The many challenges of running a hospital in Nigeria

•Nwosu, Ogunbiyi lament inability of Nigerians to enroll into health insurance, reduce out-of-pocket payments
•Say govt should increase funding for healthcare, encourage hospital operators by creating enabling environment

A consultant cardiologist, cardiovascular diseases specialist and Chief Medical Director (CMD), United Heart Hospital and Clinic, Dr. Eugene Nwosu, has lamented that the major challenge of running hospital in Nigeria is inability of Nigerians to enroll into health insurance to reduce out-of-pocket payments.

He said most Nigerians do not have health insurance, rather payments are made at the points of service as good number of those without health insurance coverage are very poor and this has affected hospital operators in the country.

Nwosu made this known at the fifth-anniversary celebration and expansion of services of the United Heart Hospital and Clinics, held, last week, at Victoria Island, Lagos. He said proper laws to support emergency coverage are not enforceable because of poor funding of healthcare care system.

He explained that in developed countries every patient in emergency room must be treated irrespective of his or her ability to pay. He noted that those treatments offered to patients without means are truly not free but the system provides a way for such facilities to recover those funds in order to stay in business.

Nwosu said most medical surgical equipment with their parts and supplies are imported in Nigeria. “Nigerians pay more for those products compared to the cost of operations in the countries of origin. The service contracts are outrageous, for instance, in one-year service contract one has many patients to cover, while medical equipment malfunctions, will definitely affect the service,” he said.

The surgeon said true cost of quality care is out of reach for most Nigerians, a few examples are the cost of life saving medications and procedures. “For instance, medications used for acute stroke or heart attack to dissolve the blood clot one vial (Atleplase) costs N582,000; coronary angiogram procedure to check the arteries to determine if the arteries are blocked costs N600,000; treating heart attack with coronary angiogram and stent costs N1.5 to N2 million; and treating severe sleep apnea with Continuous Positive Airway Pressure (CPAP) machines cost N1.2 million among others,” he said.

Alteplase (t-PA), a biosynthetic form of human tissue-type plasminogen activator (t-PA), is a thrombolytic medication, used to treat acute ischemic stroke, acute ST-elevation myocardial infarction (a type of heart attack), pulmonary embolism associated with low blood pressure, and blocked central venous catheter.

CPAP therapy is a common treatment for obstructive sleep apnea. Nwosu said Healthcare Maintenance Organisation (HMOs) and health insurance tariff are ridiculously low as one HMO offered N35,000 for chest check among others. This shows that healthcare service needs government interventions as well as Nigerians to enroll into health insurance.

He said naira instability and devolution is another major problem for all Nigerian business. “It is a nightmare I bought an equipment in April 2021 for N8.5 million today 16 months after it sells for 14 million. A lot of people will characterise the state of Nigerian economy as being in the intensive care unit (ICU).

“Please note that a lot of hospitals have been in ICU for many months now. It is common knowledge that some hospitals have not paid their staff salaries for months because there is no money,” he said.

Nwosu added: “Quality health care exists in Nigeria only for a few people. Most Nigerians do not have health insurance; payment is made at the point of service. A good number of those with health insurance have poor coverage.

“Also, proper laws to support emergency coverage are not enforceable because of poor funding of health care. In advanced societies, every patient going to the emergency room must be treated irrespective of their ability to pay.

“There is a very high operational cost of care because almost all medical and surgical equipment with parts and supplies are imported and Nigerians pay more for those products compared to the cost of operations in the countries of origin. The service contracts are outrageous,” he argued.

Further, Nwosu decried the incessant brain drain saying that Nigeria currently lacks specialists in different aspects of medicine and surgery.

“So, sometimes, it is difficult to find specialists that can make the correct diagnosis and offer the right treatment. So, Nigerians are actually suffering, I see people that are misdiagnosed and undertreated but when they seek the right care, those problems can be corrected.”

Urging Nigerians to pay attention to their arteries, the cardiologist noted that arterial health is very critical to well being. He said the hospital expanded its operations with the addition of a 64-slice Computerised Tomography (CT) scan, and full ultrasound services, even as he admonished Nigerians to be kind to their arteries.

“I want you to know that physiologic age is superior to chronic age. It is not how old you are, it is how young your arteries are. Some people are 60 years old but their arteries are 120. There are certain surgeries that an 80-year-old can go through because their operating risk is very low, while some people are 50 and their operating risk is very high.

“For example, if you are going to have surgery, and you are the type of the person that pants when climbing the stairs, even if you don’t have any other medical history, your operating risk is very high. And if you are 80 years old and you can jump around, your risk of complications is low. So your arterial health is very critical to your well-being,” he explained.

Nwosu said the effect of blood pressure on the arteries is significant. “High blood pressure narrows your arteries, so pay attention to blood pressure because it doesn’t have symptom and does not mean that all is well. The things that can make arteries get old are diabetes, high cholesterol, poor diet, smoking, and lack of physical exercise.

“Regular exercise is medicine. It counters all the risk factors of cardiovascular diseases, and it is the best anti-aging medication. It prolongs your life. One hour of exercise prolongs your life by two hours.”

On the essence of the hospital’s fifth anniversary, he said: “It has been a journey of gratitude that coming back to Nigeria, I could be part of the solution to the healthcare problem.

“This fifth-anniversary celebration and expansion of services with the addition of CT scanner and full Ultrasound services is my testimony that God is faithful. My wife and I left America five years ago for Nigeria. Leaving behind the success and comfort of the America was indeed an audacity of faith. To a lot of colleagues and friends both in America and here in Nigeria, it did not make any sense. I was responding to the call and desire to give back to my motherland.”

CHAIRMAN of the occasion, celebrated scholar and former Managing Director, Daily Times, Nigeria, Ltd, Dr. Yemi Ogunbiyi, called on Nigerians to cultivate the attitude toward regular checkups.

Ogunbiyi remarked: “I just lost a friend who had a stroke a few weeks ago, and I’m seeing more people of my age, sometimes younger than me having a stroke or cardiac complications and the answer to these is for people to do a lot of pre-tests.

“We should constantly visit our doctors for medical checkups. Once you have passed the age of 60, you must do at least, two medical checkups in a year and when you are 70, you should have it often. Solutions to these problems are constant medical checkups,” Ogunbiyi said.

Ogunbiyi commended the celebrant, adding that there is need for government to encourage hospital operators by creating enable environment, especially the CMD of United Heart Hospital, who abandoned America where he is practicing medicine and come back to Nigeria to give back to the society.

“Government needs to direct banks to give loans to people like this and they will pay the loans in next five years because this is to give back to the society and not for profit purposes, therefore government needs to encourage them,” Ogunbiyi said.

Chairman of the Board of Directors of the hospital, Mr. Sylverius Okoli, said the hospital is in forefront for prevention of heart diseases because prevention is better than cure.

Okoli said the preventive measures include: regular exercise, which would make the heart and blood circulatory system more efficient, lower cholesterol level, and also keep blood pressure at a healthy level. “Exercising regularly reduces your risk of having a heart attack,” he said

“This place capitalises on the prevention of diseases and we have involved ourselves in total clinic care. Although the superintendent is a cardiologist when we came, we found that what Nigeria needed was more general practice that will favour both big and small.

“Then, it was necessary to establish the kind of practice to ensure that a lot of people got care and what they can afford to pay. But at least, we will prevent the major breakdown of human beings, especially on those things that people don’t normally care about.”

Nwosu, Ogunbiyi and Okoli charged the Federal Government to prioritise the health of Nigerians as one of its cardinal projects and to make the health sector one of the top three priorities in the nation.

They urged the government to urgently and purposefully come to the rescue of Nigerians by making the health sector one of the top three in the nation.

They lamented that it was disheartening that millions of Nigerians are suffering from poor health as a result of the inability to afford quality health care.