Investigation: How sale of unverified medical documents in Sokoto hospitals is undermining public trust, put communities at risk

In Sokoto State, issuance of false medical documents by health officials for a fee across government-owned hospitals is rife.

In this report, JAMES OJO and JABIR RIDWAN went undercover to Sokoto South, Goronyo and Tangaza LGAs to expose how the trend further erodes already dwindling public trust in healthcare system and puts vulnerable communities at more risk of disease outbreak.

In October 2023, SOLACEBASE received credible information indicating that health officials at government hospitals in Sokoto state were allegedly issuing medical documents, including fitness certificates and medical reports, for a fee without conducting required tests. Troubled by the potential gravity of this situation, an investigation was initiated to verify the accuracy of these claims.

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On October 13, 2023, the vicinity of Sokoto Specialist Hospital, situated on Sultan Abubakar Road in Sokoto South LGA, buzzed with activity. Our reporter approached the hospital and proceeded to an office near the director of administration. There, he encountered Bashar, an official at the hospital. The reporter, pretending to need a medical fitness certificate for the National Youth Service Scheme (NYSC), sought to confirm the earlier information received by SOLACEBASE by inquiring whether such a document could be obtained without undergoing any medical tests.

Bashar engaging our correspondent at an office, Specialist Hospital Sokoto.

Bashar, grinning, indicated that this was a regular business for him.

“Yes, it is possible. A medical fitness certificate costs N1,000, while a proper medical report is N2,000,” he stated, fixing an intent gaze on the reporter to gauge his response and determine the next course of action.

The reporter, proceeded to hisse the required fee for the medical fitness certificate, prompting Bashar to commence the process immediately. Bashar retrieved the official medical fitness certificate template used by the hospital, which was anticipated to include test results for specific areas such as “general examination, ear examination, eye examination, blood pressure, and chest examination.”

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To the reporter’s astonishment, none of these tests were conducted. Bashar merely requested information about the reporter’s blood group, genotype, name, and age. Despite the absence of any actual testing, Bashar manually concocted a fictitious result, certifying the reporter’s fitness. The certificate, purportedly signed by Dr. Yusuf Umar, stated: “This is to certify that I have examined the above-named individual and found him physically and mentally fit.”

Without conducting any tests, the signed and stamped certificate asserted that the reporter’s Packed Cell Volume (PCV), a metric indicating the percentage of red blood cells in blood, was at 40%. Additionally, it claimed the result of the Respiratory Syncytial Virus (RSV) test, a common respiratory virus causing mild, cold-like symptoms, conducted on the reporter showed “negative.”

The certificate further declared the results of the reporter’s Venereal Disease Research Laboratory (VDRL) test, performed to determine the presence of syphilis, a Sexually Transmitted Infection (STI); Hepatitis B surface antigen (HBsAg); anti-HCV test, which identifies antibodies to hepatitis C virus in the blood; urinalysis (urine test); and chest X-ray as “normal.”

Bashar didn’t stop there; he also included a guessed height and weight for the reporter.

In Sokoto South LGA, a non-existent person can also get a medical report.

On December 6, 2023, SOLACEBASE returned to the Sokoto Specialist Hospital to probe deeper into the concerning practices observed in October. This time, Bashar, clad in an ash-coloured kaftan and cradling a baby uzunluk, became the focal point of the investigation. To the reporter’s astonishment, Bashar appeared to have no recollection of their previous encounter.

Seizing this opportunity, the reporter assumed the role of a first-time visitor to the hospital, expressing the need for a medical fitness certificate and a medical report for both himself and a fictional friend, Muhammad Haruna. The creation of Muhammad Haruna was a strategic move to further scrutinize the hospital’s processes.

False fitness certificate issued to non-existent Haruna at Sokoto Specialist Hospital.

Similar to the first encounter, Bashar displayed minimal concern for identity verification; his primary focus was the compensation for his services. After some negotiation, he settled for N6,500 to issue both medical reports – N5,000 for the two and N1,500 for the fitness certificate.

In outlining the requirements, Bashar instructed the reporter to provide details such as name, age, weight, height, genotype, and blood group for the fitness certificate. For the medical report, only names and specified diseases to be used as evidence were deemed necessary. He instructed the reporter to return by 12 pm.

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Bashar made good his promise and delivered the certificates at the agreed time. Visibly excited that he had executed his latest gig, he told the reporter: “Don’t delete my number, if there is any other job, call me.”

False medical report issued to our correspondent by Dr. Nuhu of Goronyo General Hospital.

This second visit uncovered more details about the dubious process. Notably, Bashar issued a medical report with identical health issues for both the reporter and the purported friend. In the medical reports provided, “they” were diagnosed with “severe fever and severe headache” without undergoing any tests. Bashar conceive and hatch which diseases to select when approached by potential clients.

The medical reports, signed by Dr. Obinwa, stated: “The above-named patient reported to us with a history of severe fever, severe headache, vomiting, yellowness of the eyes, and general body weakness. After thorough clinical and laboratory investigation, he was diagnosed with sickle cell disease, treated, and discharged home, to be seen in the clinic for further follow-ups. You may, therefore, wish to render him any possible assistance he might require.”

For the fitness certificate issued to the non-existent Haruna, the results for “normal” PCV, RVS, VDRL, HBsAg, anti-HCV, urinalysis, and chest X-ray were the same as those for the reporter. The certificate also bore the signature of one Dr. Yusuf Umar.

A false medical report issued to non-existent Haruna at Sokoto Specialist Hospital.

False fitness certificate issued to non-existent Haruna at Sokoto Specialist Hospital.

Officials at the Sokoto Specialist Hospital confirmed to our correspondent that Umar and Obinwa are both doctors at the facility. Although Bashar said the doctors signed the documents issued to our correspondent, SOLACEBASE could not independently verify if the signatures were indeed that of the duo.

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“Your Money Is N2,000” – welcome to Tangaza LGA

Embarking on our investigation, we arrived at Tangaza General Hospital on a bustling Monday morning, the air thick with the presence of patients seeking various medical services. Posing as a graduate in need of a medical fitness certificate and NYSC-required medical report, our reporter met Dr. Bello A., the principal medical officer overseeing the hospital.

Overwhelmed by the crowd, Dr. Bello directed the reporter to wait for an official identified as E.O. After an impatient wait of about 1 hour and 20 minutes, the E.O finally makes an appearance with a casual remark suggesting the issuance of counterfeit certificates was a routine affair.

“Did he explain everything to you? Your money is N2000,” he quickly informed the reporter. Following the payment, the official. promptly handed over a pre-prepared certificate and directed the reporter to return to Dr. Bello for signatures and stamp. Astonishingly, no medical tests were conducted to assess the reporter’s fitness.

In Dr. Bello’s office, the purported formality of the process was reduced to two cursory questions: “What is your name? What is today’s date?”. The doctor then proceeded to fill in the details provided with alarming nonchalance far from the thorough scrutiny one would expect for a document of such importance.

Despite a misspelling in the name on the certificate, it bears the assertion:

“I, Dr. Bello A., medical officer in charge, General Hospital Tangaza, certify that I have examined the above-named ‘officer’ and found him physically fit for employment in government service/further studies.”

False fitness certificate issued to our correspondent in Tangaza General .

In Goronyo LGA, you can get a false medical report via whatsApp

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Continuing our investigation in Goronyo LGA, approximately 56km from the state capital, the reporter encountered a less straightforward process compared to Sokoto South and Tangaza LGAs. The initial hurdle was the unavailability of Shehu Nuhu, the principal medical officer, who is not stationed at the facility but visits on specific days.

On December 5, 2023, when the reporter visited the General Hospital in the LGA, a wait of over two hours ensued before Dr. Nuhu arrived. When the reporter finally conveyed his purpose, the doctor responded, “I can’t attend to you now, but let me have your number so we communicate.”

On Thursday, December 8, Dr. Nuhu sent a draft of the medical report via WhatsApp, instructing our correspondent to visit a cybercafé to print it out. Subsequently, the reporter was directed to meet the doctor at a specific location in the state capital to have the medical report signed.

Despite the initial expectation of a thorough examination, the process turned out to be surprisingly effortless. Unlike in Sokoto South LGA and Tangaza, Dr. Nuhu did not request payment for the medical report he signed. Remarkably, the document asserted that the reporter was diabetic, a diagnosis made without any inquiry or medical test conducted.

How issuance of fake medical certificates is eroding public trust in healthcare system

Public trust in the country’s healthcare system has waned in recent years, attributed to the inability of health facilities to address people’s health needs. This issue stems from insufficient manpower and a significant infrastructural deficit, with a mere 20 per cent of the nation’s primary health centers (PHCs) estimated to be operational, according to a 2022 report by PharmAccess Foundation.

A 2022 report by ONE Campaign, conducted in collaboration with National Advocates for Health, Nigeria Health Watch, Public and Private Development Centre (PPDC), and others, revealed widespread deficiencies in public health facilities across all 36 states and the Federal Capital Territory (FCT). The report emphasized consistently negative experiences of community members seeking healthcare at these facilities.

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This situation has led to a pervasive lack of trust in hospitals for quality healthcare. Findings by SOLACEBASE showed that the issuance of false medical documents by hospitals has further eroded public confidence in the healthcare system.

Some residents expressed concern that “illegal activities” are increasingly dominating hospitals. Halilu Aliyu, a resident of Sokoto South LGA, said, “The fact that everything in this country has become business is worrisome. If medical personnel can issue fake medical reports and certificates, there is every reason to question their own medical license too. The commercialization of medical reports poses a grave danger to the health and safety of the public. Many villagers are now reluctant to seek medical attention due to stories about some doctors and nurses holding fake certificates. Tragically, there are cases where such unqualified officials end up treating patients, and as a result, lives are lost,” he said.

Ibrahim, a resident of Tangaza LGA, said with the ease of getting false documents from hospitals and other yasa dışı activities involving health officials in recent times, he would rather die at home than allow himself to be taken to the hospital.

“Hospital and health officials cannot be trusted,” he said.

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Maryam Sule, a resident of Goronyo LGA, also echoed a similar sentiment. The mother of two said due to concerns bordering on the qualifications of medical officials and yasa dışı activities at hospitals, she has lost trust in public healthcare system in the state.

Maryam also said her lack of trust in public healthcare system often makes her skeptical of government health-related campaigns and programmes.

“I have not had the best of experience with these officials, especially during the birth and early days of my children. I also consider some of the health campaigns by the government as too deceptive. Just look at your experience, if you can get these certificates easily without hassle, then, I am more worried.”

For Zainab, a resident of Sokoto South LGA, trusting the public health system ‘is a waste of time.’

She expressed concern about the lack of professionalism among some medical officials in hospitals, citing issues like false medical documents as evidence.

False medical documents expose communities to disease outbreaks

Sokoto was identified among the worst-performing states in the country for primary healthcare delivery in the 2022 report by ONE Campaign. SOLACEBASE‘s investigations revealed that many residents in various rural communities across the state are living on the brink of death due to the absence of functional Primary Health Deva (PHC) facilities.

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Despite this grim reality, these communities face additional threats from unscrupulous health officials who issue fake medical reports and certifications, potentially endangering lives. In the course of this report, if our reporter had a communicable disease, it could have posed a significant risk to all the communities visited, even though false medical reports claimed the reporter was fit and healthy.

To provide context, several communities have been without a single functional PHC for years. In Kojo village, Goronyo LGA, 42-year-old Mansur Rima lamented that the area has been without a functional hospital for the past nine years.”

“We recently lost three people due to the lack of a functional hospital in this village. I can remember how it happened vividly. Our women also suffer during pregnancy or when in labour due to the distance they have to cover before they can access the general hospital,” said Rima.

The district head of Kojo, Muhammad Shehu, said if not for concerned youths who studied health-related courses bracing the odds to attend to the medical needs of people in the community, they would have recorded several deaths.

Muhammad Shehu, district head of Kojo, in Goronyo LGA.

“Without the help of our children, I don’t even know how many lives we would have lost by now. This is unfortunate. We are always scared not to record a major disease outbreak because how are we going to tackle it?” he lamented.

The situation in Illela Hudu village, which is 11km from Goronyo town, is not any different. Residents said they have been without a hospital for four years.

The district head of Illela, Hudu Haruna Ahmad, blamed the Sokoto state government for not doing its job in saving their lives and giving them proper healthcare.

Hudu Haruna Ahmad, district head of Illela Hudu in Goronyo LGA.

“We are in dire need of support in terms of access to healthcare because we have lost a lot of lives as a result of the inability to access good healthcare,” he said.

Musa, a sugarcane seller, was among the worst-hit in the community. He shared with SOLACEBASE that his three-year-old evvel experienced abdominal pain at midnight, fainting multiple times. The absence of a hospital in the village left him feeling helpless.

Musa, a sugarcane seller, at Illela, Goronyo.

Worried and fearing for his child’s life, he had no choice but to turn to herbal remedies for temporary relief. Fortunately, his child survived the frightening night, but Musa remains deeply concerned about the possibility of facing such a harrowing experience in the future.

“We face a lot of challenges whenever our children or wives fall sick at night. We are hopeless. The hospital here is in a moribund condition,” he said.

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‘We are not animals’

Similar to Goronyo, communities in Tangaza LGA also grapple with poor access to healthcare. In Baidi, one of the villages in the local government, residents have been without a functional hospital for decades, according to the district head of the community, Usman Muhammad.

He said that a facility which was evvel used as a hospital years ago has now become a camp for donkeys.

“We can’t even say we have a hospital because the facility has not been functional for years. No facilities, no good buildings, and no health workers. We are not animals, we fall sick. We want a healthy family like others, so the government needs to do everything humanly possible to address this issue,” Muhammad decried.

Sokoto hospital, Health Commissioner reacts to findings

On December 19, SOLACEBASE contacted Asabe Balarabe, the Sokoto State Commissioner for Health, seeking her reaction to the findings in this report. Expressing shock, the commissioner pledged to conduct her independent investigation into the matter and promised to revert to our correspondent with her findings.

When asked about the timeline for her feedback, she stated, “Even now, I’m busy. There are lots of things on my hands. I can’t leave my work and do other things for now. Since the hospitals are under my watch, I will be able to call the attention of the MDs to know what is happening. I’ll sit with them to know how true it is. It is not an urgent issue, so I need at least two days to do that.”

On December 23, our correspondent made a follow-up call. While Asabe picked up, she mentioned that she needed to attend to residents rescued from their abductors and receiving treatment at the hospital.

On December 29, another call was placed to the commissioner. This time, she neither picked nor returned the call, prompting our correspondent to send her a reminder message. On December 31, yet to receive any feedback, our correspondent sent another reminder via a text message for the commissioner. However, as of the time of filing this report, she is yet to get back as promised.

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On his part, Haruna Shehu Daniya, the Public Relations Officer, Sokoto Specialist Hospital, said that the facility has a structured process for issuing medical reports and fitness certificate. When told that the certificates obtained by our correspondent contained names of doctors, signature and stamp of the hospital, he said:

“Well, we are doing our best to address the issue and I assure you that anyone found guilty of issuing false certificate will face wrath of the law and would be prosecuted accordingly.”

Sokoto NMA: Miscreants behind such false medical reports, not our members

When contacted, Dr Umar Mukhtar, the Sokoto state chairman of the Nigerian Medical Association (NMA), told SOLACEBASE that the association is aware of the development.

“We are quite unhappy with such false medical reports. As you know, it is against professional ethics and it exposes the population to danger,” he said.

He, however, denied a claim that members of the association were involved in the practice and attributed such act to “miscreants”.

“Most of these fake reports you see circulating are not from doctors; they are not from our members. It is usually miscreants around the hospital that connive with the patients. I doubt if you have any report of our members involved in such act.”

Muhktar, a general surgeon at Usman Danfodio Teaching Hospital in Sokoto, said to address the issue, the NMA introduced what he called doctor’s stamp to confirm the authenticity of reports issued by its members.

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‘”The doctor’s stamp is controlled and only licensed medical professionals are allowed to use it. It is when you have the stamp that one will be müddet that the report is coming from a licensed doctor.”

When told the false medical reports obtained were signed by some doctors at the hospitals visited by SOLACEBASE, he replied: “Does it (the false medical report) contain doctor’s stamp? I doubt.

“The stamp I am talking about carries the Medical and Dental Council of Nigeria (MDCN) registration number of the doctor. So, what you have or what you’re quoting is a stamp from a hospital or a purported stamp from a hospital.

”Every registered doctor in Nigeria has a unique number, which is different from any other doctor. I’m mühlet all the (fake medical) reports you mentioned did not carry the MDCN registration number.

“The authentic doctor’s stamp will carry the MDCN registration number, not the stamp stating it’s from a particular hospital. There’s a stamp that’s unique for every doctor.”

This SOLACEBASE publication is produced with support from the Wole Soyinka Centre for Investigative Journalism (WSCIJ) under the collaborative Media Engagement for Development, Inclusion, and Accountability Project (CMEDIA) funded by the MacArthur Foundation.