Refurbishing tertiary hospitals in Nigeria

Teaching, tertiary or specialised hospitals are supposed to be the apex health institutions where the most complicated medical conditions can be handled, where researches are churned out on regular basis, and where medical practitioners such as doctors, pharmacists, nurses, physiotherapists are trained.Tertiary care is specialised consultative health care, usually for inpatients and on referral from a primary or secondary health professional, in a facility that has personnel and facilities for advanced medical investigation and treatment, such as a tertiary referral hospital.

Examples of tertiary care services are cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns, advanced neonatology services, palliative, and other complex medical and surgical interventions.

Several studies have shown that if the 20 teaching hospitals spread across the six geo-political zones of the country are refurbished and made to function optimally, Nigerians will not need to travel abroad again for medical treatment and it will prevent brain drain in the health sector.

Also, the country would have been spared the embarrassment she got from flying the Chief of Staff to President Muhammadu Buhari, Abba Kyari, to the United Kingdom (U.K.) for medical attention.

However, teaching hospitals in Nigeria have not been able to meet that mandate due to poor funding, dilapidated infrastructure and equipment, and incessant strikes by trainee doctors- resident doctors.

Until now, teaching hospitals have been described as “mere consulting clinics”, ‘theatre of deaths”, and “final bus stop.”In fact, over 600 members of the Association of Resident Doctors at the University College Hospital (UCH), Ibadan, Oyo State, penultimate week, staged a protest against what they termed poor working conditions, unpaid salaries and absence of basic facilities at the hospital.

President of National Postgraduate Medical College of Nigeria (NPMCN), Dr. Ademola Olaitan, had identified poor funding and frequent strike as the bane of the country’s teaching hospitals.

The Guardian had reported that Nigeria does not have enough cancer treatment machines, linear accelerator (LINAC), and the few in public, government-owned, hospitals are not working optimally even as the centres do not have back-up plans.

Also, The Guardian investigation revealed that a LINAC costs about $5 million (over N1.5 billion) and the six that the Federal Government procured for six teaching hospitals have packed up.

The ministry of health recently confirmed to journalist that almost all cancer treatment machines, linear accelerators, have broken down and most patients are stranded.
However, the Federal Government has made several attempts to revamp teaching hospitals in the country.

Former President, Olusegun Obasanjo, in 2002, commissioned a project to refurbish eight teaching hospitals, which was later upgraded to 14. The project worth over N50 billion was later completed by President Goodluck Jonathan’s administration.

The 14 teaching hospitals include: Lagos University Teaching Hospital (LUTH); University of Ilorin Teaching Hospital (UITH); Jos University Teaching Hospital (JUTH); Obafemi Awolowo University Teaching Hospital (OAUTH), Ile-Ife; University of Maiduguri Teaching Hospital (UMTH), Borno; Usman Danfodio University Teaching Hospital (UDUTH), Sokoto; Aminu Kano University Teaching Hospital (AKUTH), Kano; UCH; Ahmadu Bello University Teaching Hospital (ABUTH) in Shika, Zaria, Kaduna State; University of Port Harcourt Teaching Hospital (UPTH), Rivers State; University of Nigeria Teaching Hospital (UNTH), Ituku Ozalla, Enugu State; University of Calabar Teaching Hospital (UCTH), Cross River State; Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State; and University of Benin Teaching Hospital (UBTH), Edo State.

The Jonathan’s administration had concluded plans for the third phase of the hospitals upgrade works. The then Health Minister, Prof. Onyebuchi Chukwu, had told journalist that the overall upgrade programme, including the previous phases, is designed to equip all 20 federal government-owned teaching hospitals with world-class medical facilities.

Chukwu said under the third phase, the National Hospital, Abuja; Federal Teaching Hospital, Abakaliki; the University of Abuja Teaching Hospital, Gwagwalada; Abubakar Tafewa University Teaching Hospital, Bauchi; University of Uyo Teaching Hospital; Federal Teaching Hospital Gombe; and the Special Teaching Hospital, Edo State would be upgraded.

According to an ‘Update on the On-going Federal Government of Nigeria (FGN)/VAMED Engineering Teaching Hospitals Rehabilitation Project’ submitted to President Muhammadu Buhari, by the FMoH, Jonathan, based on the advice of the Coordinating Minister for the Economy/Minister of Finance and Infrastructure Concession Commission (ICRC), Dr. Ngozi Okonjo-Iweala, approved the third phase of the project to be implemented through a Public Private Partnership (PPP) considering the tight economic situation of the country.

Based on Jonathan’s approval of the third phase, Chukwu inaugurated a Technical Working Group (TWG) under the chairmanship of the then Permanent Secretary Federal Ministry of Health (FMoH), Mr. Linus Awute. Other members were drawn from FMoH, Presidential Project Implementation Committee (PPIC), Federal Ministry of Finance, ICRC, Nigeria Sovereign Investment Authority (NSIA), Federal Teaching Hospitals, and VAMED Engineering/CPL Medical Group.The TWG considered and agreed on a PPP model for the construction of a new 500-bed world class quaternary Hospital, rehabilitation of the remaining teaching hospitals including the National Hospital Abuja and revamping of the 14 already rehabilitated through the Federal Government of Nigeria (FGN)/VAMED Engineering Project.

Tertiary and Quaternary Healthcare refer to specialised care available in referral centers and very rarely accessible to the general public.The term quaternary care is sometimes used as an extension of tertiary care in reference to advanced levels of medicine, which are highly specialized and not widely accessed. Experimental medicine and some types of uncommon diagnostic or surgical procedures are considered quaternary care. These services are usually only offered in a limited number of regional or national health care centres. A quaternary care hospital may have virtually any procedure available, whereas a tertiary care facility may not offer a sub-specialist with that training.

Meanwhile, the TWG considered having a quaternary hospital rather than upgrading the National Hospital Abuja, which they said more cost effective and likely to contribute more significantly towards saving the nation billions of dollars lost due to medical tourism.

A Memorandum of Understanding (MoU) was developed for the project and on the directives of Jonathan, the Federal Ministry of Justice reviewed and upgraded it to a Memorandum of Agreement (MoA) and reverted to him for approval.

According to the document sent to President Buhari by the FMoH, to fund the PPP project, VAMED Engineering, Austria/CPL Medical Group Nigeria has offered about 400 million Euros; and the federal government is expected to make budgetary provision in 2017 for the plan. As part of the PPP, the federal government is to make provision of 15 per cent of the 400 million Euros, which is further broken down to three per cent annually over a five-year period.

Meanwhile, the Minister of Health, Prof. Isaac Adewole, seems to be singing a new song. Adewole had at different fora told journalists that the federal government plans to refurbish seven teaching hospitals in 2017. He, however, said the FMoH would adopt PPP model in developing healthcare infrastructure in order to augment the budgetary provision, as well as fast track development in the health sector.

In fact, the Minister told journalists last month that the Federal Government will soon create seven trauma centres nationwide to cater for emergencies.He said he had invited seven Chief Medical Directors (CMDs) of the picked teaching hospitals from the six geo-political zones of the country including: Maiduguri in the North-East; ABUTH Zaria in the North-West; National Hospital Abuja; University of Nigeria Teaching Hospital (UNTH) Enugu in the South-East; University of Benin Teaching Hospital (UBTH) Benin; University College Hospital (UCH) Ibadan; and University of Ilorin Teaching Hospital (UITH) Ilorin.

The Minister said the project would cost about N35 billion.Vice President, Prof. Yemi Osibanjo, is also an advocate of PPP model for the healthcare industry. Osibanjo, last week, called for PPP for effective healthcare delivery in Nigeria.

What happens to the third phase of the teaching hospital rehabilitation PPP project, which was approved by the past administration? The Guardian gathered that Adewole has set up a committee to evaluate the project and advise him accordingly.

However, stakeholders believe that the federal government should pursue the third phase of the teaching hospital rehabilitation project by including it in the 2017 budget proposal and beyond to take care of its share contribution to the PPP arrangement.

They when completed, it will save the country the billions of dollars it loses in foreign exchange due to frequent overseas medical treatment by citizens and retain thousands of home-trained medical personnel that migrate abroad yearly for greener pastures.

The TWG said the state-of-the-art medical facilities that will be available in the 20 teaching hospitals and the Quaternary Hospital in Abuja include among others Linear Accelerator, Magnetic Resonance Imaging (MRI), mammogram, and surgical and diagnostic suites.

They applauded the current direction of the federal government to embrace PPP initiative for the implementation of the third phase of the teaching hospital rehabilitation project and the need to involve the Chief Medical Directors of the hospitals from the onset of the project in order to strengthen ownership.

The stakeholders including the TWG said the CMDs would have to decide on the choice of equipment, although VAMED will need to provide adequate information on the brands of the equipment as well as their functionality and sustainability.

They, however, cautioned that healthcare is a social service and it is not expected that proceeds from the hospitals would sufficiently defray the cost of investment; and there is need for the federal government to make adequate provision to ensure semi-annual repayment of whatever VAMED is investing, and there should be other sources of funding to sustain the project.

The TWG said there is need for a thorough needs assessment, construction of good rehabilitation centres, which are not currently available in the country, and the project should also incorporate School of Biomedical Engineering as well as technical outfit to service and maintain the equipment.

It is advised that there is need to forestall duplication of services since some of the hospitals had already gone into one form of PPP or the other such as in area of diagnostic and therapeutics.

How does the country raise its counterpart funding for the third phase of the teaching hospitals project when only 4.15 per cent (N303 billion) is proposed for health in the 2017 national budget of N7.29 trillion?

It is believed that the National Assembly must do an upward review of the budgetary allocation for health in 2017 to meet the minimum 15 per cent recommended by African heads of state in Abuja in 2001, popularly known as The Abuja Declaration; so that the country can urgently begin refurbishing of 20 teaching hospitals and establishing of a quaternary hospital in Abuja.