**9. Cost of endoscopic procedures**

The cost of endoscopic procedures in developing countries is often out of the reach of many patients. Poverty is a major problem that militates against access to health care. Poverty exacerbates poor health while poor health makes it harder to get out of poverty. In Nigeria, most patients have to make out – of – pocket payments at the point of service and this has adversely affected service delivery. The Federal Government of Nigeria recently introduced the National Health Insurance Scheme but the coverage is still very low and does not cover all medical procedures and treatments. Catastrophic expenditure is more frequent when health care has to be paid for out – of – pocket at the point of service.
