Chaos for patients, hospitals as Nigeria's currency crisis bites

• Pregnant women denied treatment without cash
• Healthworkers stranded, hospitals struggle to stay afloat
• Experts call for funding for health insurance for the poor

LAGOS - A day before his wife was due to give birth, Taiwo Ajayi Oluwole frantically called relatives and friends in a desperate bid to get any cash they could lay their hands on to pay the maternity hospital in Abuja, Nigeria's capital city.

Though he had money in the bank to cover the medical bills, the hospital insisted on a down payment of 100,000 naira ($217) in cash, before it would book her in for a caesarean section.

The central bank's attempt last month to make Nigerians swap old banknotes for new has not only left patients unable to pay for healthcare, but many medical professionals also cannot get to work in a country where cash is still very much king.

Violence and protests erupted across Nigeria as ATMs struggled to dispense new notes to the many people who had banked all their old cash before the Feb. 10 deadline and were left without any money.

The policy, now tied up in lawsuits, was aimed at curbing inflation, corruption and boosting cashless payments in Africa's biggest economy. Though the Supreme Court has postponed the ban on old notes twice, it is still not clear whether the central bank will recognise the ruling.

Oluwole said going to the bank was not an option as he had already spent more than 16 hours that week waiting at a number of ATMs in the city in search for cash to pay for the delivery of his child.

"I begged strangers, random people queueing for hours at ATMs, to sell their money to me. I never knew I would ever have to buy naira in Nigeria," he said, adding that he was only able to pay the bill after he exchanged $500 he had saved for emergencies at half the normal rate.

Two weeks after the hospital delivered a baby girl through caesarean section, Oluwole's wife had to go back to the hospital for follow-up checks.

"Bank transfers were not going through, so I went to buy cash again," the new father said.

Glory Ikudaisi had a similar experience at a faith-based clinic where she had been receiving antenatal care. As she went into labour, the clinic refused to admit her until she had paid half her bill upfront in cash.

"When I saw other pregnant women in labour waiting at the reception because they didn't have cash, I knew they were serious," she said from Lagos, Nigeria's biggest city.

After the birth, the clinic would not let her leave until it had confirmed her sister's bank transfer had arrived in its account.

"I don't know what will happen if I have to go to the hospital for any emergency with my baby," the new mother said.

Lives at stake

Stephen Kache, a paediatric surgeon at a state hospital in the northern city of Kaduna, said it has been demoralising to watch mothers from remote villages take babies needing emergency care back home because they did not have cash.

"Most of our patients are peasants, poor artisans from the villages around the city, and they don't have smartphones or bank accounts to make transfers," he told Context.

"If we treat them for free, they still need to pay for tests and drugs," he said.

Only 3% of Nigerians have health insurance, according to data firm Statista. Most are government staff or work in the formal sector, leaving the millions in informal work without a safety net when they fall ill.

Health experts and rights groups said that if a new law passed last year seeking to provide health insurance to some 83 million poorer Nigerians had been effective, many people would not have had to find cash to pay their medical bills.

Uche Ojinmah, head of the Nigerian Medical Association, said 70% of the country's healthcare expenditure was in cash, and hospitals and patients were struggling to cope without it. But, he said, hospitals should make an exception when lives were at stake.

"There are two lives at risk for a woman in labour. Emergencies are emergencies," Ojinmah said.

Healthworkers stranded

Hospitals say they are not the villains and say they are making losses trying to keep their facilities afloat.

Segun Adekunle, who runs the accident and emergency unit of a private hospital in the city of Oyo, southwest Nigeria, said many mobile money transfers and bank payments made by patients had failed, and the hospital was struggling to balance its accounts.

"There is simply no cash for us to run hospitals and buy medical supplies right now," the hospital administrator said in exasperation over the phone, adding that he was still chasing discharged patients whose bank transfers had failed.

He said some health workers were forced to spend hours in the queues at cash points when they should be caring for patients.

"Staff can't come to work, they don't have naira to pay transport fare. Only the senior doctors and nurses who have cars have been coming to work regularly," he said, adding that the situation was worsening as shortages of supplies and staff were delaying patient treatment.

Two of Nigeria's 36 state governments have come up with emergency funds for hospitals to treat pregnant women and children. Elsewhere, patients are left to find cash.

"This policy continues to create inequality and put people in a destitute situation where their rights to dignity are impacted in a manner that they have to rely on others for their survival," said Osai Ojigho, Amnesty International's Nigeria director.

($1 = 459.9600 naira)

(Reporting by Bukola Adebayo; Editing by Jon Hemming)