Enyeribe Ejiogu, David Onwuchekwa (Nnewi), Hassan Abdullahi (Zaria), Tony John (Port Harcourt) and Gyang Bere (Jos)
It took the COVID-19 pandemic to expose the deep and extensive infrastructural deficits and general rot that have plagued the country’s healthcare system over the years.
The decay process commenced right from the day the military regime headed by the then General Olusegun Obasanjo ordered doctors in the government service, who also ran clinics in their spare time to augment their income, to either stick to the government jobs exclusively or resign. Hundreds of highly experienced consultants resigned in droves and headed for overseas, particularly Britain (where most of them trained) and America.
Several of their colleagues who were not really keen on relocating overseas chose to set up private hospitals. That experience led to the establishment of a small hospital by three specialist doctors who were friends. The small hospital they established in Surulere eventually metamorphosed into Eko Hospital Plc, which became the first medical facility to be listed on the Nigeria Stock Exchange as a quoted medical services company, now operating from a building majestically located in Ikeja, Lagos. The mass resignation was the starting point of the brain drain that hit the health sector like a thunderbolt.
The efforts of the government to cushion the effect of brain drain through the mass Indian doctors in the late 70s to fill the gap created by the exodus of Nigeria specialists and resident doctors abroad, did not do the country much good. The exodus has not abated as well trained healthcare professionals – doctors, pharmacists, nurses, medical laboratory scientists, etc – are still being recruited by Canada, Britain, United States, the United Arab Emirates (working mainly in Dubai) and Qatar, among other countries.
After the Obasanjo regime handed over the reins of governance in 1979 to the civilian administration of late President Shehu Shagari, ineptitude and lack of vision on the part of the government led by the National Party of Nigeria (NPN) further imperiled the health sector as the vital biomedical infrastructure for the delivery of quality healthcare services began to rot.
It was in the midst of this that the austerity measures imposed by the Shagari administration through the Economic Stabilisation Act 1982, led to the disappearance of essential drugs as the pharmaceutical companies operating in the country became hamstrung by restriction in the issuance of import licences, which were needed to secure foreign exchange. The licences became a tool for political patronage, and were given to well-connected individuals from a certain part of the country to re-sell to the companies that really needed them.
Within a short time, government hospital pharmacies were overtaken by the out-of-stock (OS) syndrome. Incidentally, when the then Major General Muhammadu Buhari and Major General Tunde Idiagbon (Buhari/Idiagbon regime) overthrew Shagari in a coup d’etat on December 31, 1983, the civilian government was accused of turning government hospitals into mere consulting clinics.
When Olusegun Obasanjo returned as a civilian president in 1999, he tried to salvage the teaching hospitals by initiating the VAMED Project, under which the tertiary hospitals were to be re-equipped with modern digital imaging technology and other high-end bio-medical equipment. As it is with all things that have to do with successive Nigerian civilian administrations, the VAMED project did not fully deliver on the desired result.
Of course, some new buildings were constructed in a number of the teaching hospitals and some were furnished with healthcare equipment, but the stark reality was that the “new” machines soon fell into disrepair, thereby leading some knowledgeable stakeholders to suspect that the equipment supplied under the scheme were essentially refurbished machines.
In a fresh attempt to arrest the infrastructural decay in healthcare, the Federal Government came up with a plan to refurbish 11 teaching hospitals spread across the six geopolitical zones of the country. However, it was recently announced that the Federal Government had so far received $890 million from foreign donors to combat malaria, HIV, tuberculosis, polio and some other diseases. It continues to receive substantial foreign donor funds to support its COVID-19 response and other challenges. The question today is, how far has the refurbishment programme gone? What successes have been recorded? Is there a turnaround yet in the state of medical imaging services? To answer these questions, Sunday Sun undertook a tour of selected tertiary hospitals, to learn about their situation today vis-à-vis the plan to refurbish them. What emerged is not a pleasant picture. Read on:
Obsolete equipment dot NAUTH
The Nnamdi Azikiwe University Teaching Hospital (NAUTH), Nnewi, Anambra State is one of the third generation tertiary hospitals striving to make a name for itself in the Nigerian healthcare sector. It is currently operating from its temporary site, while the permanent site is located 10 kilometres away on a sprawling landmass at the confluence of Nnewi, Ozubulu and Oraifite, the three communities that jointly donated the land.
NAUTH is hamstrung by infrastructural deficits. Construction work at the permanent site began 20 years ago, but the progress has been very slow. The current Chief Medical Director of the health institution, Prof Anthony Igwegbe, attributes the slow pace of work to severe funding shortages.
NAUTH is today challenged by obsolete medical equipment, which frequently breakdown and the situation is made worse by the fact that spare parts for them are not readily available. The hospital, Igwegbe reveals, has machines for radiology and oncology. It also has diagnostic digital imaging technology such as CT-Scan and MRI (magnetic resonance imaging), among others, to handle various health conditions. However, the stark reality is that a number of the machines have broken down and not in use.
“The CT-Scan has been down for about six months now. MRI has been out of use for more than one year because it is an old model, and the first generation of the equipment. The spare parts of these machines are no longer accessible. Of course, we have commissioned for the repair. There is demand for the machines, no doubt,” Igwegbe said.
This situation has created a boom for private establishments in Nnewi, Onitsha, Enugu and other places, where NAUTH patients who need such diagnostic services and radiotherapy are referred to by doctors at the tertiary hospital.
Years ago, the Federal Government identified 11 teaching hospitals which it said would be refurbished across the six geopolitical zones of the country. Though the committee set up by the Federal Government has visited the institution to conduct need assessment and submit its report, nothing further has happened.
ABUTH: Obsolete Cobalt-60 machine overdue for replacement
Ahmadu Bello University, Zaria, is the premier university in the northern part of the country and parent of Ahmadu Bello University Teaching Hospital, ABUTH, which is widely regarded as the flagship tertiary health institution in northern region.
Studies by the Nigeria Oncology Society show that the incidence of cancer is on the increase, and cuts across age groups. “Unfortunately priority attention is not being given to cancer treatment in the country by the government.
“Many programmes are competing with cancer at the national level, so cancer is not a major priority. Secondly, the problem is that cancer is not receiving any support from foreign donor agencies compared to malaria, tuberculosis and HIV, which are communicable diseases and thereby get attention. There is no holistic incorporation of cancer in the government’s funding programme. We do not have other vital equipment, which are all expensive. With adequate financial support we can change the present scenario of cancer treatment in Nigeria. We need to invest in infrastructure. We seriously lack cancer treatment centres. How many are in existence and functioning in the country? The only major one in the North is at ABUTH. Then you have at the National Hospital, Abuja, UCH Ibadan, LUTH Lagos, UBTH Benin, UNTH Enugu and a private facility in Lagos.
“We also have small centres in Sokoto and Gombe. So, you can see the spread is not uniform. Even if all the centers are operating optimally, they are not adequate for Nigeria. With an average of 500,000 cancer cases per year, you will begin to understand why cancer is like a death sentence in the country. The cancer centre at ABUTH has not been functioning for two years, and this place is supposed to be a centre of excellence for cancer care. The Cobalt-60 machine is obsolete. The initiative by the Federal Government to refurbish and designate 11 teaching hospitals as centres of medical excellence remains in limbo till date,” Prof Sunday Adewuyi, head of Department of Radiology and Oncology, and Coordinator of the Cancer Treatment Centre, ABUTH, lamented.
To change the narrative on cancer therapy in Nigeria, he believes that the government must exhibit aggressive commitment to a holistic turnaround programme that will lead to complete replacement of the obsolete machines that dot our teaching hospitals. As it is now, the country, Adewuyi said, needs modern equipment like the megavoltage machine.
“The determinant factor is the megavoltage machine. We need the megavoltage machine because, in accordance with international standard, treatment of 60 per cent of cancer patients requires radiotherapy in one way or the other. But with our peculiarity, cancer patients generally come late to the hospital, when their situation has deteriorated and that’s when you need to do radiotherapy, but the machines are not available. We are talking of linear accelerator for radiotherapy. A major cancer centre like ABUTH Zaria which has been in existence for a long time and training manpower, should have more than one megavoltage machine so that if one is down the other could be used. The government can easily fund the acquisition of these machines, but what appears to be lacking is the patriotic commitment to do what is necessary. And it needs to be done in a hurry,” he said.
Demand for MRI diagnostic services high at UPTH
The effort towards completing the installation of the new high grade Magnetic Resonance Imaging (MRI) machine acquired by the University of Port Harcourt Teaching Hospital for its Department of Radiology is progressing very well, as the head of the department, Dr. Obaaba West, noted with glee.
Back in 2006, UPTH acquired an MRI machine, but it was not put to use because the demand for the machine was very low. However, the new one which is being installed was acquired by a firm under a public-private partnership (PPP) arrangement. This became necessary in response to the growth in demand for the machine.
On this West said: “Right now, we have so many un-met demands for high-end digital diagnostic equipment; in fact, there is much demand for the one we are about to install. We are just waiting for the machine to be installed.”
For the meantime, patients that need diagnostic imaging services patronize private centres that have the machines.
Cancer patients groan at JUTH over lack of radiotherapy machine
As it is in some other teaching hospitals in the country, cancer patients at the Jos University Teaching Hospital (JUTH) experience excruciating pains. This is not due to lack of specialists in the field; rather the absence of the required radiotherapy machines. For this reason, radiologists or oncologists at JUTH now refer patients to tertiary hospitals in Kano, Zaria and Ibadan for diagnostic imaging and treatment.
Expectedly, this increases the financial burden on cancer patients and their families, in terms of transportation costs entailed by undertaking several visits to see doctors at the aforementioned facilities.
Though JUTH has CT-Scan and MRI machines for diagnostic digital imaging, both of them have broken down due to the high demand by patients in the hospital.
Consultant Radiologist and Clinical Oncologist at JUTH, Dr. Samuel Kwis, is understandably alarmed by the rapid increase in the number of patients, who visit the hospital. In this regard, Kwis’ earnest desire is that the Federal Government would see the need to establish and equip a cancer treatment centre at JUTH, Jos, for the North Central geopolitical zone of the county.
He gave insight into the cancer picture: “Recent research has shown that cancer is on the increase. By the end of this year, there should be almost 9.6 million new cases annually. The incidence is on the increase because of our lifestyle, our diet and environmental factors are contributing to the rapid increase.
“The demand of the people having cancer has begun to increase compared to the past decades. Currently, JUTH does not have the radiotherapy machine, but it is something that the management is hard working to get. Currently, there are only two or three centres that have functional machines in the country – National Hospital, Abuja and Lagos University Teaching Hospital, but the one at Dan Fodio University, Sokoto is epileptic. We are very hopeful that by next year, if the government does as we hope, we should get the machine. We should start building the facility where the machine will be installed because a room where such machine is kept is very expensive to build. You are talking of building a solid concrete room of one to two metres in thickness so you can imagine how much you need to build that room; so, it is capital intensive.”