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‘Neglecting PHCs for upgrade of General Hospitals would be counterproductive’

By By Gbenga Salau

19 March 2023   |   3:06 am

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Recently, the Lagos House of Assembly adopted the recommendations of its Committee on Health Services for the upgrade of five of the state general hospitals to tertiary health institutions.

Recently, the Lagos House of Assembly adopted the recommendations of its Committee on Health Services for the upgrade of five of the state general hospitals to tertiary health institutions.

The lawmakers sought the upgrade of a general hospital in each of the five divisions in the state.

They made the resolution after deliberating on a report submitted by the chairman of the House Committee on Health Services, Olusola Sokunle, who identified the five affected general hospitals as those in Badagry, Alimosho, Ikorodu, Epe and Lagos Island.

Sokunle, while canvassing for the adoption of its committee report, said that the committee visited all the general hospitals across the state to determine the ones that could be upgraded to the tertiary level.

According to him, the upgrade of the general hospitals had become necessary, as it would help reduce the pressure on the facilities of the Lagos State University Teaching Hospital (LASUTH).

However, if the upgrade of the five general hospitals to teaching hospitals scales through, it means there would be seven teaching hospitals in Lagos State only. There are at present two tertiary hospitals in the state, Lagos University Teaching Hospital (LUTH) owned by the Federal Government and Lagos State University Teaching Hospital (LASUTH) owned by the state government.

This also implies that the Lagos State government would be overseeing six teaching hospitals if the proposal gets the executive arm’s approval.

Meanwhile, since December 2012, it is expected that countries and sub-national policy drives around the health sector should be geared towards Universal Health Coverage (UHC) objectives.

This was following the United Nations General Assembly resolution imploring nations across the world to fast-track progress toward Universal Health Coverage (UHC).

According to the World Health Organisation (WHO), Universal Health Coverage (UHC) means that all people have access to the full range of quality health services they need, when and where they need them, without financial hardship.

It added that it covers the full continuum of essential health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course.

WHO stated that the delivery of these services requires health and care workers with an optimal skills mix at all levels of the health system, who are equitably distributed, adequately supported with access to quality-assured products, and enjoy decent work.

So, it is expected that the drive by the Lagos State House of Assembly in the health sector should be geared towards meeting the UHC objectives.

But health experts have said that Universal Health Coverage (UHC) depends on a strong primary healthcare system, not the tertiary healthcare that the lawmakers are proposing.

Giving a review of the conditions of PHCs in the state, recently, the Commissioner for Health, Prof Akin Abayomi, said that at least 60 per cent of the primary healthcare centres in the state are not in a very desirable state.

Abayomi said: “A functional Primary Health Centre is the foundation of a vibrant healthcare system and is part of the blueprint for the transformation of the medical infrastructure strategy in Lagos State.  Lagos State has over 325 PHCs, with at least 60 per cent not in a very desirable state. The state government is currently putting plans in place to refurbish these facilities to cater for the health needs of residents.”

Abayomi added that primary health care is the bedrock of any health care system, stressing that it is because the challenges confronting that level of health care system are not adequately addressed which is why the secondary and tertiary levels of care are usually overwhelmed.

Commenting on the upgrade of the general hospitals, a public health practitioner, Dr Olaniyi Afolabi, said that a house is built from the foundation or scratch to the top and not vice versa.

So, it was not surprising he further said that upgrading the general hospitals to tertiary hospitals at the neglect of Primary Healthcare Centres (PHCs) is penny wise, pound foolish, because it would be counterproductive, to say the least.

Also weighing in on the issue, Omotayo Olojede, another public health practitioner, said that while upgrading general hospitals is a good investment, equipping the PHCs is the easiest way to achieve UHC. “This is because PHCs are the closest and the most accessible to the people,” Olojede maintained.

He also agreed that upgrading PHCs (personnel, equipment and materials) would decongest existing secondary and tertiary health facilities. He further said that many secondary and tertiary health facilities are dealing with conditions that could have been resolved at the PHCs, which is just because most PHCs are sub-standard

“In Lagos, I would not say that the PHCs are dilapidated, because compared to other states in the country, Lagos State PHCs are way better. However, I believe more could still be done. While upgrading general hospitals is not a bad idea, it should not be at the expense of PHCs.

“PHCs need more personnel and improved capacity to offer more services. If PHCs are not equipped to handle minor ailments effectively and efficiently, the general and teaching hospitals will never be enough and we would be back to square zero in no time,” Olojede observed.

Also x-raying the assembly’s position requesting for the upgrade of the general hospitals to teaching hospitals, the National President, Association of Nigerian Private Medical Practitioners (ANPMP), Dr Kayode Adesola, said that the plan was a waste of scarce resources considering prevailing challenges in the health sector.

Adesola stated that upgrading general hospitals to tertiary hospitals was futile without necessary medical personnel, observing that many hospitals are struggling to recruit and retain healthcare workers.

He said: “The building and equipment will not do the work. The lawmakers should legislate on policies that will attract and retain health care workers, to stem the tide of brain drain in the state.”

He, therefore, suggested the strengthening of the Primary Healthcare Centres (PHCs) across the state, which would help to decongest and reduce pressure on the secondary and tertiary hospitals.

“The PHCs should be the goal, once you strengthen it, you have taken care of 80 per cent of health cases. Let us concentrate on what will help everybody, not just giving out contracts and building structures,” he maintained.

On his part, Dr Oluseun Ogunnubi said that the Lagos State government has done a lot in the health sector.

“No other state in Nigeria can be compared with Lagos State in terms of investment in the area of health. We call it mini Nigeria when it comes to health spending. They have done a lot in terms of maternal mortality reduction, infant mortality reduction, infant healthcare and adult care as well as social welfare package, and emergency services.”

Ogunnubi said that from his personal assessment and audits of Lagos State general hospitals, they are well equipped to be upgraded to teaching hospitals.

He added that Lagos State University Teaching Hospital (LASUTH) was once a general hospital, as Ikeja General Hospital, just as the Lagos Teaching Hospital (LUTH) was one time a general hospital and they were upgraded to tertiary hospitals.

Ogunnubi said: “With constant upgrading, I believe that almost all the general hospitals in Lagos State, especially the flagship general hospitals are worthy of being turned into teaching hospitals. And when they are converted into teaching hospitals, there would be an accreditation panel for all the departments to train health personnel.

“So, it is important to know that Lagos State has done well and the general hospitals are well equipped and the advantage of these general hospitals being turned to teaching hospitals is that they will provide opportunity for students to be trained.

“Gone are the days that students will complete their medical school training and they will have to wait endlessly for years before they could start residency programme. Also, the issue of brain drain in the health sector is of concern with doctors leaving the country in large numbers.

We need more teaching hospitals to train medical personnel so that those who are willing and denied residency programmes elsewhere can go into any of these hospitals.

“Thus, the more hospitals we have as teaching hospitals, the more work that will be available, as those who graduate from medical schools can aspire to be consultants and those who finish medical schools can become doctors and specialists.

“Therefore, it is a step in the right direction and every other state of the federation should emulate Lagos by ensuring that the general hospitals in their domain are well equipped to become a state of the art hospitals befitting of being converted into a teaching hospital,” Ogunnubi stated.

For Dr. Taiwo Obomon, upgrading the general hospitals to teaching hospitals is a laudable one. “However, this has to be done alongside an upgrade of the PHCs to general hospitals. Indeed, many of the PHCs are neglected, thus, many patients at the grassroots do not get the adequate and prompt medical attention needed. An upgrade and strengthening of these PHCs would go a long way to achieving universal health coverage.

Although the assembly adopted the report of its committee on health, the legislator representing Lagos Mainland 2, in the state assembly Mr Moshood Oshun, while contributing to the discussion, made case for the establishment of more general hospitals across the state, saying that instead of converting the five hospitals to tertiary health facilities, more hospitals could be established for easy access by the residents.

Oshun further argued that the funds to be used for the upgrade of the hospitals could be used to establish new general hospitals in the local councils.

Also, in his submission, the Speaker of the House, Rt. Hon. Mudashiru Obasa, said that there was a need to sustain the glory of the five general hospitals by upgrading them to tertiary health institutions.

Obasa, nonetheless, said that there was a need to create synergy among general hospitals. He further said that there must be regular sensitisation to make Primary Healthcare Centres more functional.

Of note, however, was that the Lagos State House of Assembly committee on health also recommended the overhauling of the Primary Health Centres (PHCs) by the state government with the local councils expected to intensify awareness and sensitisation about the usefulness of the centres.