The sky was a little bright. It was in November. My son had malaria, so I decided to take him to Ilorin General Hospital for medical treatment.
It was akin to a marketplace, with people seated, patiently awaiting their turn to be called. When it was our turn, a tall, fair-skinned woman called us forward. As we entered the doctor's office, the assistant, accompanied by a staff member, requested a medical certificate for someone in Cotonou, Benin Republic. However, the doctor declined the request.
After the doctor treated my son, he instructed the woman to take us to the pharmacy to pick up the prescribed medication. On our way out, a man whom the doctor had denied a medical certificate approached her, and she reassured him that some doctors would issue it without any issue.
As we nearly got to the pharmacy, a nurse came over and handed the woman a document to take to the doctor for signing. It felt like magic when she told the man that this was exactly what he had asked for. According to her, medical staff are efficiently issuing out certificates to people without conducting any tests.
Based on that premise, investigative journalist Buhari Olanrewaju Ahmed was enticed to conduct undercover research on how government hospitals issue medical certificates for proxies.
How to Obtain a Medical Certificate At Ilorin General Hospital By Proxy
It was early Monday in January 2024 at Ilorin General Hospital. Many patients anxiously awaited medical attention, each with their unique concerns, unlike the typical patient who seeks a doctor to address complaints.
I headed towards the medical ward, I encountered a woman, Mrs Ramat Habeeb (a pseudonym), and informed her that a friend residing in Abuja required a medical certificate for international travel. She asked me to wait for her to assist.
After a while, she approached and stared at me, scrutinizing me closely to confirm that I wasn't sent to implicate her. For the first time, she chose her words carefully. She said that the tasks would be challenging and that the doctor would not issue a medical certificate without the necessary tests.
However, she suggested I stand as a proxy for the person, as no mode of identification was required during the process.
Mrs. Habeeb pointed to a desk where they had posted the number of tests that I would undergo. She informed me that I would need to open a folder. She then guided me to the area where I could obtain a folder. The place was crowded, with some patients having been there since 6 am, waiting to receive numbers from the card record unit.
The assigned number determines how quickly one will be attended to; for instance, if your number is 20, you will have to wait until the doctor has attended to the 19 people who arrived before you.
Meanwhile, she told me to follow her. We entered through the back door, and I was asked for my name, age, and address. Everything was done manually. It was during the process that I gave Mrs Habeeb N1,000 because I had to pay to obtain a card at the revenue office very close to where I was registered.
How Laboratory Attendants Collect Money Without Issuing A Receipt
I was directed to the place where I would undergo a medical test. Upon entering, she looked at me and asked if I knew my genotype and blood group. I replied, "No." She then informed me that the cost was N4,000, even though a doctor previously told me that all the tests amounted to N2,000.
I informed her that a doctor said the cost was N2,000. She became upset, calculated the test herself, then stood up and said that was the correct amount. However, due to the referral, she requested N3,000, which I paid in cash without receiving a receipt.
I learned that for any test conducted at the general hospital, one needs to make the payment first at the revenue office, and a receipt will be generated for the patient.
However, she collected the money without issuing a receipt.
She provided me with a container to collect my urine sample, and after obtaining it, she used a syringe to draw blood from my veins for a health assessment. The lab attendant told me to return the following day for my medical results.
The following day, I went directly to her office to collect my medical report. She inquired if the woman who referred me knew about my visit, and I confirmed it. She opened the logbook to verify the name provided on the card, she handed me the medical results, and I left her office.
However, I observed that she followed me, keeping an eye on my direction. Before reaching the doctor's office, I took a photo of the medical report.
Medical Record Personnel Failed To Ask For My Means Of Identification
I observed that the doctor seemed unaware of the entire situation but neglected to request proper identification before approving and giving the go-ahead.
The doctor inquired about my destination; I informed him it was the UK. He gathered the medical report, placed it in a folder, and told an office assistant to take me to the Chief Managing Director's office for approval. Upon arrival, we met the secretary, who generated a printout and instructed me to proceed to the revenue office to make a payment of N2,000.
After paying the money, I returned to the Secretary's office to present the receipt. She printed the original medical certificate without verifying my identity. After stamping it, she told me to go to the doctor's office for his signature.
The doctor signed and gave me the certificate.
How To Obtain A Medical Report In Kwara Government Hospital Without Undergoing A Test
I uncovered the medical report racketeering at Kwara Government Hospital and visited Offa General Hospital to investigate the practice.
It was around 9:30 am when I entered the hospital. I noticed a woman working as a staff member and inquired about obtaining a medical report. She directed me to an office next to the building where she was located. I proceeded to the office to inquire further, and they told me to open a folder in the card unit. I was informed that I needed to undergo a series of tests at the lab before receiving the results.
I went back to the woman who guided me to the office and explained what they instructed me to do. I also told her that one of my friends in Abuja urgently required a medical report.
She said that there was no need to open a folder. According to her, many people seeking the same thing don't always request to open a folder, and that's how they manage to streamline the process.
As we were talking, a lady, who turned out to be a staff member at the hospital, approached, and the woman informed her about my need for a medical report for my friend.
The woman explained that obtaining it is quite straightforward, but nowadays, people are exercising caution to avoid falling into the trap. They are wary of being caught in the act and subsequently losing their jobs without any alternative means of survival.
She told me to wait and proceeded directly to the office where I had been directed to make an inquiry. After a few minutes, she came out with a female staff member, and they engaged in a discussion. Following their conversation, I was summoned.
The female staff member in charge of the medical department asked if I knew my friend's genotype and blood group. I confirmed, and she said it would cost me N5,000. Without hesitation, I paid the amount.
However, no receipt was issued, and I did not receive a card during the process.
After providing the required details, within 5 minutes, they issued the medical report to me without conducting any tests.
During the visit to the Civil Service Hospital and Cottage Hospital in Ilorin, both owned by the state government, I found that some medical staff members stated they could not issue medical certificates or reports by proxy.
They said any person who needs the document must be present to fulfil all the requirements.
What Law Says
A legal practitioner based in Kwara State, Barrister Ibn Mahmud Harnua, from AbdulWahab Bamidele and Co., discussed the legal implications of issuing a medical certificate or report without undergoing the necessary tests as required.
He said, "Forgery is a very serious offence in Nigeria. There are numerous acts that constitute forgery, and one of them is the forgery of a medical report. By the ethics that govern medical practitioners, just like lawyers, they are not permitted to issue a report without conducting a test.
“This is to ensure that there is no false impression that a test has been conducted."
He explained that engaging in such practices is not only against medical ethics but also constitutes criminal and fraudulent activities, going against the tenets and intent of Nigerian law. He noted that certificate forgery is considered a crime in Nigeria under both the penal code and the criminal code.
"The panel code is relevant to the Northern part of Nigeria, including the Federal Capital Territory (FCT), whereas the criminal code applies to the southern part of the country. Under Section 463 of the Criminal Code, there is a prescribed three-year imprisonment sentence for forgery,” he said.
“Meanwhile, forgery offenses are addressed in Sections 362 to 364 of the Penal Code, carrying penalties of up to 14 years of imprisonment."
"So, when you visit a medical doctor and an inquiry is conducted, or the authenticity is sought after, and it turns out to be fake, and the hospital states that there are no traces of any test conducted. They may also deny that the document was not signed by a qualified medical doctor or assert that the signature of the doctor was obtained without his knowledge. Meanwhile, they may claim that the doctor signed without conducting the test. In any of these scenarios, complications are bound to arise."
He said that arrests will be made, investigations will be conducted, and the proceedings may ultimately result in arraignment in court.
What Authorities Need To do
Barrister Harnua said governance is a collective responsibility, and one of the ways the state government can address issuing of medical certificates or medical reports either by proxy or without conducting tests is by providing useful information to the police by telling them that an agency of the government is issuing a medical certificate. They should send a copy to the police to let them investigate the authenticity.
He said there should be a deterrent measure so that others will not do such again.
He further explained that issuing medical certificates or reports without conducting any tests poses a significant risk. According to him, the state government must step up its efforts to combat this menace, and the media should play a crucial role in disseminating accurate information.
By exposing the dangers associated with forgery and other criminal offences, the press can contribute to raising awareness among the public, he noted.
He said, "The court must not take charges of forgery lightly. It is imperative that they ensure these allegations are tenuously dealt with. A person should not have a forgery case lingering in court. The court should handle it expeditiously and ensure that justice is served to all parties involved."
Speaking on Data Management, Barrister Haruna faulted the government for its inadequate handling of data, emphasizing the repetitive nature of data routines such as NIN, BVN, KYC, and International passport.
He stated that if all these data were harmonized, it would discourage people from obtaining medical certificates or medical reports by proxy or without undergoing necessary tests before results are issued.
"If we implement data harmonization, the doctor will be able to accurately identify the actual person in need of the certificate. It will also enable the identification of a proxy who may have arrived on behalf of someone else."
He explained the importance of doctors consistently requesting identification from people before issuing any medical certificate or report is to ensure the authenticity of the individuals involved and prevent doctors from becoming victims of potential fraudulent activities.
Kwara State Commissioner For Health Decline To Speak
Initial efforts were made to get the reaction of the Kwara State Commissioner of Health proved abortive.
When I visited the Kwara State Ministry of Health along Fate Ilorin, Dr. Amina Ahmed El-Imam, the Kwara State Commissioner for Health, declined to speak. However, she directed the Press Secretary of the ministry, Mr. Bashir Lawal, to speak with me.
Lawal said, "You know in Kwara State, we have a commissioner who is a political appointee. Therefore, she's not in the right position to comment on the issue of medical certificate racketeering as she is not closely connected to the hospital."
This report is produced with support from the Wole Soyinka Centre for Investigative Journalism (WSCIJ), under CMEDIA Project.