Sodiq Ojuroungbe
National Identity Management Commission require citizens to present their biometric data, including fingerprint scans, as part of the NIN enrolment process. SODIQ OJUROUNGBE writes on how the journey to obtain a digital identity has become frustrating for lepers and other Nigerians living with disabilities.
For over two years, all efforts made by 73-year-old John Ojoawo to obtain his National Identity Number have been futile. Every trip made to the enrollment centre leaves him spent, perplexed and downcast.
The septuagenarian, who has lived with leprosy for the greater part of his life believes that not having a digital identity compounded his challenges, majorly among them being discrimination and the inability to be reintegrated into society.
Life at the leper colony located in the Elega area of Abeokuta, Ogun State, he told PUNCH Healthwise, has been difficult; since he was ostracised from his family and community.
The huge burden of leprosy stigma weighs on him heavily and denies him the ability to find menial jobs for survival.
Despite a successful treatment regimen, he lives with physical disabilities that include the loss of his two hands.
When NIMC began the process of registering all citizens for the NIN, Ojoawo told our correspondent that he tried to get the digital number but could not, even when NIMC brought the registration centre to the lepers’ colony.
Without a NIN, the 73-year-old man has been unable to open a bank account and access many other essential services in Nigeria.
After trying and failing to get his NIN multiple times, he finally resorted to using his son’s bank account for financial transactions.
As he sat in his room at the colony, recounting his many struggles to PUNCH Healthwise, he painfully recalled how a commercial bank returned his money when they were unable to capture his fingerprint during registration after several attempts
“I don’t have a NIN. I was the one belonging to my child because the system couldn’t capture my fingerprint. It was easy for some others because leprosy affects people in different ways.
“Some become bald in their hands like mine, and we that are affected like this, except if the government finds another way, there’s no way we can get NIN enrolment because the machine can’t detect our fingers,” the elderly man said in smattering English.
Ojoawo’s experience is not isolated as findings by PUNCH Healthwise revealed that there are many persons living with disabilities in Nigeria who have been unable to obtain their NIN.
It was gathered that the challenges they face are not limited to the NIN enrollment process alone because they also struggle to access other government services, such as banking, tax payment, and obtaining international passports, among others.
The World Health Organisation described leprosy, which is also known as Hansen’s disease, as a chronic infectious disease caused by a type of bacteria known as Mycobacterium leprae.
The WHO explained that the disease, which predominantly affects the skin and peripheral nerves, may cause progressive and permanent disabilities if left untreated.
According to the global health body, the disease is transmitted through droplets from the nose and mouth. Prolonged close contact over months with someone with untreated leprosy is also what it takes to become infected with the disease.
Digital identity debut
In response to repeated kidnappings for ransom and the inability of security authorities to identify and trace abductors via their mobile lines, the Federal Government mandated that all Subscriber Identification Modules be linked with NIMC.
The government said the synchronisation would help the government identify crooks and provide a digital framework for improving security and strengthening the economy.
In a statement credited to the Nigerian Communications Commission on December 15, 2020, the government directed telecommunication providers to disconnect all SIMs without a NIN attached by December 30, 2020. The deadlines were reviewed multiple times.
Since the directive by NCC in December 2020, millions of Nigerians thronged NIMC offices and enrolment centres across the country, waiting long hours just to register and get the identity number.
NIMC, in 2020, set a target of capturing all Nigerians in its database between 2023 and 2024 after the Federal Government secured a World Bank credit facility of $430 million for the NIMC under the Nigeria Digital Identification for Development Project.
The project seeks to increase the number of persons enrolled for NIN from 36.894 million on October 11, 2019, to 148 million by June 1, 2024.
Part of the target is also to enrol 65 million women and girls and 50 million children under the age of 16 by before the date.
The project also mandates the NIMC, as part of its intermediate results indicators, to periodically consult with beneficiaries, stakeholders, marginalised groups, and the government.
In February 2021, former Minister of Communications and Digital Economy, Dr Isa Pantami, announced the FG’s plan to replace the Bank Verification Numbers with NIN.
It further mandated using the NIN for transactions, including opening bank accounts, voter registration, and payment of tax, among others.
According to NIMC, NIN consists of 11 non-intelligible numbers randomly chosen and assigned to an individual after enrolment into the National Identity Database.
The NIMC Act 2007 provides for the establishment of the NIMC, its functions, powers, establishment of the National Identity Database, assignment of the National Identification Number as well as issuance of token General Multi-purpose cards.
PWDs suffer exclusion
Section 27 of the NIMC Act stipulates that to partake and enjoy government services without NIN is an offence, punishable by fine or imprisonment.
Despite being a compulsory document to enjoy digital public infrastructure in the country, PUNCH Healthwise gathered many people with disabilities, especially those without fingers have been denied participation in having the unique digital identity.
For PWDs, the challenges of NIN enrollment are even greater. Many people with disabilities, including people with leprosy, have difficulty getting to an enrollment centre due to mobility issues.
Though NIMC opened temporary registration centres in many of the leper’s colonies across the country, including where Ojoawo lives, people without fingerprints were unable to obtain digital identity numbers.
A digital expert, Oladele Igbagboyemi said having a NIN is essential to accessing many services in Nigeria.
According to him, people cannot open a bank account, which translates to the inability to save money or access financial services.
He also pointed out that they cannot register a SIM card, which makes it difficult to communicate and stay connected to friends, loved ones or business associates.
“They can’t obtain an international passport, which makes it impossible to travel or move around the country with ease. In addition, without a NIN, people can’t participate in the National Health Insurance Scheme, which provides access to healthcare. This lack of access to essential services and opportunities has a profound impact on the lives of people like Ojoawo,” he lamented.
Some of the people living with leprosy who spoke with PUNCH Healthwise, expressed displeasure that they were not considered eligible for the NIN because they do not have fingers, despite having a birth certificate and other documents that proved their identities.
Titus Olatoregun, who also lives in the same Elega leprosy colony, said he lost hope in the digitalisation process because several efforts to get enrolled were not successful due to the inability to detect his fingerprints.
He said dejectedly, “I feel like I am less human and don’t even exist in this country. Without a NIN, I can’t open a bank account, or apply for a loan.
“I am stuck in this place; unable to move forward in life all because I don’t have fingers.
“I am a Nigerian, just like everyone else. I deserve to have a NIN just like anyone. It feels like the system is designed to exclude people like me living with disabilities.
“It is not my fault that I don’t have fingers. I just want to be treated like everyone else.”
Also, a 54-year-old woman who identified herself simply as Bolaji, said anytime those with leprosy get to the enrolment centre at the Akomoje area of Abeokuta, they usually meet a large crowd and the officials would tell them they can only register an allotted number daily.
She said, “We have gone there about five times, yet we couldn’t get it done. It has been over eight months since my information was entered into the system but I have not collected my slip. I can’t do anything without it because they said I need my NIN to be able to open a bank account, among other things. I asked them if I could do it again elsewhere but they said no.
“Officials in my back said I can’t open an account unless I provide my NIN. I even asked them if it was possible to make use of my child’s NIN, but they said it must be my own.”
Speaking on the predicament of residents, the secretary of the colony, Folrunsho Lukman said, “Those with bad fingers tried to register but some were unsuccessful, while others scaled through. I have my NIN. The NIMC brought the system here to register us and it was very easy.
“I also have a bank account, we also have a way we did it that made it very easy. We met with the bank and told them we have a large number of members that want to register and they came to do an online registration for us but we later had to finish the registration at their office.
“It is only some of our members who were unable to get their NIN and apply for bank accounts. We hope something can be done to capture them.”
Promoting digital inclusion
According to the WHO, in 2018, about 29 million of the 195 million people who comprise Nigeria’s national population were living with a disability.
The global organisation indicated that persons with disabilities lack access to basic services and that attitudinal barriers represent a major impediment to their socioeconomic inclusion.
It noted that inclusive policies are either nonexistent, weak or inadequately implemented.
Corroborating WHO, human rights advocates say that the requirement for fingerprint scans to obtain NIN is promoting digital exclusion for people without thumbs.
While lamenting that the inability to access digital identity schemes is like shutting people without thumbs out of the digital world, the stakeholders insisted that fingerprint scans are discriminatory and violate the rights of such people.
A digital rights advocate, Tunde Adegbola said, “NIN is supposed to be a way for everyone to access government services and participate in the digital economy. But for people with no thumbs, it is an obstacle that is impossible to overcome. It is a form of discrimination and a human rights violation.”
He, however, urged the FG to find alternative ways to issue NIN to people without thumbs, noting that biometric data like iris scans or facial recognition could be used instead of fingerprint scans.
Supporting his stance, Oladele, a digital expert earlier cited, said the FG has not shown commitment or urgency to finding a solution to the problem.
“It is disappointing that the government has not acted fast to address this issue. People without thumbs are being excluded from the digital world and denied access to basic services. This is a clear violation of their human rights,” he lamented.
“This report is produced under the DPI Africa Journalism Fellowship Programme of the Media Foundation for West Africa and Co-Develop.”
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NEWS STORY ONE:
Physicians warn kidnap epidemic, economic crises may worsen physical, mental illnesses
Janet Ogundepo
As the economic crisis continues to bite harder and insecurity, especially kidnapping on the rise, medical experts have expressed worries over the possibility of an increase in the rate of non-communicable diseases and mental health illnesses.
The experts in separate exclusive interviews with PUNCH Healthwise noted that individuals and patients with NCDs are living in fear of the inability to buy essential medications due to the rising costs, coupled with the fear of being kidnapped.
According to the World Health Organisation, NCDs are diseases such as heart disease, cancer, chronic respiratory disease, hypertension and diabetes, adding that they are among the leading causes of death worldwide.
Shedding more light on how insecurity and rising drugs cost impacts negatively on Nigerians, the experts noted that living in constant fear and uncertainty would definitely lead to an increase in disease conditions and complications.
Recently, reports on kidnapping and killing incidents across several parts of the country have heightened, sending shivers down the spine of Nigerians.
The Federal Capital Territory, which is the nation’s seat of power, has been inundated with kidnap cases.
Of late recently, the Lagos-Ibadan Expressway and Ekiti State witnessed several kidnap cases with the latest being the abduction of five pupils and four teachers of the Apostolic Faith Group of Schools in Emure-Ekiti.
Last weekend, the Lagos State Chairman of the People’s Democratic Party, Philip Aivoji, and party officials were kidnapped at Ogere, along the Lagos-Ibadan Expressway.
These abductions come on the heels of the recent release of five sisters abducted alongside their father in Abuja in January.
The kidnappers requested a ransom of N60m and killed the eldest of the girls, Najeebah, in a bid to press home their ransom demands.
In several areas of the North and South East, killings and kidnapping continue unabated and according to worried Nigerians, the incidents have cast serious doubt on the ability of the security agencies to secure people and properties.
Meanwhile, the Civil Society Joint Action Group pegged the figure of violent deaths and abductions since the inauguration of the Tinubu-led administration at 2,423 and 1,872, respectively.
The economic crises, caused by the fuel subsidy removal by the President during his inauguration on May 2023, the Central Bank of Nigeria’s decision to float the naira leading to inflation, rise in production costs and the exit of British pharmaceutical giant, GlaxoSmithKline in August, have also been identified as factors leading to increases in the prices of goods and services, especially drugs.
Aside from leaving in fear and apprehension, the experts stated that the situation had left many Nigerians unable to meet their daily dietary needs and medications.
Consequently, there are fears that the situation would worsen the physical, physiological and mental health conditions of Nigerians with an underfunded health sector, which is less than five per cent of the country’s budgetary allocation, and with less than 45,000 doctors to care for over 213 million citizens.
Speaking with PUNCH Healthwise, the Unit Head of Endocrinology, Diabetes and Metabolism at the Department of Medicine, College of Medicine, Lagos University Teaching Hospital, Professor Olufemi Fasanmade, said patients with long-term non-communicable diseases are currently living in fear of the inability to buy their drugs.
He further noted that due to the dire economic crises, many patients no longer undergo routine medical check-ups in the hospitals, consequently leading to the fear of disease complications.
“Patients are now afraid of how they can afford their drugs, how they can continue to buy the drugs and the fear of complications arising if they can’t get the drugs.
“Many of them are anxious and some have not been coming in for their regular check-ups because either they can’t afford tests, drugs or transportation, or all three combined. That is a clear and present fear being nursed by the majority of patients,” the don said.
Fasanmade, who is also the President of the Endocrine and Metabolism Society of Nigeria, added that constant anxiety in patients with NCDs might increase their high blood pressure, sugar levels and sleep disorders.
He further noted that this would lead to deteriorating health conditions and worsened complications.
The endocrinologist added, “It is a vicious cycle because they are afraid that they can’t afford the routine drugs they take, thereby, reducing the medicine intake. With this, the complications get worse and they still can’t afford to take care of the complications, thus, bringing about more issues.”
The don, however, projected a sharp rise in the adoption of herbal and alternative medicines due to the increased drug prices.
“What we are going to see more in the future is that many more patients would revert to either native medicines or other alternative forms of treatment, including spiritual, among others because of the inability to afford orthodox medicines.
“Several patients say that they have started using herbs or prayers to take care of their health problems and this is mainly because of the cost of care,” he said.
On his part, a professor of psychiatry at the University of Ilorin, Kwara State, Peter Ajiboye, also agreed that insecurity and economic crisis are creating fear in Nigerians.
He added that this would increase anxiety symptoms, among other mental health conditions.
“The kidnap epidemic and economic situation are exposing a lot of people to undue fear and stressful conditions which has a lot of implications. For example, someone who is face to face with a kidnapper could have several reactions such as panic attacks and acute stress reaction, which makes the person become restless and unable to keep calm. This can lead to increased heart rate, sweating and fainting, among others.
“Having a close encounter with fearful conditions such as kidnap could cause post-traumatic stress disorder. After such a person has been released, there could be several health problems that could come up such as anxiety, irritability and loss of sleep.
“For the general populace, the insecurity and dire economic situation would increase stress levels which is a type of tension that could be unbearable. If someone continues to be subjected to such stressful conditions, there could be a lot of reactions, such as shouting, being irritated, restlessness, incessant headaches, loss of concentration and forgetfulness. If these continue unabated and people are pushed to their limits, they begin to develop anxiety and if left untreated, become depressed and start nursing suicide ideations,” Ajiboye warned.
The don further mentioned that the conditions could also trigger psychosis in persons with a familial history of mental illness.
Ajiboye, who is also a consultant psychiatrist at the University of Ilorin Teaching Hospital, said that such conditions could in the long run lead to hypertension, diabetes and reduced body immunity.
He added that individuals with NCDs could further have worsened symptoms.
The psychiatrist urged the government to address the economic and insecurity challenges in the country.
He advised individuals to avoid stressful conditions, be security conscious and avoid situations that could trigger fear.
“For some people, what they see and hear on the news and social media could be what triggers fear in them. For persons who have increased anxiety and tension after hearing such news, there is a need to regulate one’s exposure to triggers When under undue stress, it is better to get someone to speak to so that the situation can be addressed before it leads to a physiological, physical complication or mental health condition. People who are on treatment should take their medications regularly and if they need to call for assistance to get their medications, they should do so. We must learn not to focus on both the individual problems and those facing the country. We must do all we can to remain healthy,” the don advised.
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STORY TWO:
World Cancer Day: Economic crisis affecting patients’ access to care, NCS president
Janet Ogundepo
The economic crisis in the country has further worsened the plight of cancer patients in Nigeria, the President and Chief Executive Officer of the Nigerian Cancer Society, Dr Adamu Umar, has said.
Speaking in an exclusive interview with PUNCH Healthwise, he noted that the depreciation of the naira and the lack of holistic health coverage have increased the cost of care, leading to the death of some cancer patients who could no longer afford treatment costs.
PUNCH Healthwise in one of its reports noted that since the President, Bola Tinubu announced the removal of fuel subsidy in May 2023, the prices of goods and services witnessed an unprecedented increase.
Subsequently, the Central Bank of Nigeria’s decision to float the naira against other currencies led to naira depreciation and inflation.
Also, the exit of the British pharmaceutical giant, GlaxoSmithKline, in August 2023, led to over 300 to 900 per cent rise in the prices of drugs.
As a result, patients with long-term non-communicable diseases have continued to lament their inability to afford essential drugs.
According to the president of the NCS, which is a collation of cancer advocates in Nigeria, many cancer patients can no longer afford their medications.
Cancer, the World Health Organisation says, is the second leading cause of death globally, accounting for nearly 10 million deaths in 2020.
The National Cancer Institute says it is a disease in which some of the body cells grow uncontrollably and spread to other parts of the body.
Globally, the World Cancer Research Fund International pegged cancer figure cases at 18.1 million in 2020.
In 2020, Nigeria recorded 124,815 new cases, with breast and prostate cancer being the most common cancer types.
Speaking on the country’s current cancer rate, the NCS president stated that there were 120,000 new cases, of which 80,000 patients have died.
To further raise awareness and sensitise the public about cancer, on February 4 every year, World Cancer Day is commemorated.
WCD is an initiative of the Union for the International Cancer Control, which is the global cancer governing body. The theme of this year’s celebration is “Close the care gap.”
Further speaking with PUNCH Healthwise, Umar said that although cancer cases among children increased, it cannot be compared to that of adults.
He added that due to the lack of harmonisation in data collection, the prevalence rate of cancer in Nigeria was unknown.
Umar, however, stated that 10,000 new cases were recorded within three months in 2023, indicating an improvement in diagnosis and early hospital presentation.
“The prevalence has not changed in the sense that we have about 120,000 new cancer cases, according to recent statistics, and out of which over 80,000 died of the disease. Most of the cancer presentations we have in Nigeria are late and when cancers present late, of course, one would expect a worse outcome.
“This is one of the major problems we are having in Nigeria. Another major problem is data collection. The data we use are those obtained from the data registries and hospitals that keep cancer records. But when you look at them, you will discover that for every cancer patient in the hospital, hundreds are out there that are undiagnosed. So the statistics may not be a true reflection of what is on the ground.
“On the other hand, for example, last year, within three months, we recorded over 10,000 new cancer cases. This is an indication that though it seems as if the cancer cases are rising, the actual case might be that there is an improvement in awareness rate and mechanism employed by advocates.
“There may equally be an improvement in the diagnostic modality for detecting cancers early. So when we have a rise in cancer cases, it doesn’t scare us because we look at it that more people are coming forward to be diagnosed,” he said.
Umar, who is also a public health physician, stated that cancers of the breast, cervix and prostate were the leading cancers in Nigeria and that the economic crisis was worsening the plight of patients.
“Even when the rate of the naira to the dollar was affordable and drugs were available, access to medicines by most Nigerians, especially for cancer patients was a herculean task. It is something that the ordinary Nigerian can’t afford.
“The current inflation, dynamics of the exchange rate and general situation of things in the country further go to show that there are compounding factors that made sure Nigerians don’t get access to the right medicines. This is why there is the need for the Universal Health Coverage. In the National Health Insurance Act, cancer is covered but not holistically.
“Cancer care is financially consuming and with the way things are in the country, cancer patients are suffering and people are dying because they can’t afford care,” the NCS president lamented.
He added that low literacy levels, especially among individuals in rural areas, and the misconceptions associated with cancers were responsible for late hospital presentation and access to care.
The NCS president, however, said there has been increased cancer awareness in the rural areas to ensure early detection and hospital presentation.
Umar further noted that although childhood cancers are on the increase, data on the three common cancers were still higher and constituted over 70 per cent of cancer cases.
“With improved diagnostic modalities and awareness, we have more cases of childhood cancers coming up and rare forms of cancer as cancer of the blood. It is not that these cancers were not in existence before now; it is just that there has been progress in diagnostic modalities in the country, such that we now have sophisticated and world-standard facilities and tools. So, there is an increase in the number of new cancer cases and improvement in care,” Umar added.
The public health physician concluded by advocating for a holistic UHC, increased budgetary allocation to healthcare, operationalisation of the vulnerable fund, and Cancer Health fund for indigent citizens to address the cancer care gap.
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STORY THREE:
Tinubu orders immediate action plan to curb drug price hike
Angela Onwuzoo
As Nigerians grapple with the skyrocketing cost of essential medicines, President Bola Tinubu has directed an immediate action plan to curb the hike in prices of drugs nationwide.
Consequently, he directed that an Executive Order be developed to reduce identified barriers to local drug manufacturing to enable the industry to thrive.
The Coordinating Minister of Health and Social Welfare Prof. Ali Pate, disclosed this in Lagos during a meeting with key stakeholders in the pharmaceutical sector aimed at exploring ways of addressing myriads of problems confronting the sector, especially hike in prices of drugs.
The meeting, which was organised by the pharma stakeholders enumerated various challenges that have plagued the sector for so many years and hindered it from making progress, and which the minister promised would be addressed by the Federal Government.
The stakeholders listed challenges in foreign exchange, expediting local production, procurement, policy inconsistency & implementation, pharmaceutical manufacturing development funds, and research & development as some of the critical issues begging for urgent attention in the sector.
They also lamented that the Nigerian pharmaceutical industry was heavily import-dependent.
The stakeholders in attendance include chief executive officers of pharmaceutical industries; the Director General, National Agency for Food and Drug Administration and Control, Prof. Moji Adeyeye; President, Pharmaceutical Society of Nigeria, Prof. Cyril Usifoh and Registrar, Pharmacists Council of Nigeria, Ibrahim Ahmed.
Others are President, Federation of Nigeria Pharmaceutical Industry Associations, Dr. Okey Akpa: Chairman, Pharmaceutical Manufacturers Group of Manufacturers Association of Nigeria; Oluwatosin Jolayemi, heads of pharmaceutical groups and professional bodies.
Speaking, Pate said the Federal Government was pursuing pharmaceutical manufacturing and local manufacturing aggressively to ensure that they thrive and Nigerians have access to affordable and safe medicines.
The minister said, “This consultation that we have had is fine and we will have the second consultative forum in three months times.
“As you know, the president has directed that an Executive Order be developed to look into it and will begin to reduce the barriers to local drug manufacturing to enable the industry to thrive.
“And we expect that over time, it will reduce the cost of pharmaceuticals. The rising cost of pharmaceuticals is a major issue that bothers all of us as a government.
“It is not only a Nigerian issue, it is a global issue. In the context of our administration, we are very focused on what we can do to reduce the burden on Nigerians, especially the most vulnerable.
“So, this is a very fruitful consultation that we have had with the industry.”
Experts in the pharmaceutical industry say the massive devaluation of the naira and the unfriendly business environment are adversely affecting Nigeria’s pharmaceutical sector and its profitability.
According to them, instead of the sector improving, things are getting worse as more pharmaceutical companies keep folding up.
Of late, the pharmaceutical industry has been facing a serious crisis, which has been attributed to the country’s harsh business environment occasioned by the paucity of forex, high inflation rate, and high loan interest repayment rate.
In August 2023, British multinational drugmaker and biotechnology company, GlaxoSmithKline, announced its exit from Nigeria.
Earlier, the President, of the Federation of Nigeria Pharmaceutical Industry Associations, Dr. Okey Akpa, while reeling out major problems plaguing the sector, said that despite their continuous efforts to ensure the availability and affordability of effective and safe medicines in Nigeria, the industry was still faced with some challenges that inhibit the expected growth.
Akpa, who is also Managing Director of SKG Pharma Ltd, said, “Our members have invested in state-of-the-art manufacturing facilities, some of which have received certifications from the World Health Organisation for Good Manufacturing Practices.
“We have achieved milestones, such as WHO pre-qualification for a product and as a matter of fact, we boast of some of the most extensive manufacturing facilities in Sub-Saharan Africa.
“We are also leading in the manufacture of diagnostics and medical devices with the recent opening of the first in-vitro diagnostic manufacturing facility in Sub-Saharan Africa. This further demonstrates our capability to compete globally if adequately supported.
“Our continuous efforts aim to ensure the availability and affordability of effective and safe medicines, including rare and innovative ones, by focusing on local production and strategic importation.
“However, our Industry faces some challenges that inhibit the expected growth. The recent scarcity of drugs and the attendant high costs underscores the need for the government and all stakeholders to pay critical attention to the pharmaceutical industry in Nigeria.”
The pharmacist assured the minister of the stakeholders’ commitment to collaborating with him to ensure sustainable access to quality, safe, effective, and affordable medicines, vaccines, and medical devices in Nigeria.
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