From Kemi Yesufu, Abuja
Betty Apiafi is chairperson of the House of Representatives Committee on Health Institutions. The lawmaker representing Ahoada East/Abua/Odual Federal constituency of Rivers State speaks on the 2017 budget especially as it relates to the heath sector and other issues.
What is your take on the allocation to health in the 2017 budget?
That is a very difficult question to answer because the budget is a document sent to the National Assembly for legislative input. But what I can say about capital budget not only for Health Institutions but other sectors, especially now we’re in a recession. …the issue of people brandishing words that the capital budget of the country is some percent higher than the previous year’s expenditure gets many people thinking this is a good budget. I think we should go past that stage and ask more direct questions like: what are we using this capital budget for? Only then can we actually know that the capital budget is going to produce the kind of result that we need to move the country to another level . I am saying this because, you have projects that are not properly thought out and they are at different stages of completion.
So what is the option for getting better performance of the budget?
Today, Nigeria is in recession and the cost of construction has escalated so much. So, for you to even look at the capital budget at this time, you have to go back and streamline…And unfortunately we don’t have a list of uncompleted projects. We’ve always been saying in the House that the Bureau of Public Procurement or our MDAs should at least have a list a list of uncompleted projects or we should have a national database on it. We can now go back to those capital projects and begin to look at what is critical. If you have listened to any of our Budget defense sessions with the teaching hospitals, you will hear us telling them that if you have a project that is just starting and you haven’t done much, leave it, take the priority, take just one or two priority projects that you can finish. Because, first of all, contractors are going to ask you for variation, so it’s better for you to take the project that you have the money for. If it’s a building and you can roof it, roof it. And if its a building you’ve roofed, do the finishing and get to use the structure and scale down on other constructions that are at foundation level for instance. So, for us to say that capital budget in the country will make an impact, we have to go into what really makes up capital budget.
The Federal Ministry of Health got N 22 billion for its capital budget of which it want to use N11 billion for counterpart funding for projects with donor agencies and N6 billon for medical centres of excellence. Do you agree with these plans?
Yes and no. No in the sense that before you speak about capital projects , you have to be project specific and before being project specific, you should ponder, how impactful is that project under is in the present circumstance. Unfortunately, I don’t have the information on what exactly they want to do with the N11 billion counterpart fundings. But like I said, what exactly are we targeting? Because for me, the healthcare sector is not only about building infrastructure, and not just expanding existing infrastructure, it goes beyond simply putting in money. From what we’ve seen in the last two years, it goes beyond putting money. One of the areas we have to work out is industrial disharmony in the sector. Again, different health professionals wouldn’t say theirs is a conducive environment to work.
There is always this difference among key players that is almost getting out of control in the sector. And outside that, if you’re designating centres of excellence, it goes beyond just designating them. What kind of manpower do you have to offer services at these centres. How do you set that place apart? I’ll give you an example.
The University of Abuja Teaching Hospital started in the General Hospital, Gwagwalada. And later, for over six years, the Federal Government through capital budgeting built a beautiful edifice they called a trauma centre.
For me, government should have done is to allow the University of Abuja Teaching Hospital to continue to run the old general hospital to take care of the Nigerians who cannot pay the medical bills, but run the Trauma Centre for those who can pay and use it to subsidize those who cannot. Because what is happening in the sector is that government has to budget for recurrent expenditure, capital expenditure, overhead and so on, and when you look at government owned hospitals internally generated revenue, it’s immaterial. Of course, the failure of the secondary and primary health levels has piled a lot of pressure on tertiary institutions. But that can still be handled and that’s why I used the University of Abuja Teaching Hospital as a typical example.
While you’re handling the overflow issues from the primary and secondary health sectors, you use the Trauma Centre to handle other issues and charge and people will come. Nigerians are looking for good hospitals. The teaching hospitals have better manpower and they should have better equipment and better regulation if they run them well.
Unfortunately, you know what happened to the University of Abuja
Teaching Hospital? As they finished that Trauma Centre after six years of government investment , they went into what they called a Public Private Partnership agreement with an unknown company. The company was supposed to supply equipment and run the place. Three years down the line, nothing happened.The building is locked up, deteriorating and the hospital services has also deteriorated because the old general hospital they are using is small, it cannot contain the patients. So, they more or less reduced the University of Abuja Teaching Hospital…for me, I don’t even think it’s up to the standard of a general hospital.
So, when you’re designating a place as a Centre of Excellence, it goes beyond putting money, it has to be a complete overhaul. If, for instance, you’re designating National Hospital as one of the Centres of Excellence to benefit from the budget, I personally think we’ll scale down the services we render and take on the kind of services you don’t get from other hospitals…maybe kidney issues, heart issues, liver issues…and then equip the place properly. But not when a hospital will do thirty cesarean sections in a week or in a month.
When Nigerians go to hospital, because of lack of customer service and maybe because of the over-congestion of the hospitals, relations move into the hospitals to live with the patients. So, I don’t have the details of what the ministry wants to do with N6 billion for seven hospitals designated as centres of excellence…but we’re waiting.
We’re going to let them have their budget, we won’t get involved in it or try to stop them, but we will oversight them and Nigerians will hear. Because designation is one thing, but having the proper, well -thought-out programmes and processes another.