Lagos’s oldest hospital reflects poor condition of health sector in Nigeria’s richest state

On a Thursday in August, an aged girl gripped her daughter’s hand for help as they slowly descended the steps. They’d simply seen a health care provider on the Medical Out-patient Division (MOPD) in a one-storey constructing of the 131-year-old Normal Hospital, Odan, Lagos State.

Onlookers outdoors the clinic’s ready space watched the frail affected person’s hesitant steps with empathy. The hospital doesn’t have services for folks with mobility points or particular wants.

“We have now been coming since final week for cardiovascular causes. Individuals her age must be attended to downstairs, however sadly, their MOPD is upstairs,” the daughter mentioned, declining the reporter’s request for his or her names.

One of many onlookers, Kazeem Babalola, 65, escorted a member of the family to the ability. He mentioned he had used the hospital since he was a child.

“It must have developed past this because the oldest hospital within the state. As an alternative of correctly renovating and equipping it, they patch and paint. Final 12 months, in case you bear in mind, a health care provider died on the physician’s quarters. It was a preventable loss of life attributable to negligence.

“A state like Lagos shouldn’t be managing buildings over 100 years previous. What if this previous girl falls?” Mr Babalola mentioned.

The overall hospital was based in 1893 as a British army hospital and was strategically positioned between Broad Road and Marina on Lagos Island. It was handed over to the Nigerian authorities on 1 October 1960, Nigeria’s Independence Day, and later to the Lagos State authorities on 7 Could 1967 after the nation was break up into 12 states by the army administration of Yakubu Gowon.

Poor upkeep

The incident Mr Babalola cited concerned Vware Diaso, the medical physician killed when an elevator crashed from the tenth ground on the hospital’s physician’s quarters in August 2023.

Ms Diaso was on internship on the hospital and had lower than two weeks to finish the necessary one-year programme.

Her colleagues accused the hospital administration of ignoring complaints concerning the defective elevator.

The Medical Guild, an affiliation of medical doctors working on the whole hospitals and instructing hospitals within the state, later revealed that the elevator was put in by a contractor who didn’t have an “elevator system set up certification.”

The state authorities subsequently sacked and blacklisted the ability managers in control of the hospital and suspended the final supervisor of the Lagos State Infrastructure and Asset Administration Company (LASIAMA) following suggestions by a panel that appeared into the accident.

When PREMIUM TIMES checked exactly one 12 months after the incident, the elevator had not been mounted. Nonetheless, a signpost outdoors the constructing said that Julius Berger, a number one development firm in Nigeria, had been contracted to rehabilitate the 10-storey constructing. The mission period is 36 weeks: April 2024 to January 2025. The federal government has but to reveal how a lot it awarded the contract to the corporate.

Renovation, upkeep

Data present that the state authorities spent N1.23 billion on renovations and upkeep on the hospital between 2021 and 2023. But, a tour of the ability revealed many buildings in disrepair.

The Lagos State Public Procurement Company (PPA) data confirmed that HK Designs Restricted was awarded a contract for “completion of renovations, renovations and scheduled upkeep.” Nonetheless, the contracts didn’t clearly state which components of the hospital have been mounted, elevating questions of accountability and transparency.

Nonetheless, the identical contractor carried out the renovation of the final kitchen, pharmacy retailer/shelling out, laundry, and “provision of entrance welcome centre first and second perimeter fence” for N272 million.

Afolabi Benson*, a senior physician on the hospital, instructed PREMIUM TIMES that it’s underfunded and poorly maintained, making it unconducive for the workforce and sufferers.

“That physician’s quarters is 20 years previous, and among the buildings you see listed below are over 100 years previous. HK Designs is barely in cost of some tasks.

“The areas with a contact of gray are the one locations HK Designs has touched. These are the periphery as a result of when you find yourself driving outdoors, these are those you see near the highway till you enter the hospital.

“What the administration is doing is patch issues right here and there. What the hospital requires is a decisive, huge, definitive, purposeful overhaul, not patch and patch that,” he added.

HK Designs Restricted is a non-public firm registered on 7 February 2005. Buraimoh Sikiru is listed as its proprietor within the Company Affairs Fee (CAC) standing report.

Nonetheless, when PREMIUM TIMES visited the registered deal with at Osolo Approach, Ajao Property, Lagos, it was occupied by a gross sales agency.

A close-by bureau de change claimed the corporate had moved to Canal Shut, however PREMIUM TIMES couldn’t find it.

Inadequate mattress areas, insufficient tools

Talking with PREMIUM TIMES, Misturah Damilola lamented inadequate mattress area on the hospital’s casualty and emergency medical providers unit.

Ms Damilola mentioned she took her over-70-year-old father to the hospital in August for seizures, however he was attended to outdoors and on the reception and spent two days with out a mattress.

“I noticed many different sufferers who additionally needed to be handled outdoors due to the identical lack of mattress area,” she mentioned.

Three medical doctors who spoke with this newspaper additionally bemoaned the state of the hospital’s tools.

“Normal Hospital Lagos, with 9 surgical specialities, barely has three working theatres,” Seun Abiodun*, one of many medical doctors, mentioned. “You don’t also have a full complement of anaesthetic machines for these theatres. We have now an intensive care unit (ICU) that can not be used as a result of they didn’t present the wanted tools, ventilators, and so forth.

“These are distinct areas of surgical observe, and you’ll think about. How can 9 specialities share three areas, for instance, if they’ve an operation to carry out? However sufferers received’t perceive this; they may solely complain concerning the dates and postponement, and it’ll look as if it’s the medical doctors who’re suspending the operation,” Mr Abiodun mentioned.

One other well being employee instructed PREMIUM TIMES that the intensive care areas would not have screens. “Emergency room barely has sufficient very important signal studying tools to maintain a detailed visualised monitor of each affected person in there,” the supply mentioned.

In line with Blessing Adebayo*, one other well being official on the hospital, the pathology and laboratory division lacks important tools like haematology analysers, that are very important for counting and figuring out blood cells.

She mentioned the division additionally doesn’t have Seminal Fluid Evaluation to expedite affected person care.

Underfunded?

Lagos is Nigeria’s richest state by a distance. Its inside income in 2023 was a few third of the overall inside income of all 36 states and Abuja, and it was greater than that of all 19 northern states mixed.

Nonetheless, a evaluation of Lagos State’s funds efficiency report during the last 5 years reveals that healthcare has not been its topmost precedence. Sufficient cash is just not allotted to the well being sector and even the allocations are usually not sufficiently financed.

Though allocations to the well being sector have elevated, they’re under the Abuja Declaration’s really helpful 15 per cent of annual budgets.

Abuja Declaration (2001) is a pledge by African Union nations to extend authorities well being funding.

Solely 5 out of 36 states in Nigeria met this threshold of their 2024 funds: Kano, Kaduna, Yobe, Abia, and Bauchi states allotted between 15.02 per cent and 16.46 per cent of their budgets to well being.

In distinction, Lagos State allotted 7.6 per cent (N119 billion) to well being from its N1 trillion funds of 2023. It allotted 7.3 per cent in 2022 and 6.2 per cent in 2021.

Allotted funds not financed sufficiently

The Lagos Normal Hospital acquired N752.6 million out of the N924.3 billion unique funds in 2021, N793.4 million out of N1.2 billion in 2022, and N868.9 million out of the N1.58 billion unique funds in 2023.

The Lagos State funds efficiency for the second quarter of 2024 reveals that the Ministry of Well being has acquired N46.5 billion, representing 28.7 per cent of the overall funds of N162.1 billion allotted to it for 2024.

Compared, different ministries in Lagos State acquired considerably increased whole funds allocations for 2024, together with the Ministry of Finance (N556.4 billion), Ministry of Transportation (N209.6 billion), Ministry of Works and Infrastructure (N206.9 billion), and Ministry of Financial Planning and Finances (N237.4 billion).

This disparity raises issues that healthcare is just not accorded precedence in Lagos.

“There may be gross underfunding and underutilisation. The budgetary allocation is just not sufficient, but it’s not made obtainable to be used,” one in all our sources mentioned.

Workers scarcity, heavy workload, deaths

On the hospital’s pathology unit, a healthcare employee conversing with a colleague expressed frustration concerning the elevated workload, stating {that a} single individual was doing the job of two.

In July, the state Commissioner for Well being, Akin Abayomi, echoed this sentiment and mentioned the state had a scarcity of roughly 30,000 medical medical doctors.

The mind drain phenomenon has additional depleted the state’s healthcare assets, leaving the remaining medical doctors overstretched and susceptible to burnout from lengthy hours.

“We’re being overstretched attributable to mind drain, resulting in diabetes, hypertension, stress, and burnout. Those that keep behind work passionately, and their efforts should be appreciated,” Aliu Azeez*, a senior well being official within the state, mentioned.

Mr Azeez highlighted the results of understaffing, together with prolonged working hours and fatalities amongst medical doctors attributable to overwork.

“We recorded fatalities in nearly each hospital in Lagos within the final two years because the mind drain worsens. Normal Hospital Odan misplaced one individual this 12 months; in Ikorodu, two folks died final 12 months; at Badagry Normal Hospital, a health care provider died final week; and Alimosho recorded three or 4 in a single week. These are all associated to overwork.”

In March 2024, the Coordinating Minister of Well being and Social Welfare, Muhammad Pate, mentioned Nigeria has solely 55,000 licensed medical doctors to serve its rising inhabitants of over 200 million.

Mr Pate mentioned that in Lagos, the inhabitants of medical doctors was about 7,600 and 4,700 in Abuja.

The scenario in Lagos and Abuja is, nonetheless, nonetheless higher than in most different states.

“The doctor-to-population ratio in Abuja is 14.7 per 10,000 inhabitants; in Lagos, it’s about 4.6, though the common is 2.2 by 10,000,” the minister mentioned.

Nonetheless, on 13 August, President Bola Tinubu accepted the Nationwide Coverage on Well being Workforce Migration to handle the exodus of well being employees from the nation.

As Mr Pate introduced, the coverage is a complete technique to handle, harness, and reverse well being employees’ migration.

He added that the coverage can even encourage the return of execs to Nigeria by way of engaging incentives and reintegrate them into the nation’s well being system.

Coverage vs actuality

Moruf Abdulsalam, chairman of Medical Guild Lagos, noticed that the “coverage framework could be very obscure.”

In line with Mr Abdulsalam, to reverse the mind drain, the federal government should take decisive steps to handle contributing components like “financial prosperity, insecurity, poor remuneration, poor and stiff working circumstances, and lack of incentives like mortgage, automobile/home, and so forth.”

“For now, there’s nothing in it for the Nigerian medical doctors. It solely seeks to encourage these within the diaspora to return to struggling on the bottom. How attainable do you assume that’s?” he mentioned.

Talking about Normal Hospital Odan, Mr Abdulsalam mentioned it has been stricken by years of neglect however famous plans to revamp the ability.

He mentioned, “Lagos State has about 28 common hospitals unfold throughout all native governments and Native Council Growth Areas (LCDA) apart from Ojo native authorities, whose common hospital is presently underneath development. These services are underneath the direct administration of the Well being Service Fee.

“The Normal Hospital Odan is the oldest of all of them, bequeathed to the Lagos authorities when the state was created. It has little doubt suffered some neglect and structural depreciation over time, however we’re conscious of a phased plan for renovation and revamping that has taken ceaselessly.

“A part of this structural decay is what affected the medical doctors’ quarters on the hospital with the resultant tragic elevator crash which claimed the lifetime of our late colleague, Dr Vwaere Diaso.

“Nonetheless, since that incident, development works are presently being undertaken by Julius Berger to renovate the constructing and by OTIS to interchange the broken elevator.”

“Lagos is responsive however can do higher”

Dankuwo Oyenuga, a senior registrar in obstetrics and gynaecology on the common hospital and former Vice President of Medical Guild, Lagos, mentioned the healthcare scenario in Lagos has improved during the last two years, however “there’s nonetheless room for extra progress.”

Mr Oyenuga mentioned the state’s willingness to have interaction in dialogue exhibits its dedication to bettering the welfare of healthcare employees.

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He mentioned: “Infrastructure and employees perspective has improved, and remuneration has elevated, together with a latest hike in hazard allowance. The federal government has responded to advocacy efforts and is making an attempt to handle issues, however it could possibly nonetheless do higher.

“Improved working circumstances, housing, and advantages will help reverse mind drain and encourage healthcare employees to remain. A proposal for mortgage choices for housing and vehicles has been made to the federal government.

“Whereas there’s nonetheless work to be carried out, the federal government’s responsiveness is a constructive step ahead.”

Footnote: The asterisked names have been modified to guard the sources from victimisation

The story was supported by the Centre for Journalism Innovation and Growth (CJID) funding.