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Electricity, water, funding others impinge UCH at 66, CMD laments

By Seye Olumide, Rotimi Agboluaje (Ibadan)

26 November 2023   |   4:30 am

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Professor Jesse Abiodun Otegbayo is the Chief Medical Director (CMD) of the University College Hospital (UCH), Ibadan. The Professor of Medicine/ Consultant Gastroenterologist and Hepatologist, spoke to SEYE OLUMIDE (Southwest Bureau Chief) and ROTIMI AGBOLUAJE on the 66th anniversary of the college, the achievements and challenges. What story would you say of UCH at 66?…

Professor Jesse Abiodun Otegbayo is the Chief Medical Director (CMD) of the University College Hospital (UCH), Ibadan. The Professor of Medicine/ Consultant Gastroenterologist and Hepatologist, spoke to SEYE OLUMIDE (Southwest Bureau Chief) and ROTIMI AGBOLUAJE on the 66th anniversary of the college, the achievements and challenges.

What story would you say of UCH at 66?
WELL, I will say that we have come a long way. UCH is the leading teaching hospital, the oldest and the biggest. It has been a kind of long journey so to say. As an institution, even as a human being, the older you get, the more problems have to do with your health. You will start having some joints pain, neck pains, back ache, you have heart problems; all these things come with age.

The same thing with vehicles or any machine, when you use it for a long time, wear and tear start to tell, so at 66, I think UCH has some of these symptoms that come with age. But I believe that as 66, we have also gone a long way from where we started from in 1957.
When UCH started, I was told the staff strength was 150, today we have established personnel approved over 7,000 so you can imagine the migration from 150 to over 7,000 personnel and of course, as at the time UCH was established, it was the only teaching hospital in Nigeria, today, we have 64 teaching hospitals including, Federal Medical Centres.
The implication of this is that the resources that used to be focused on UCH now have to be shared among all these 64 teaching hospitals and that will bring about a decrease in the attention that UCH receives in terms of funding and that makes the challenges that I might want to list.
The challenges
Funding has been an issue, there is no Federal Government institution that can say it has all it needs and because we are also an institution that provides social services, we cannot charge our patients the amount on the kind of services that we render because we are public funded, even though partially we are still, to some extent, funded by the public, I mean by the government. Therefore, we cannot charge like some private hospitals of equal status will charge.
Secondly, another challenge is the issue of power or energy and it is not just UCH or only teaching hospitals in Nigeria, banks have now reduced their operating time just because of the cost of diesel and the cost of energy or unavailability of power. UCH has this challenge that has to do with electricity every month. Ibadan Electricity Distribution Company on the average brings nothing less than N51 million bill to us. In fact, some months, it’s more than that. There was a particular month where we got a power bill of N71 million from IBEDC or PHC that is apart from the amount we spent to procure diesel every month. We often spend between N18 to N20 million naira on diesel monthly and you know the cost of diesel has gone up lately, now we buy diesel for about N1,200 to N1,400 per liter and our Internally Generated Revenue (IGR) is unable to cope since we can’t put all our IGR on diesel. The institution needs to render some other services like buying cotton wool and all other medical equipment or needs to take care of our patients.
Still on power, we have to buy a power generating set. Today, we have over 70 power generating sets, which we service and maintain frequently. So power has been a major issue. Fortunately, I was at a reception with the new Minister of Power, Mr. Adebayo Adelabu, who promised that the Federal Government would do something about energy for some teaching hospitals and universities and that UCH will be part of it.
Part of what the minister said is that government would take UCH and other sensitive institutions away from the national grid so that we can be self-sufficient.
Other challenges that we have also revolve around power. During that reception, I told the honourable minister that power means life to UCH, so you now see the chain of effects when you lack power.For instance, you need power to pump water to the hospital in our reservoirs because if there is no water, you can’t pump water, some people will tell you there is no water in UCH, so our laboratories, all the equipment, no exception uses power. So, when there is a lack of power, patients go to the laboratories they want to carry out some tests, they will say come back when there is power. All the radiology equipment such as, CTscans; x-ray and all the ultrasounds use power, same way as other things like in the theater, the ICU and many other services. You see the multiplying effect that the lack of power has on us. It will be a major breakthrough if we are able to overcome the issue of inadequate power supply and the cost.
Many of the electrical installations in this hospital especially the underground cable, level KDA station, they were installed when UCH was established and many of them have not been changed and they are giving us problems now, we are having what they call cable burst and about two years ago, I requested for a bill of what it would cost us to change them, it will cost us over N1 billion. There is no way we can do that from our IGR and we couldn’t get it from our capital. I believe government is doing something about this but we hope it comes much earlier.

The source of our water supply to the hospital is another challenge facing us. The only source of fresh water to the hospital is the Dandaru Dam but today the dam has been overgrown.
When we were students in the early 80s white tourists used to ride boats in the dam from Eleyele, you will see them driving their speed boats and doing sports but now it’s dry. What we are doing now is to dredge a small part of the dam to enable it to supply UCH water. During dry season, UCH faces challenges on water. As the dry season is approaching now I’m already concerned about what we do to get water. We are appealing to the Oyo State Government or those in charge of the ecology of Nigeria, to help us if the dam can be dredged to supply seamless water to the hospital. Those are the major challenges we have.

But aside from these, what are the other areas of challenges in terms of medical equipment?
We can do better as an institution if we have some equipment that we lack for now. Also in the area of ecology of cancer care, there is a machine called linear accelerator we need it badly. Oftentimes, we refer our cancer patients to private hospitals in Lagos and some other places where the cost is very prohibitive and many of them come back because they cannot afford it. We also have a problem with staffing. At present we are short staff, clinical and non-clinical staff.

Is there any data on the issue of staffing?
I have to check that with the Human Resource. I don’t have the exact figure because people resigned virtually on a daily basis. About six nurses would resign daily, I’m not saying weekly, for doctors it’s a bit less. About two to three doctors do resign and travel abroad for greener pastures. Other health workers do resign too. It’s just that the rate is lower.
Even non- clinical staff like those in administration, engineering are all leaving. It is also affecting our law department. This year alone about three of our lawyers have left, yes, people are just going once they have opportunities they leave and it is affecting our services. These other professionals apart from clinical staff are also essential. For Instance, I am a clinical staff and I used particular equipment to carry out my job on the patient but if the machine I use is faulty I will experts on that line to fix it otherwise I won’t be able to work. What I trained to do is to use the machine to make diagnosis of treatment. If there’s any fault, if there’s no engineer or technician, I will have to wait till they fix it, I can’t work. Even when we are working effectively, patients are supposed to pay for services. So, we need experts to manage the books.
If everybody should have health insurance, patients would just come you don’t need to think about going to pay here and there, you just get the codethe NHIS number or NHI number then you start your treatment; but because that is not available here they will have go and pay for x-ray here, go and do this, go and do that. Paying out of pockets for treatment is not a good thing, it is making our service difficult.
Where I’m going is that you need an accountant to be doing this, because if they don’t pay, the people that will release materials for treatments will not because they have to give an account. So, if you think accountants are not important, they are otherwise we will just be rendering services and at the end you won’t see the money coming in and you don’t have those materials to take care of the patients so it has effects. You have to consider both the clinical and non-clinical staff.

What’s the estimate of patients UCH attends to on yearly basis?
In UCH, our services have been expanding. The number of patients we see in a year is about 240,000 new cases. And for us to tackle all these challenges, I believe there’s a need for Universal Health Coverage for Nigerians because paying out of pockets can never give us the best in terms of healthcare delivery.
Nigeria also needs to rejig the Primary Health Care (PHC). The teaching hospitals are burdened with loads of what would have been taken care of by the primary or secondary care level.
Most of the secondary care hospitals like general hospitals are really not functioning appropriately across Nigeria. Only a few were effective when we were students. General hospitals used to train, they used the PHC to train house officials, they do their housemanship there but now I am not aware of any general hospital around us here that has accreditations to train the lowest doctor the lowest level of doctor.
The standards or the equipment have not been upgraded, they don’t have enough staff or the required staff.
Considering the challenges at the PHC and SHC, teaching hospitals are overburdened; they are overwhelmed, they are over-subscribed and the time we should have been spending on very difficult cases we also attend to people with malaria, diarrhea and so on and our facilities are stretched, our staff are overworked and it’s part of the reason why some of them are leaving.
They believe they do all these works and at the end of the month, what they are given as salary is small and they see somebody giving them more for doing lesser, because over there in abroad they are regulated, there’s a number of hours to work because they believe if you are fatigue or over worked, you will make mistakes and they don’t want that, they give you time to rest but here we continue, everybody wants to see the doctor, you must see them, you go to the clinic you see how many patients waiting to see one or two doctors. The doctors are human beings.

How did you really mark UCH at 66?
Because of finances we crammed everything into one day, it used to be a one week event, there’s no money and the country is not smiling at anybody. When people now see spending flamboyantly, they will think we have the money.

Is there no way UCH makes profit?
It does but not a profiteering agent so to say. What we do is to add a mark-up, you see if we go to the market to buy this drug for N10 you can’t sell it to the patients at N10. We would buy, preserve it inside a fridge and that fridge would consume power, which we would have to pay for heavily. A lot of others in the personnel that will work on the same drugs and sometimes we have to weigh the drugs on scale, a lot of other things added, so we usually give a mark-up of 10 percent, it’s not for the profit. There is also what we called administrative charges, we use paper, we use prescription paper for the drugs, where do you later get that cost if you don’t bill into it, so it’s not as if we want to make profit, it’s just a mark-up to offset other things that go along with the purchase of the drugs.
I don’t know if my view is clear? For instance, if you buy an ultrasound machine for certain amount, you know you have to maintain it, service it, sometimes the company will give you a heavy bill, they don’t care whether you are a hospital, the same bill they will give the bank is what they will give UCH because they are also in business, we can’t blame them.
UCH doesn’t have any exemption that recognises it as a social service rendering institution, so, we are treated just like every other institution in the public market and that’s why the power holding company too is charging us industrial tariff when we are not an industry that makes profit and they know but they are in business, they want to maximise their profits. We cannot close our eyes to that because of the patients that we serve, we must have some level of human kindness as health workers, we make sure that everybody or as many people are safe health-wise.