Some Doctors Sabotage Govt Hospitals For Self Gain - Prof. Agan

Prof. Thomas Agan, Chief Medical Director, University of Calabar Teaching Hospital 

Prof. Thomas Agan is the Chief Medical Director of University of Calabar Teaching Hospital and the Chairman, Committee of Chief Medical Directors of Federal Tertiary Hospitals in Nigeria. In this interview, he speaks on the state of health facilities and challenges faced by these hospitals in health care delivery.

Excerpt : 

You have been CMD for the past 6 years, how do you see the state of the health sector in Nigeria?

Everything you do, from the President to the unborn baby depend on the state of your health. Therefore, you must be healthy before you become an active politician, doctor or whatever you want to be. The three tiers of healthcare delivery, namely, primary, secondary and tertiary have not thrived very well because of poor funding. However, I must appreciate the present regime of President Buhari for improving budgetary provision to the health sector. It will be highly appreciated if this budgetary provision is implemented. I must commend the previous regimes especially President Obasanjo who introduced VAMED to upgrade the equipment in 14 tertiary hospitals. There was a continuation during the Yar’Adua and Jonathan’s era. 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. Yearly, there have been improvement in budgetary allocation to the health sector, but the question is, is this money being released? It’s unfortunate that because of the recession in the economy, not only in Nigeria but worldwide budgetary allocations are not always fully released. Be  that as it may, more has to be done. The bottom line is the fact that we need universal health coverage where everybody-young, old, rich, poor-will have access to basic healthcare delivery. As at now, 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 the universal health insurance, everything will be covered such that if a patient goes to the hospital, he/she will be aware of the fact that his expense has been covered with insurance. This means the farmer in the village should have access to basic healthcare; the rich man in the town should have access to basic healthcare. So if Nigerians have that universal health coverage, more will be done. I’m confident that the present government in Nigeria is looking towards that and this is why recently they tried to start implementing the National Health Act, the bill which was passed two years ago. So I believe so much that that will happen.

But most facilities in the hospitals are in a deplorable state.  Why is it so?

The issue of power is not peculiar to the Calabar Teaching Hospital but is a national challenge. The power is so epileptic and we have to utilize backup power which is generators. Now, what is happening is that hospitals pay above industrial rates. As at November last year, we were paying about N40 per kilo watt instead of N33.7 per kilo watt. Today, we pay about N49.3 per kilo watt which is far higher than industrial rates and collectively and variously, we have tried to appeal to the enabling powers, that is the government to see the possibility of reducing this rate to domestic rate and it is appalling that we have not gotten a positive response. Even though public power supply is epileptic, we still pay very high. Secondly, the generators, we need to see to its maintenance, we look at diesel supply which sometimes we need to get two trucks of between 20 – 40,  000 litres. Now you know what this means. Our overhead allocation is N6 million per month. Since January till now, we have only received 5 months allocation which cannot even take care of a tanker of diesel. So the truth of the matter is that no matter what you do, there is always going to be some 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 apply the facilities. Without power, you cannot do much. Even the major thing which is research and training cannot be undertaken without power. So, what I am saying in essence is that because of this incessant power failure, we have a lot of challenges and it is not funny. One of the solutions to this is for federal government to fund power supply to the health sector centrally. If this is done, you will witness improvement in service delivery, training and research all translating to improvement to good health for the people and improvement in the economy of the nation.

Recently, you were quoted as saying that most deaths are attitudinally related. Can you say more on this?

Attitude remains a major cause of death in our country and indeed our hospitals. Just look at attitude from the patient, the relatives and even the immediate society, denials, religious interference, poverty, ignorance all have attitudinal basis leading to delays that impact negatively on the health outcome. Attitude of the health care giver 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. Gentlemen, I stand to be corrected. I have suffered it myself not once and not twice!

Recently, the federal government stated that it is considering stopping doctors from engaging in private practice. How do you see this move and how does this impact on public health?

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 for those who can afford to pay them in their private facilities and then take the patients over 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 that is punishable in hell fire.

I believe that government should look at the various sectors within the health sector itself so that things can be done the way they ought to be done. For me, it’s either you are doing private practice or you are working for the government.

Do  you think these people are sabotaging the system?

Well, permit to say again that 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 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. For me, this attitude robs off on the junior workers because, already, you are inculcating bad working habits into them and if we are leaving legacies, what legacies are we leaving? 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. There is no doubt about that. This matter is becoming a topical issue and management is educating patients. Whoever tells you that if you come to his 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 that are in deplorable state?

That’s why I talked to you about outsourced services. The attitude of some of the patients is terrible. How would you imagine a patient who uses newspaper to clean up and then put it in the toilet? It will block it. The situation is not very friendly because of the outsourced services we had to suspend one way or the other. 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 the government came to verify the money being owed for outsourced services and we were told these monies will be paid immediately. As I speak to you, we do not have any clue whether the money will be paid. As at April, 2017 almost N300 million is being owed for outsourced services which is from 2012 to 2016. It is budgeted for usually under service wide votes but we have not received it even as I have sent a reminder to government on behalf of teaching hospitals in the country. Some of these outsourced staff have taken the hospital to court as if the hospital is the one owing them. I feel bad that they are suffering because of the simple small money. We are all Nigerians and these people are dying. So if this money is paid to these people, they 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 the patients, staff will become infected.

How about autonomy, is the hospital looking in this direction to reduce its pressure on the government

When you talk of autonomy, it means you want to privatize the hospital and if you privatize it, then 90% of staff must leave so you increase the number of people that are unemployed and also the hospital’s charges. That’s not what Nigerians want. What we should be talking of is making Public Private Partnerships (PPP) more feasible and flexible for people to operate. Investors will bring their money and invest in hospitals. For example someone will invest in radiology department and it will be managed by the hospital and the investor. If you take a particular section   and the person invests there, whatever comes out of it will be managed by both parties. Again, when you talk of PPP, the public workers are very apprehensive because those who are working for government may need to be edged out. So the solution is PPP and the conditions for it have to be softened.
Prof Zana Akpagu 8475436767365951324

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