By Emmanuel Unah
Prof. Tthomas Agan is the Chief Medical Director, cmd, of University of Calabar Teaching Hospital, ucth, and Chairman, Committee of Chief Medical Directors and Medical Directors of Federal Tertiary Hospitals. in this interview, Agan speaks on the state of health facilities in the country and the challenges faced by the hospitals in health care delivery.
You have been CMD for the past six years. How do you see the state of the health sector?
The three tiers of healthcare delivery, namely, primary, secondary and tertiary, have not thrived because of poor funding. However, I must appreciate the regime of President Buhari for improving budgetary provisions to the health sector.
It will be highly appreciated if the budgetary provisions are implemented. I must also commend the previous regimes, especially that of President Obasanjo which introduced VAMED to upgrade the equipment in 14 tertiary hospitals. There was a continuation during the Yar’Adua and Jonathan’s eras.
The drive by the present government will assist the health sector. States and local governments should take critical appraisals and funding of the secondary and primary health services respectively. However, the bottom line for Nigeria is universal health coverage.
At the moment, only a small percentage of Nigerians are covered by any form of insurance. Most of those who are covered are staff of government. Right now, over 70% of expenses in health by individuals are out of their pockets. With universal health insurance, everything will be covered such that if a patient goes to hospital, he/she will be aware of the fact that his expense has been covered by insurance.
This means even the farmer in the village will have access to basic healthcare. I’m confident that the present government is looking in that direction and this is why recently they tried to start implementing the National Health Act which was passed two years ago.
But we hear that the bulk of the facilities in our hospitals are in a deplorable state. Why is it so?
The issue of power is not peculiar to the University of Calabar Teaching Hospital, it is a national challenge. Power supply is epileptic and we have to utilize backup power which is generators. Now, what is happening is that hospitals pay above industrial rates. As of November last year, we were paying about N40 per kilowatt instead of N33.7 per kilowatt.
Today, we pay about N49.3 per kilowatt, which is far higher than industrial rate, and, collectively and variously, we have tried to appeal to the authorities to see the possibility of making us pay domestic rate but we have not received positive response. Secondly, the generators we use too frequently because of the epileptic public power supply, we need to see to their maintenance; we look at diesel supply which sometimes means two trucks of about 40, 000 litres. Our overhead allocation is N6 million per month. Since January, we have received only five months’ allocation which cannot even take care of a truck of diesel. So the truth of the matter is that no matter what you do, there is always going to be challenges.
Power supply in the health sector is a major issue bearing in mind the fact that, without power, you cannot treat a patient; without power, you cannot use the facilities. Even the major thing, which is research and training, cannot be undertaken without power. So, what I am saying is that because of incessant power failure, we have a lot of challenges. The solution is that the Federal Government should fund power supply to the health sector centrally. If this is done, you will witness improvement in service delivery, training and research.
Recently, you were quoted as saying that most deaths are attitudinally related. Can you say more on this?
Attitude remains a major cause of deaths in our country and indeed our hospitals. The patient, relatives and even the society, in terms of denials, religious interference, poverty, ignorance, all have attitudes leading to delays that impact negatively on health outcomes. And the ways the health care givers do their jobs, from the hospital gate through the emergency unit, record staff, account staff, nurses, health assistant, doctors, laboratory scientist, radiographer, theatre, and every form of delay suffered by our poor patients are attitudinal.
The person at the medical records equally says ‘you are not the only person here – the clock is ticking’, that’s attitude. If you build all the delays caused by healthcare providers, you will realize that attitude of health care providers plays a major role in deaths in our tertiary institutions. I have suffered it myself, not once, not twice!
Recently, the Federal Government said it was considering stopping doctors from engaging in private practice. How does this impact on healthcare?
I think it is a move in the right direction especially as it applies to those working in the public sector. The law that established the medical practice says that you are free to engage in private practice in as much as it does not interfere with your official duties. Generally speaking, as consultants, if you run a hospital, it means that you admit patients like we do in federal hospitals. But when you have a private practice, it also means that you admit patients.
This move should not only end with doctors but should be extended to scientists who open private laboratories as well as pharmacists and physiotherapists. You cannot serve two masters at a time. Most public officers just bear the name that they are staff of teaching hospitals, federal medical centres or public hospitals.
They are permanently in their private practices. Sometimes they have agents that move patients from public hospitals under any guise to their private settlements. It is sad to say that some may not see their patients from clinic through wards, theatre until they are discharged. We either work in the public sector or run our outpatient consulting clinics whose activities should not interfere with our official duties or run our private practices fully.
Rather than being in their places of employment during official hours, they are in their private facilities. Some of them only come around to look at those who can afford to pay them in their private facilities and then take the patients there. How come sometimes people who are at the point of death are rushed down here and when they die, it’s said ‘they died at UCTH’. I call this attitudinal corruption punishable with hell fire.
Do you think these people are sabotaging the system?
It’s pure sabotage. I can tell you clearly that a lot of us may not have even seen our patients in the last one year and are still said to be the staff of the hospital. Are they morally justified that they are the ones managing the patients? This happens because some of them have junior officers who will look after patients. You know in a hospital like this, we have house officers and resident doctors before the consultants and probably the resident doctors have been coming. This attitude rubs off on the junior workers because you are inculcating bad working habits into them. I call it attitudinal corruption.
Have you gotten any report that hospital staff tried to lure patients to their private practice and what steps have management taken to discipline those staff?
There is no law for now that says ‘this is how to sanction’ such staff. But I verbally reprimand them. This matter is becoming a topical issue and management is educating patients. Whoever tells you that ‘if you come to my private clinic, you will get the best’; report that person to me and that person will be reported to government because we are all government employees. We will stop it soon.
What do you plan to do with the wards in deplorable state?
That’s why I talked to you about outsourced services. The attitude of some of the patients is terrible. Imagine a patient who uses newspaper to clean up and then puts the paper in the toilet! The paper will block the toilet. The situation is not very friendly because of the outsourced services we had to suspend. These people were not being paid and there was massive looting and stealing within the system.
In April this year, we all met in Port-Harcourt to iron out the issue of outsourced services and government came to verify the money owed and we were told the money would be paid immediately. But as I speak, we do not have any clue as to when the money will be paid.
As of April, 2017, almost N300 million was owed on outsourced services which covered 2012 to 2016. It is budgeted for usually under Service Wide Votes but we have not received the money even after i sent a reminder to government on behalf of teaching hospitals in the country. Some of these outsourced staff has taken UCTH to court as if the hospital is the one owing them. I feel bad that patients are suffering because of this unpaid money.
We are all Nigerians and these people are dying. If this money is paid, the people handling the outsourced services will come back and keep the system clean. If these people are not working, the hospital deals with what is called biological hazards infecting conditions. If we do not handle human parts properly, there is a high probability that patients and staff will be infected.