‘Why Lagos concessions N5b cardiac, renal center
What informed the idea of this facility?
In recent times, there has been an epidemiological shift in the disease pattern with an increase in Non-Communicable and Mental Health disease burden that are seen across the state. I am talking of chronic diseases, especially hypertension, Diabetes Mellitus (DM), and cancers – a state of affairs that is increasingly telling on available statistics from the state’s public hospitals.
It is an acknowledged fact that cardiac and renal diseases constitute a growing health burden globally. These diseases, if not adequately managed, progress to end-stage organ damage thereby contributing significantly to morbidity and mortality indices. Identified risk factors are hypertension and diabetes. This is again buttressed by available state hospital statistics, which also show an increase in end-stage renal diseases. On a yearly basis, the state sponsor renal and cardiac disease patients requiring financial assistance for treatment and/or transplant surgery abroad, with most of the cardiac cases being children with congenital heart diseases.
This cardiac and renal centre is to handle all these cases including their complications. That is why this centre was constructed and equipped. It is capable of doing very many things – detecting and investigating causes of renal diseases and address them too.
It is a three-floor building; properly equipped to handle virtually all cases of heart and kidney problems. We have clinics where doctors will take history and make diagnosis; we have counseling rooms, consulting rooms, diagnostics room where electrocardiography can be done. There is also echocardiography laboratory for further diagnosis. Cardiac catherization lab; a specialization lab that can diagnose as well as treat (the second of such laboratories in the country). Here they can inject specific diet into your blood stem; trace all the blood supplies either to the arm or legs, to see if there is any blockage and if there is any, without any surgical operation, there can be maneuvering to open up that blockage. And if there is any need to do surgery, that section also has two theatres where it can be done, either for the heart or cardiac. We can do both kidney and heart transplants at the centre.
Why did the state government concession the facility to a private company to manage?
We realized that we have challenges with human resources especially in key specialties to handle this facility and that is why we adopted the Public Private Partnership (PPP) initiative. We threw it open to bidders and at the end we signed an agreement (a Limited Liability Partnership) with Renescor Health Limited, represented by Dr. Ladi Awosika.
Why we opted for Renescor is that majority of these people (staff of the centre) are Nigerians in Diaspora. Though they are experts based overseas, they are willing to come back to the country, to treat these problems and also build expertise.
You would also recall that we have had some cardiac missions in the past; nine to be specific, with about 56 beneficiaries, mostly children. A lot these children have what is called congenital heart problems; problems of the heart that they were born with and requiring surgical correction. We could not handle all of them because of the constraint of resources. So, they were sent to India. The best is to bring those expertise here.
One of the agreements in the partnership is that there must be proper skills transfer; we must be able to use the expertise that they are bringing in to train local people – our medical students, the residents, some consultants who require expertise in cardiology or renal problems. And the training is not limited to doctors alone, but also our nurses in intensive care management either for heart or kidney care. We can train technicians that can also handle some of those equipment on ground. With the agreement, we are using one stone to kill many birds.
We also have some experts in cardiology and have their clinic in Lagos and are part and parcel of this arrangement. They have seen cases of pulmonary haemorrhage in six years that they have stayed here than what they had seen abroad and those cases were treated successfully. They have seen more cases now, even from outside of Lagos because of the expertise that they have.
You know what, some people have been referred abroad wrongly, but because they are lucky, they have went to these guys before going on the trip, and they found that there is nothing wrong with the person. They have a culture of confidence that we must also put around here.
What is the statistic really like for these kidney and heart diseases in Lagos?
From what we have seen, 20 per cent of our people are hypertensive and that figure nearly tallies with experiences of some literatures. Four to five per cent of those cases are diabetic. It a bit difficult to access the trend because we don’t have sufficient data locally. With respect to renal disease, this is even worst. Because most of these cases are not diagnosed early enough, they don’t go to hospital until they get to end stage of the renal disease.
Apart from not being detected early, when they are detected, they need to go through dialysis, which is the ‘cheapest’ form of treatment in this category. Ideally, a person needs three dialysis sessions per week. It is very expensive and because many cannot afford it, they are left with one or twice sessions. Unfortunately too, we don’t have too many units that carry out dialysis. From statistics we have, I think we have only 60 of such units in the country. 30 per cent of those units are in Lagos and for those in Lagos, 80 per cent of them are in the private sector. Very few tertiary facilities are doing transplant, with St. Nicholas doing the highest number. What we are doing in Lagos state is to create that avenue for people to use and that is the essence of this new facility.
It is also a fact that people have been referred overseas for treatment or transplantation. Some were successful while some were badly treated and had to come back. That is the reality.
With hypertension, there are severe complications. One can get blind, have stroke, gangrene of the leg, which diabetes too can cause. Hypertension too can kill your kidneys, even when there is no hypertension, but because the kidneys are dying, it can lead to hypertension. They are very serious problem and that is why we have to start keeping records properly. Hypertension or low blood pressure can cause palpitation of the heart and if not properly treated it can lead to shock and there are different types. These are not the kind of conditions that can be diagnosed in just any hospital. This is where this facility is very important.
How many hearts and kidney patients can this facility cater for?
We will try as much as possible to address as many as come. Just one facility cannot deal with the problem of Nigeria. In any normal country, this kind of facility is done by the private sector. Because it is expensive to build and maintain. More so, that kind of maintenance revolves around the staff. Look at our country, how many cardiologists; heart doctors do we have? Because of the complexity of Lagos, both (two cardiologist) are here and a lot of people come from outside Lagos to see them. So, the many of this centre that we have, the better.
Government is showing that we can do these things here. We need more of this facility but government cannot do it alone. Again, it is not a facility anyone can just walk into and ask for treatment, otherwise people working in there would not be able to carry out those services for which you (patient) have paid for. People have to be referred there.
What are your plans to reduce the cost of kidney transplants, currently at over N3m, given this new facility?
That is affordability and will be affordable. But don’t forget that the facility has been built with serious money and it is going to cost even more to maintain the key equipment. What we have done in the agreement, especially for the poor people, is that anyone that must go from out teaching hospital has to be referred there, and 10 per cent of every case that they see in that place per month will be treated free. Anything in excess, if they conform to the protocol, will be borne by the state government under our insurance scheme.
There is a bill pending in the House of Assembly to address things like this. It has passed First, Second Readings and also through Public Hearing. Once they passed that and it becomes law, then these issues can be addressed properly. But if I tell you that every bed would be declared free, is a lie. If we try that, the place will packed up in less than one year. We will try as much as possible, within the limit of resources, to address those issues.
To get the services cheaper, the concessionaire is talking directly with international manufacturers of consumables and gets them as the most affordable rate. Sustainability is also tied to the economy of the country.
We look forward to doing two renal transplants every week by the time we are six months into operation. Dialysis will scale up to about 60 a day in the next few weeks. Opening of that facility will nearly double the number of critical care bed available in Lagos at this point in time. So, it is not only about the cost but also for people that are currently dying without the opportunity for treatment.
It is known that NHIS packages are often silent on renal or cardiac issues. Is it any different with the state-own insurance scheme?
What we have are different packages for different people and based on the package that is chosen, there are fees that you have to pay. For those people who are poor, there are certain things the government will do on their behalf, provided they go through the processes and procedure on ground. There must be protocol and referral; otherwise, the whole essence will be defeated. If we can go to other people’s countries and sit-down for the process to take its course, why can’t we do it here? So, there are people that will be taken care of by the government on account of their status.
The original estimate for the facility is N5billion. Has it in anyway increased and by how much?
There are other issues and cost that came with the facility, like raising the topography of that place, addressing the issues of drainage, road accessibility and power. If we are to add that, it is definitely more than N5b. But those are public records you can have access to. There are so many dimensions to cost. To say it cost N5b that will be an under-statement.
How would you explain that this facility has been concessioned, given the fact that the government solely paid for it construction?
This people are paying concession fee to the government and not the other way round. So, it is incumbent on them to do these things properly the way it should be done. There is a monitoring clause and others to ensure that they are done properly. If concessions are not being done, it then means again that we have bastardised the process in this environment. It is a concession that specifies the role and responsibility of each partner. So, if partner A defaults, partner B knows what to do. In any case, the concession is for five years. If they perform very well, there will be a renewal for another five years. If they have enough need locally, there may not be any need to review. This is just one out of what we need here. Ghana has more CT scanners in their country than we have in Nigeria, not to talk of the number of MRIs, and not to talk of South Africa.
Would the state be making campaigns for renal donors?
Generally, donor is an ethical issue. Donor issue is patient specific. We cannot say we want hearts or one kidney. All these have to be matched to a particular patient’s need. And to match, they test blood and all manner of things to be sure that they are compatible. If I graft you now, your body will reject it. The closer the patient is to the donor (sibling, at best) the better for compatibility and successful transplantation. We will leave the issue of donor to the concessionaire to manage.