic minimum service of package cover. And then in the private sector, we’re incorporating them into that narrative so that if you have private insurance, you at least have the basic minimum package,” he stated.
“And that we’ve now restructured the tiers so that there is a cleaner operation of insurance in the state.”
Abayomi said better healthcare financing could also help address the brain drain by increasing the flow of money into the health sector and improving providers’ ability to retain and attract professionals.
“It all boils down to healthcare financing. It boils down to demand financing, the ability to finance the purchase of your care,” he added.
He said insurance could distribute healthcare costs among residents while reducing the financial burden on government.
“Health insurance does many things. It reduces the risk. It causes a cross-subsidy and social solidarity. It takes a lot of the burden away from government so that the private sector can flourish in a health system,” he noted.
The commissioner said increased purchasing power for healthcare could also help slow the migration of health professionals.
“Now when that happens, it will start to slow down brain drain because brain drain is an economic narrative.
“If we fix the demand-side financing, then funds will flow. If the public, if the business people in Lagos suddenly see that Lagotians have purchasing power for health care, they will fix the supply-side,” he said.
Public Hospitals Remain Heavily Subsidised
Abayomi also defended government investment in public healthcare, saying the state heavily subsidised services provided in its hospitals.
“The public health service is extremely subsidised. We build the hospitals. We pay 20,000 staff. We’re the biggest ministry in Lagos state government. We repair facilities. We buy equipment. We’re constantly paying for training. We’re paying for administration, overheads, power,” he added.
He said the subsidy meant that fees charged at public hospitals were generally less than half the cost of comparable services in private facilities.
“So they generally charge a range of something less than 50% of what private sector charges. Health is doing actually quite well,” he noted.
On budget implementation, Abayomi said, “We’re above 90 percent.”
The commissioner also addressed concerns over payment procedures and allegations that patients were sometimes required to make cash payments before receiving treatment.
He said the state had outsourced payment gateways to private operators to separate payment administration from clinical activities.
“We’ve now outsourced the payment gateways to the private sector so that it doesn’t mess up with clinical activities. So we engage payment collectors, and they are in all our facilities, and they collect the due charges that the patients have experienced within the facilities,” he added.
He said several companies were involved in operating the payment gateways.
“They’re different, yeah, and they’re different pay gateways,” he said.
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