Nigeria’s unhealthy health institutions

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By Funmilayo Aremu, Vincent Kuraun, Biola Azeez, Isaac Shobayo, Adeolu Adeyemo, Johnkennedy Uzoma, Michael Ovat, Subair Mohammed, Alphonsus Agborh and Godwin Otang report on the lack of basic infrastructure in some government-owned healthcare facilities across the country.

The Nigerian health sector has always been faced with multiple challenges ranging from poor funding to inadequacy of skilled workers owing to mass exit of skilled personnel, lack of infrastructure, accessibility and affordability for current and prospective patients, among others.

The situation now seems to be taking on a worrisome dimension with growing concerns among Nigerians whose lives are being threatened daily. Their hopes for accessible and affordable health care seem to have been dampened by the lack of basic infrastructure, particularly beds, in government-owned hospitals.

One of such cases is that of one tweep, Prince God-give Azza (@IAMPRINCEGIVE), who took to his Twitter account to lament the death of his sister who, according to him, gave up the ghost right outside the emergency centre of the Lagos University Teaching Hospital (LUTH).

“Right in front of LUTH emergency centre, my kid sister died this morning after waiting for over two hours because there were not enough beds. I don’t blame anyone but greedy politicians. Nigeria happened to you Debbie. Rest in peace,” Prince said in the tweet.

Many Nigerians in the comment section consoled him over the death of his sister and wondered how a government-owned hospital could have bed shortage in the present age. Many others narrated their experiences with government hospitals in Nigeria and how some of their relatives suffered the same fate.

These revelations and accusations are coming against the backdrop of the excruciating socio-economic pains most Nigerians are going through as a result of the bad shape of the country’s economy. The nation’s health sector has consistently recorded a low due to poor funding and other impeding factors. But Nigeria, a significant signatory to the 2001 Abuja Declaration on health funding, Sunday Tribune’s investigation revealed has constantly failed to meet the letter of the agreement.

The Abuja Declaration of 2001 is an agreement made by heads of states and governments under the African Union (AU) that encourages countries to dedicate at least 15 per cent of their annual budgets to the health sector. But checks by Sunday Tribune showed that Nigeria has never met the 15 per cent commitment of the declaration since it became a party to it.

Even though the 2023 health budget significantly increased to N1.17 trillion as against the N835.12 billion in the 2022 health budget, it still does not meet the 15 per cent commitment as it is only 5.75 per cent of the 2023 budget.

In a 2021 survey, Global Health Security (GHS) Index ranked Nigeria 85th –fourth in Africa behind South Africa, Mauritius and Kenya– among 195 countries with available critical capacities or lack thereof to prepare for future epidemic and pandemic threats. This was a significant improvement from its 2019 rankings, which placed Nigeria at 11th in Africa while assessing each country’s vulnerability to epidemic emergencies and their capacity to respond.

In spite of the lofty improvements, a 2017 report by McKinsey & Company, a global management consulting firm, noted that the country only boasts of 0.9 hospital beds per 1,000 people including inpatient beds available in public, private, specialised hospitals and rehabilitation centres.

While the figure is less than the global average of 2.3, beds in the country’s Intensive Care Unit (ICU) meant for emergencies is estimated at 0.07 per 100,000 people.

In the light of this, Sunday Tribune examines the state of health care in terms of infrastructure and patient care in some government-owned hospitals in the country.

Lagos University Teaching Hospital, Idi-Araba

Speaking with Sunday Tribune on the event that occurred on March 16, leading to Deborah’s death, the Head of Corporate Service/PRO, Omolola Fakeye, said LUTH, like every other teaching hospital in Nigeria, has its own challenges while describing Deborah’s death as “most unfortunate.”

Recalling the incident, Fakeye said: “She was actually rejected from other hospitals including Lagos State University Teaching Hospital (LASUTH) because of bed space and it was LASUTH that finally referred her to LUTH as stated in the referral notes she brought and unfortunately, there was no bed space here too at that time.

“The general public perceived the case when the tweet went viral as if LUTH deliberately rejected that young girl. It is rather unfortunate; it is not as if we don’t have empathy that the young lady died. She has a whole life ahead of her but unfortunately, the incident happened.

“It was because of this incident that Honourable Femi Gbajabiamila heard us and now, we have an over N5 billion project going on. Five sets of out-patients buildings will house 252 consulting rooms when completed.

“It was most unfortunate that a young child’s life was cut short but it wasn’t due to negligence by LUTH.”

On the other challenges facing the hospital, she disclosed that the 61-year-old hospital was established when the population was less than a million, adding that most of the structures in the hospital which were constructed at inception are still being used to serve over 15 million people who now reside in Lagos State.

“We have expanded to the best of expansion that can accommodate healthcare. Don’t forget there is a standard in healthcare. We cannot say we want to save lives and then compromise on standards.

“Currently, the Accident and Emergency Unit here in LUTH can only accommodate 36 patients at a time. Some years back, the former Skye Bank gave us a building and a section of it was used for accident and emergency services just to extend or expand our emergency services.

“What we do when there are no more bed spaces is, we triage outside. We get them stabilised, then we refer them because once we accept a patient, that patient becomes our responsibility and if we are found wanting in any way, the same patient you are trying to help would come on us and say that we were unfair to them. So, we don’t admit more than our capacity,” she explained.

Fakeye also recalled the 2020 incident where a mother brought her child in an emergency situation and the hospital stabilised the child but she went on to publish “false news” about the Blue Roof section of the hospital which went viral until the hospital sent a rejoinder.

“The patients’ relations building was under construction at that time, but as we speak, it is complete and LUTH now has three Patient Relations Places,” she added.

“We celebrated 60 years but still have the old buildings, whatever you find new and dynamic here is via collaborations as the government alone cannot carry the burden of healthcare.”

Fakeye also unwittingly disclosed another major problem most government hospitals are facing currently, which is re-staffing, after being faced with the “Japa syndrome” that depleted the ranks of medical experts.

“We are also having serious human resource problems now. In the past, when we wanted to recruit residents doctors for a space of 200 to 300, we [would] usually have over 3,000 applicants. But right now, we are begging, just come, but the only thing is that we cannot compromise our standard. But if you are qualified as a resident doctor, we will take you.

“We are even looking out for those ones that have just completed their NYSC so that we can employ, but we can’t even find them. We employ nurses today before they will finish registration, they are gone. These are our challenges,” she disclosed.

The PRO further pleaded with the Federal Government to build more health care facilities like LUTH, saying “by now, we should have about five of LUTH in Lagos. In the United States or other developed countries, a hospital of this size and magnitude is available in each county.

Lagos State University Teaching Hospital, Ikeja

Fears about the issue of inadequate beds for patients in government hospitals in Lagos State returned to national focus recently when a BRT crossed the path of a train at full speed, resulting in deaths and injuries to passengers of the bus, who are mostly civil servants.

Viral photos and videos on social media showed victims of the accident with varying degrees of injury being laid on the ground within the premises of the Lagos State University Teaching Hospital.

The sight sparked outrage, compelling the officials of the Lagos State government to explain why the patients had to be laid on the ground first, before being properly admitted to wards within the hospital.

Commissioner for Health in the state, Professor Akin Abayomi, would not confirm whether LASUTH currently has a bed space challenge or not, but explained that the proper thing to do when there is a mass casualty is to triage –place everyone in the open space, then sort the victims out, according to the severity of their injuries, in order to prioritise saving lives.

“They will sort out the patients, they will move the critical patients first, then they start to move the moderate patients, and then they move the mild patients,” he said.

The Chief Medical Director of the hospital, Professor Adetokunbo Fabamwo, who denied there was a crisis of bed space during the accident, also disclosed that victims of disasters are always treated freely.

According to him, “In LASUTH, when we have disaster cases, we treat them completely free of charge. But then, of course, we send a bill to the government and they usually pay the bill.”

While commenting on the challenges of low bed space across general hospitals in the state, the spokesman of the State Ministry of Health, Tunbosun Ogunbanwo, told Sunday Tribune that the state government is doing a lot to address the burden of low bed space which, according to him, is occasioned by the daily influx of people from neighbouring states into Lagos to access quality healthcare that is being offered across public hospitals in the state.

According to him, the Lagos State government has embarked on the upgrade and expansion of health facilities to accommodate more patients.

“We are upgrading and expanding hospitals across the state. New hospitals are being built at Ojo. There is an expansion of general hospitals at Harvey Road, Ikorodu and Isolo. There is a lot of infrastructural development taking place at LASUTH.

“There is a new structure at LASUTH where we have a maternal and child healthcare building. So, the government is doing a lot in order to take care of the health needs of its citizens.

“We have a lot of hospitals with heavy infrastructure. A lot of people are coming into Lagos on a daily basis to access quality healthcare and this administration has done a lot to meet up with the challenge.

“You can see the moment we had the BRT-train accident; you could see the way we responded swiftly. Immediately, all the victims were taken to various hospitals across the state.”

University of Ilorin Teaching Hospital (UITH)

In the University of Ilorin Teaching Hospital (UITH), Kwara State, the challenge of inadequate bed spaces for patients seems to have remained in the facility in the past few years.

A source in the teaching hospital, who craved anonymity, said: “It is not a peculiar situation in the UITH. It is a general phenomenon. A large number of patients compete for bed space because we have many people coming from far and near to get special medical services of various kinds in the teaching hospital.

“People bring patients from the neighbouring places such as Ogbomoso, Igbeti, Saki in Oyo State, Ekiti, Niger states, among other areas, to the teaching hospital.”

Sunday Tribune gathered that on many occasions, influential people have to lobby the hospital’s top management staff to intervene in order to get bed space, while some are made to come from home to reduce the tension usually created by the problem.

A visit to the facility also showed that relatives of patients, who had accompanied and provided one immediate need or another to patients, sleep outside wards in the teaching hospital, while patients receive treatment inside the wards.

Efforts to speak officially with members of hospital management on the situation were not successful. However, a source among medical staff in the hospital described the situation as a general one in Nigerian hospitals.

The source, who said that the UITH ranked among those teaching hospitals in the country with relative provision of infrastructure by the management and philanthropists, agreed that more efforts could be made to ensure adequate provision of necessary infrastructure.

Plateau State Specialist Hospital and Jos University Teaching Hospital

Sunday Tribune’s findings at the Plateau State Specialist Hospital and Jos University Teaching Hospital, Plateau State, revealed that the two health institutions are lagging behind in many areas and living in the past.

Apart from the bed shortage where some patients can be seen on mats along the hospital corridors, it was discovered that the Plateau State Specialist Hospital equally grapples with the lack of basic consumables to take care of the patients on admission.

A patient, Amina Yusuf, who was about to be discharged, said the service being rendered by the hospital keeps diminishing due to lack of competent doctors, nurses and other paramedical staff that were supposed to be on ground.

“Though the few available are trying their best to keep the system going, there is a shortage of the requisite manpower. It is as though the state government has abandoned this critical sector,” she said.

A medical doctor, who volunteered information on the condition of anonymity, said despite the recent recruitment of doctors and other health workers, the hospital is still struggling to meet the demands of patients that throng the hospital daily, adding that facilities are grossly inadequate compared to any standard hospital.

But at the Jos University Teaching Hospital (JUTH), a cross-section of staff who spoke with Sunday Tribune on the condition of anonymity, said the situation had improved a little bit with the arrival of the new Chief Medical Director, Professor Pokop Bupwatda. They, however, quickly added that the facilities therein are ageing and there are complaints of epileptic power supply.

Further checks revealed that patients were in most cases hurriedly discharged due to a lack of enough bed space to give way for those with critical conditions.

A staff member of the teaching hospital who did not want his name printed said there are relatively competent medical personnel available, but added that the hospital is battling with the issue of lack of sufficient drugs.

University of Osun Teaching Hospital

The case seems to be different in the University of Osun Teaching Hospital, Osogbo, as findings revealed that the hospital has enough bed spaces for patients in their wards.

Investigations into the humanitarian services establishment revealed that there are spare beds kept in the stores and available to be deployed when the ones in all the wards are fully occupied.

A senior worker in the hospital who preferred anonymity told Sunday Tribune that the state government recently rolled out some beds to the hospital which are yet to be used.

A patient, who simply identified himself as Mr Adegoroye, while speaking with Sunday Tribune, confirmed that there are enough bed spaces in the hospital and that every patient is being attended to accordingly.

Meanwhile, all efforts to speak with the management of the hospital on the matter yielded no positive result as all those met declined to comment.

University College Hospital, Ibadan

In spite of reported lack of adequate bed space at the facility, checks by Sunday Tribune showed that there seems to be adequate bed space for patients at the University College Hospital (UCH), Ibadan, Oyo State.

While efforts to reach the hospital management proved abortive, Sunday Tribune visited the Accident and Emergency Unit and the Intensive Care Units and found out that no single patient was admitted on the floor or mat as indicated by various reports.

During the visit, it was discovered that spare beds were brought in as patients were rushed into the Accident and Emergency Unit.

Chukwuemeka Odumegwu Ojukwu University Teaching Hospital, Anambra State

At the Chukwuemeka Odumegwu Ojukwu University Teaching Hospital (COOUTH), Amaku-Awka, Anambra State, the Chief Medical Director, Dr Joe Akabuike, disclosed that the state-owned teaching hospital is fully equipped with medical facilities for effective healthcare service delivery to Nigerians.

According to Akabuike, “I understand that across the country, most tertiary and secondary health facilities (teaching hospitals and federal medical centres) are nothing to write home about. In most of these institutions, the situation is so bad that patients are required to provide their own medications such as hand gloves, syringes, bandages, among others.

“This is just as many have had to purchase drugs from pharmacies outside the hospitals before they could get the attention of the doctors. But here in COOUTH Awka, the case is not the same. The state government is always in a monitoring mode to ensure that no patient admitted to COOUTH lacks prompt attention.

“You can investigate, most of the complex health issues are referred to COOUTH from other states, because of the facilities and capable hands available. So, we have no challenges with bed spaces in COOUTH. There are enough beds to accommodate the sick.”

According to the CMD, COOUTH is equipped with notable healthcare facilities including an ultra-modern Mother and Child Referral Centre; Dialysis Centre; a private ward and 64-slide CT scan put up by the Anambra State government.

He, however, said any teaching hospital or federal medical centre that does not have the challenges of bed spaces means that such facilities lack the all-around capacity to work optimally. He also called for improved welfare for healthcare providers as a means to curtail the brain drain in the country’s health sector.

A male patient at the emergency ward of the hospital, who pleaded anonymity, however, lamented the lack of constant power supply, poor attention to patients and lack of materials for staff to work with.

He appealed to the state government to improve the welfare of workers in the hospital in order to motivate them.

Federal University Teaching Hospital, Owerri

The Public Relations Officer of the Federal University Teaching Hospital, Owerri, Imo State, Dr Jacy Achonu, while speaking with Sunday Tribune, said a lot is being done to improve the condition of patients.

The PRO said that the management had established some structures purposely to decongest various wards especially those in emergency conditions so as to avoid lack of bed spaces in the hospital.

She said that the issue of bed spaces in a hospital usually occurs because of patients’ urge and regular demands to receive adequate medical care and services for quick recovery.

According to her, every patient prefers to come to FUTH where they are sure of total and adequate care from the hospital.

The PRO, who took Sunday Tribune on a tour of the female and male emergency wards, said that as it stands now, new structures have been built for emergency patients while adequate treatment is being administered to the patients in the hospital.

Dr Achonu said that in order to attend to other patients in emergency, patients are treated and moved to available beds so that patients in emergencies would be attended to immediately.

Efforts made to speak with some of the patients was rebuffed by the management.

University of Calabar Teaching Hospital, Calabar

The management of the University of Calabar Teaching Hospital (UCTH), Calabar, Cross River State, revealed to Sunday Tribune that it has a total of 636 bed spaces spread across “the main hospital, the Comprehensive Health Centre and the Federal Staff Clinic.”

The Director of Nursing Services in the institution, Mrs Iris Ayumba, told Sunday Tribune that the beds are sufficient for now, but being a laboratory heath institution, there is always room to demand an increase of bed spaces for the facility when the need arises.

“The challenge of bed spaces is not peculiar to the University of Calabar Teaching Hospital. I can tell you, with utmost sincerity, that the present management is doing everything within its power to rectify whatever challenges we may have had in the past.

“The present management has put in so much efforts to ensure the patient’s welfare. Whatever shortcoming is not extraordinary, there’s no hospital without a bit of shortcoming. We are ensuring that our patients are well taken care of.

Sunday Tribune visited the facility and found admitted patients occupying some of the available bed spaces while some beds were empty.

Federal Medical Centre, Asaba

At the Federal Medical Centre, Asaba, Delta State, when Sunday Tribune visited, there was no such problem of patient being treated on bare floor. According to the Managing Director, Dr Victor Osiatuma, the beds in the facility are enough to accommodate patients as admission is determined by the availability of beds.

According to him: “It is inhumane to admit patients only to keep them on the floor inside or outside the ward. In the case of an emergency where the number increases, we take them to other wards for treatment.

“In a few cases, those that we can’t admit are referred to other facilities instead of keeping them on the floor,” Dr Osiatuma said.

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