IT is a sorry state of affairs for Bakari Ramadhan, a bodaboda rider who has been admitted to Muhimbili Orthopaedic Institute (MOI) for the past three weeks.
Despite battling with injuries sustained from a road crash, Bakari has no idea how he will foot his medical bills once he is discharged from hospital. The 24-year old man from Kilosa District in Morogoro Region is not insured in any way.
He depends on MOI’s hospitality, where he receives medical treatment and free meals provided by the facility every day.
His life has been plunged into uncertainty that will most likely trap him in the vicious cycle of poverty after being hit by a speeding vehicle in Mbagala, Dar es Salaam, while riding a motorcycle to Mtoni-Mtongani to pick a passenger was hit while trying to avoid a speeding vehicle that was coming ahead of me.
I, however, failed to get out of the road on time, resulting in the crash that saw me being injured on my hand and head,” the visibly disappointed Bakari says, adding that the vehicle left him for dead.
Before being admitted to MOI, Bakari, a father of three children, was first rushed to Temeke Regional Hospital and due to the severity of his injuries, he was transferred to MOI where most road traffic crash victims, including bodaboda victims, end up on emergency bases or for definitive treatment.
This is so because MOI offers the best orthopaedic and Trauma services in the country.
Abandoned by loved ones
“I was admitted here and underwent hand surgery,” he said before pouring out his heart that, neither his relative nor friend visits him.
He feels abandoned and all he wishes for is God’s grace to quickly recover and get a clean bill of health.
“I have no one to pay my bills. My family depends on me and all I’m wishing for is a quick recovery and if possible, the hospital discharges me so that I may pay the bills after resuming work.
“I earn between 20 000/- and 30 000/- per week and I have no other means of generating income. Working as a bodaboda rider is the only form of employment I have in town,” he said while wiping away tears from his face.
The tip of the iceberg
Bakari’s case is just, but the tip of the iceberg as many bodaboda riders are entangled in the same quagmire.
Their lives immediately become a living hell once they get involved in a crash, especially that, which leaves them bedridden.
The lack of insurance, especially health insurance, has been a thorn in the flesh for both the government and the riders’ families as their meagre finances are siphoned by medical bills, leaving them broke more than a church mouse.
It is unfortunate that despite developing countries, including Tanzania, using motorcycles as a means of public transport and as a form of employment for the youth, the welfare of these riders is at stake.
Just like Bakari, there are thousands of bodaboda riders, mostly the youth, in Dar es Salaam and in the country as a whole, who ply the roads without personal protection.
According to the 2018 Road Traffic Injuries Report by the World Health Organisation (WHO), road traffic injuries are the leading cause of death for children and young adults aged 5-29 years.
A research conducted by MOI orthopaedic specialist, Dr Bryson Mcharo, reveals that the rate of injury for people in lower income groups was 2.5 times greater than those in higher socioeconomic groups.
The majority of motorcycle crash injury victims are self-employed. Entitled ‘Motorcycle Crash: Injuries Pattern and Associated Factors among Patients Treated at Muhimbili Orthopaedic Institute (MOI)’, the research indicates that in 2010 motorcycle crash injuries were responsible for 30.8 per cent of all road traffic injuries treated at the emergency department.
The road traffic crash injuries were 56 per cent of all patients admitted to Muhimbili National Hospital, with motor vehicle traffic crash being the leading cause of fatal injuries accounting for 41 per cent of all deaths.
According to Traffic Police Report 2018 on Road Safety and road crashes related matters, 3,719 motorcycle riders were injured in 4,621 motorcycle road crashes that occurred between 2016 and 2018.
Siphoning meagre family resources .
The report says road traffic injuries cause considerable economic losses to individuals, their families and to the nation as a whole.
These losses arise from the cost of treatment as well as lost productivity for those killed or disabled by their injuries and for family members who need to take time off work or school to care for the injured.
In an interview with one Maria Swai, who is currently taking care of her husband admitted to MOI after he escaped death by a whisker in a road crash while riding a motorcycle to eke a living.
“It is very hectic as I have to wake up early in the morning every day to see him and then at lunch time and in the evening when I have to bring him his dinner.
I commute a lot, hence I fail to engage in any productive activity,” visibly distressed Mary says.
The family has been plunged into uncertainty as Maria’s husband, Mr Swai (36), is the breadwinner, but now that he is helplessly in hospital, with no hope of settling the medical expenses, the family’s welfare is compromised.
According to Maria, her husband has no health insurance, savings or any other personal protection that would cover his medical expenses.
Burdening the government
In an interview with the ‘Daily News on Saturday,’ an orthopaedic and trauma specialist at MOI, Dr Kennedy Nchimbi, said only four out of 60 bodaboda road crash victims reporting to hospital per month possess health insurance.
“Most of them (mostly riders) who come here have no health insurance or any plans on how to settle their medical bills,” says Dr Nchimbi.
To come to the rescue of genuine cases of such patients he said the hospital had a system that supports the uninsured and those, who are poor, to receive treatment required before being presented with medical bills, whereby the cost is shared between the patient and the government.
“The government pays a certain amount of medical expenses and the rest is paid by the patient,” he said, adding that, those, who couldn’t contribute to medical expenses under cost-sharing arrangement, were referred to the social welfare for help.
He said motorcycle crash victims reporting to hospital surpassed the number of other patients, when it came to accessing treatment under the medical expenses cost-sharing arrangement.
MOI Welfare and Public Relations Manager Juma Almasi said 60 per cent of the patients involved in accidents, including road traffic crashes, were treated under MOI’s social welfare bills.
Mr Almasi said such patients, including motorcycle riders, had their treatment costs catered by the social welfare under the country’s exemption policy and those, who were treated under the social welfare plan were those, who had reported to MOI on emergency cases, without a relative and those, who failed to cover the bills after treatment.
Mr Almasi said the social welfare paid an average of 500, 000/- per patient for those referred to the department. However, the amount increases if the patient requires further treatment, including operation.
Free meals – breaking new ground
“Apart from treatment, motorcycle crash victims are provided with free meals…so the government spends money on meals and medical expenses,” he said, stressing the need for personal health protection for all motorcyclists as the best solution to help cut down medical expenses.
“This happens only in Tanzania where patients are given free meals. In other countries such as Kenya and Uganda, patients are not given meals by the hospital,” he said, reiterating that the resources spent on motorcycle road victims were enormous.
He went on to emphasise the need to encourage and promote the use of personal health insurance for all motorcycle riders to cut costs the government spent on motorcycle road crash victims’ medical expenses. It is estimated that 3.4 per cent of the country’s GDP is lost as a result of road traffic crashes in Tanzania.
According to WHO, road traffic crashes cost most countries 3 per cent of their GDP.
Low insurance uptake
The Tanzania Insurance Regulatory Authority (TIRA) told the ‘Daily News’ that it had registered many companies that provided insurance or medical cover, including personal protection for bodaboda riders.
TIRA Communications Officer Phostine Oyuke went on to single out GA Insurance Tanzania Limited as one of the companies offering insurance on medical cover for motorcycle riders.
An insurance officer with GA Insurance Company, Mr Gerald Kilimo, said apart from motorcycle insurance covers, the company offered personal insurance against accidents.
Mr Kilimo said personal insurance against accidents covered expenses upon death, permanent disability, temporary or total disability and medical expenses of motorcycle riders and any other person involved in accidents.
He said the cost for personal cover against accidents on all the four areas ranged between 8,000/- and 10,000/- per year.
“Those getting personal insurance against accidents are required to pay a small amount of money. For instance, on death cover, the insured person pays 10,000/- per year,” he said.
According to Mr Kilimo, in case the insured person dies in a road crash, his or her relatives can be given 10m/- as condolences.
However, despite the increasing number of bodaboda riders in Tanzania, the company has registered a small number of them on personal insurance.
“The number of motorcyclists seeking personal insurance from our company per year is below 20,” he said, adding that lack of public awareness about the importance of personal protection was a major setback in enabling motorcycle riders to acquire them.
However, TIRA in collaboration with insurance companies conducts public awareness campaigns for bodaboda riders each year on the need for them to acquire insurance to protect their lives.
Section 4 of the National Motor Vehicle Insurance Act (Chapter 169 R.E 2002) states that third party insurance for a motor vehicle provides protection against loss in the event of an accident, providing compensation for injuries sustained to anyone involved in a crash involving an insured vehicle.
The head of Legal Department at the Traffic Headquarters, Assistant Superintendent of Police (ASP) Deus Sokoni said the compulsory third party did not cover personal protection for drivers.
“The same applies to motorcycle riders; they are not covered in motorcycle insurances, whenever they are involved in a road crash,” he said.
A road safety stakeholder, Mr Henry Bantu, says imposing mandatory laws on personal health insurance could be the best solution to enable motorcycle riders to access medical treatment without hustles.
“The bulky of road crash victims are the youth, especially motorcycle riders, who come from poor households. So, mandatory laws on personal insurance for motorcycle riders will help save government funds used for medical treatment,” he said.
WHO says in its report that road traffic injuries can be prevented by governments taking action to address road safety in a holistic manner.
Such actions require involvement from multiple sectors such as transport, police, health, education and actions that address the safety of roads, vehicles and road users.
Effective interventions include designing safer infrastructure and incorporating road safety features into land use and transport planning, improving the safety features of vehicles, improving post-crash care for victims of road crashes, setting and enforcing laws relating to key risks and raising public awareness.
Light at the end of the dark tunnel
The government recently announced plans to set rules, which will direct every motorcycle operator/rider to have health insurance before acquiring a driver’s licence.
Minister for Health, Community Development, Gender, Elderly and Children Ummy Mwalimu said her ministry and that of Home Affairs were jointly working on an initiative that would see all motorcycle operators and riders having health insurance.
Tanzania Orthopaedic Association (TOA) also proposed a plan that would see all owners of motor vehicles and motorcycles charged some money under their motor vehicle insurances that could be directed towards hospitals handling emergency cases for road crash victims.
The money, according to TOA, will help recover costs that the government and other health institutions spend on road crash victims, who fail to pay their medical expenses after treatment.
A stitch in time saves nine
With the government forking out money that could be used for other developmental purposes on treating road crash victims, especially those from Bodaboda mishaps, it is high time regulations were put in place to ensure every motorcyclist is insured to save taxpayers’ money.
On the other hand, these important health covers will help economically stabilise families, who are in most cases left disoriented and in dire straits once their bread winner is incapacitated by a road crash.
It is, therefore, imperative for the responsible stakeholders and the powers that be to note that a stitch in time saves nine.