Why it is becoming difficult to cope with indigent patients — Dr. Adetunji, chairman, Oyo State Hospital Management Board

In this interview by SADE OGUNTOLA, Dr Gbola Adetunji, the Chairman, Oyo State Hospital Management Board, says that there have been tremendous improvements in the services rendered by general hospitals across the state, but challenges still faced include shortage of manpower, infrastructure and equipment.

THE hospitals under Oyo State Hospital Management are majorly providing secondary healthcare services in the state? Where are they in terms of this statutory role?

Under the Oyo State Hospital Management, we have 37 general hospitals, 3 semi-tertiary hospitals, 10 dental clinics and 7 ordinary clinics being taken care of by this present administration. And in the last 3 years, there have been tremendous improvements in the services that are rendered by these facilities. We still have challenges but we are tackling them one after the other. The first challenge is manpower; the second challenge is infrastructure and the third is in services and equipment.

We have been able to address some of these challenges, especially at the tertiary level. These are Adeoyo Maternity hospital, Ring road state hospital and Jericho Specialist hospital, all in Ibadan. Both the Adeoyo Maternity Hospital and Jericho specialist hospital are accredited for training resident doctors.

We have addressed the issue of manpower shortage. This administration so far has been able to employ 526 health workers. These include 35 doctors, 86 nurses and other categories of healthcare workers. Even though it is still inadequate, that is an improvement.

In the area of infrastructure and equipment, we raised Adeoyo Maternity Hospital to standard it is accredited for fellowship training in obstetrics and gynaecology by the Nigerian Postgraduate Medical College of Nigeria, the same thing for Jericho Specialist Hospital, which has been accredited for postgraduate training for family physicians by the same college.

As I said, we have 37 general hospitals, many of which still need renovation, but we have been able to secure an N24 billion French loan for this renovation which is going to take off by next year. The renovation exercise is going to include 4 hospitals across the state. These include Ring road state hospital, General hospital Iseyin and General hospital Moniya.

At the Ring Road State hospital, they have been able to bring in new services and equipment; we have a functioning CT scan, mammography, ultrasound, a dialysis centre and a functional high dependency unit (HDU).  The HDU is for taking care of people with serious medical challenges like stroke and head injuries. Our charges are much less compared to other hospitals, including private ones. We charge less because we are supposed to give secondary healthcare which is subsidized.

So, we have been able to take services to a higher reckoning. For example, now at Adeoyo Maternity hospital, we do about 80 cesarean sections every month. Sometimes they do even up to seven caesarean sections at night.

We now have facilities for laparoscopy a type of surgical procedure that allows a surgeon to access the inside of the abdomen (tummy) and pelvis without having to make large incisions in the skin. All of these have been at a lot of cost to the government.

 

The 2021 Multiple Indicator Cluster Survey rated neonatal and mortality deaths in Oyo as high, what do you have in place to tackle these?  The survey said that unskilled birth attendants are high, too.

If you are looking at Adeoyo maternity hospital, the mortality rate for pregnant women is very low because the facility has been brought up to standard. And we take many patients from primary health care centres and private hospitals, even though we are overworking our doctors. We have only 4 obstetric and gynaecologist specialists, luckily 2 others have just passed their final examinations and are also our staff. So we are moving ahead. We have not gotten to where we want to go yet, but it is much better than we met it.

Now, most unskilled birth attendants take place at the primary care level and private hospitals, not at the secondary care level and it is not my jurisdiction. Most of the deaths will occur at that level because even in our general hospitals, we have nurses and midwives that can cope with even difficult delivery cases. We don’t use the low levels of healthcare workers.

 

Currently four general hospitals in the state have semi-autonomy in their operations, how has that impacted service delivery for their teeming patients?


These four startup facilities are Adeoyo maternity hospital, Ring Road Specialist hospital, state hospital saki and state hospital Oyo. This started about a year ago and it is a test case because we want to extend it to other hospitals if they can show that services are improving as a result. And indeed, it has achieved this.

For example, the number of patients attended to at these hospitals has increased looking at their internally generated revenue. For instance, the IGR of Adeoyo Maternity hospital and Ring Road hospital is over 100 per cent. If there are no patients, their IGR cannot improve.

 

But people talk about long waiting time in hospitals; they talk about the unavailability of water and electricity. Are these issues still faced by patients at your hospitals?

Of course, there must be waiting time when at the hospital for medical care, but the hospitals, in particular, the semi-autonomous hospitals are coping.  That is why they are semiautonomous so that they will be able to find the fund to buy diesel; ensure there is water in their taps and so on. And semi-autonomous hospitals are given some solar services to cope, through light up Oyo State.

 

Indigent patients are an issue in many hospitals, how is it like in the general hospitals across the state?

We have this problem too. At Adeoyo Maternity Hospital, we see cases every day. Many come without their husbands and are emergency cases requiring a caesarian section. You cannot send them away. We are working on a model to use to tackle this issue. For now, many of them are still treated and the hospitals get some refunds from the Ministry of health. But it is becoming too high for us to cope with because the people are many.  You can imagine at Adeoyo maternity, sometimes the nurses have to buy baby’s clothes for women that have been delivered; some cannot even pay for the surgery. They get blood for transfusion for them on their own.

So since some of these hospitals are now semiautonomous, we want them to keep a certain percentage of their income and use it in taking care of indigent cases and those they cannot take up, push back to the government so that they can get some refund from the Ministry of Health.

 

Is there a good referral platform for an effective healthcare system between primary, secondary to tertiary health facilities in the state?

We are just trying to bring up a proper referral care system to Oyo state. We want to designate hospitals and have health centres attached to them so that patients can know where they should go if they need a higher level of care.  Ambulance services are also needed for effective referrals.

Currently, most of our hospitals have ambulances. The 10 ambulances bought by the state during COVID-19 pandemic have been distributed to other hospitals. We got another 7 ambulances from the global fund and they too have been distributed to our health facilities. There are still several hospitals without ambulances but everything has to be gradual because everything needs money and it is not only health that the government is spending money on.

 

It is common for patients to claim that their rights are being infringed on at the hospital, what is your opinion on this?

The right of the patient is that they should get care from the health facilities but they have to understand that these facilities are overwhelmed. One, we know that we are still short of staff, and then we are trying to cope with the migration of nurses and doctors, especially even though it is now extended to medical laboratory staff too.

They should understand that in a general hospital setting, there will be more patients than doctors. And so they have to learn to be patient since they did not drive them away, they should just wait for their turn, and they will be seen.

When patients come to the hospital, they do what is called triage to see the patients. The more critical ones are treated first and the other people can wait but they don’t want to understand.  Even if we want to employ enough doctors, we cannot even get them even if we have the wherewithal to get the number of doctors that we need.

 

The management of the University College Hospital (UCH), Ibadan, promised to support Oyo State in providing care, how far has this been actualised?

We have an MOU and the arrangement on this is online. It started last year and it only involves the Ring Road State Hospital and Adeoyo maternity hospital, where we have 14 doctors come in from UCH, Ibadan to consult. We also have a training agreement, so they can also bring their residents to our hospitals for clinical postings. It will be extended to other hospitals in the state with time.


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