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Nigeria: National Hospital Abuja

Henry Ewunonu writes on how the National Hospital Abuja can be repositioned to offer better health services.

On May 22nd 1999, Nigeria’s last military head of state (God willing) commissioned an ultra modern medical edifice named the National Hospital for Women and Children (NHWC)), strategically located between the exit and in-route expressways of the central Business district of Abuja.

Built through a trust fund of the family support programme (FSP), a project of the erstwhile First Lady Hajiya (Dr.) Maryam Abacha, the NHWC Abuja set forth with the mission of being the ‘Flagship of the medical Institutions in Nigeria endowed with sophistication in men and materials.’ The corporate objective was to provide a friendly atmosphere for the care of all discerning patients without discrimination.

The Hospital was to ‘serve with empathy for the sick and devotion to duty’. The services were promised to be ‘prompt, courteous, comprehensive, efficient and effective’. NHWC boasted as their strength; ‘the use of state of the art technology in a clean, conducive and patient-friendly environment using highly skilled and motivated staff who see to their employment as a vocation more than a bread basket’.

The order was tall, the expectations high but lower than Kilimanjaro considering the enormous endowments of the Almighty in men and resources to Nigeria. The inauguration of this hospital put paid to the dreams of the Society for Obstetrics and Gynaecology in Nigeria (SOGON) which at a courtesy call during their 1981 Scientific Conference in Abuja, prayed the then President Shehu Shagari GCFR to establish a center of excellence as one of the measures to mitigate the unacceptably high maternal and child mortality statistics in Nigeria. As it was in 1981, most unfortunately so it still is, even in 2010.

NHWC became finally established as a corporate entity by the decree no. 36 of 1999 (now act of the National Assembly). The hospital gate opened to patients on September 1st 1999. Manpower was recruited from home and abroad. The 1st baby, a female true to its cause, was delivered on 11/1/99.

Though the hospital was conceived to cater for Women and Children- related health issues in Nigeria and the West African sub-region, to research and pioneer excellence in Paediatrics and Gynaecology especially Gynaecologic Oncology, Nigerian men would not rest to partake in enjoying the dividends derivable in this messianic citadel until former President Olusegun Obasanjo ordered the change of name to the National Hospital Abuja (NHA) on 10th May, 2000 and expansion of the clientele to include men and boys. NHA had its structural development commenced by Arab Contractors and later completed by Mssrs J.B. Nigeria PLC.

The Medical equipments were substantially supplied and installed by Mssrs Philips Projects (B.V.). The hospital was planned to be developed in phases- the first to accommodate 200 beds and the later phase to complete the envisaged 500-bed capacity.

NHA was a cynosure of all discerning eyes alluding to its architectural excellence likened to the sartorial elegance of an Italian made suit. The ambience of its waiting rooms, the business-like outlook of its consulting suites, the coziness of the wards and the mystifying yet reassuring newness of the brand new equipments sent a serious signal to the diseases bedeviling Nigerian people.

From 1999-2010, 11 good years have passed. It is not emboldening to ask how the center has fared in terms of living up to its vision, mission and mandate. I am not sure there would be a positive answer to the enquiry especially as it relates to delivering efficient, prompt, courteous and effective services to her ever-teeming clientele in a manner that makes those who seek treatment overseas appear as fools.

On another hand, I am not very sure that the hospital would boast of having pioneered, provided research support and broke new grounds in medicine on a scale to make her deserving of the accolade-‘Flag ship of medical institutions in Nigeria’.

On a scary note however, feelers emanating from the Nigerian People in response to various ill-treatments meted out to them by the hospital abound in the Nigerian Press. Writing in the Sun Newspapers of Saturday June 5, 2010, Richard Agunta chronicled the pains of a heart-broken Onukaba Adinoyi-Ojo family whose wife and mother unfortunately died in the hospital on August 29, 2009.

The piece opined that the deceased family accused the hospital’s service of being ‘characterized by long delays, sloppiness, unprofessionalism, lack of coordination between the different units and inadequate personnel at the intensive care unit (ICU) and other units of the hospital’. It also quoted parts of a SERVICOM appraisal report on the hospital which observed that ‘there is low staff morale and motivation due to the fact that good work is neither commended nor rewarded.

Services are rendered on preferential treatment basis and not on first come first serve bases. Servicom also noted that ‘there are no clearly defined processes involved in monitoring performances against set standards to show that the hospital adheres to its set standards on customer care in the area of promptness, speed of response and staff treatment of customers, as customers wait endlessly before services are accessed’.

The report diagnosed ‘indiscipline, gross misconduct, truancy, diversion of patients by some senior doctors to their private clinics as contributory to the bad image of the National Hospital’.

Following in the same view, a recent appraisal of service delivery in all federal tertiary hospitals in (23 FMCS, 14 University Teaching Hospital, 8 Neuro-Psychiatric, 2 Orthopaedic hospitals, Federal Staff Hospital Abuja, NHA, National Eye Center and the National Ear Care Center showed that only the Aminu Kano University Teaching Hospital (AKTH), Kano scored 2.5 over 5 (63%) in a 1 in 5 service delivery and FMC Birnin-Kudu 1.2 or 30%. National Hospital scored 45.5%, not up to pass mark.

What has happened to the dream that dates back to 1981? What re-branded negatively the hitherto selfless and dedicated staff present at the inception of the hospital, some of whom worked voluntarily without remuneration for three months? What is it that mysteriously demoralized the committed consultants who squatted in shared apartments without offices, who once worked as if nothing else existed in the world?

Who knows what stole the smiles, humility and true empathy for the sick that NHA nurses had? What wiped away those things that made Nigerians thank heavens for NHA? It cannot all be explained by poor funding; the hospital remained afloat when it had zero capital budgets, no overhead subheads and only 60-70% of personnel emoluments, it didn’t collapse. Today, the hospital can never complain of lack of funds for genuine programs other than that required for making the members of staff happy.

It is a well known fact that the proverbial fish gets rotten from the head. The Government recognised this when from inception it decided to set NHA apart from the ills bedeviling other tertiary centers in the country supervised by the Federal Ministry of Health with a well thought-out recipe by over-sighting the center from the President’s sitting room. In times past, the government has responded with great sense of responsibility and speed on any issues militating against the delivery of the hospital’s mandate.

It is on record that in response to the call for better management of the hospital, the presidency had between 2003-2005, engaged a foreign hospital managers who could have succeeded if a careful study of the problems was undertaken before engaging them, if only gain was not put before delivery and Nigeria placed before self. Former President Obasanjo also had to second his personal physician to head NHA in response to a distress call for failing leadership. The tenure of that Chief Medical Director (CMD) ended June 1 2010. The hospital’s Governing Board has finalized the recruitment process of a new CMD.

Whose direction should they look? What should guide them in making the choice? In her submission at the public hearing for a bill to amend the hospital’s establishment act in 2008, The Association of Resident Doctors ARD identified that non-compliance with the provisions of the enabling law in composing the Board, inability of the Board to stamp its authority on the management team rather than playing along with them are responsible for our failures.

They also identified poor funding, low staff morale occasioned by poor welfare, indiscriminate to inappropriate staff recruitment, over-politicisation of the administrative apparatus from within and without worsened by failure of leadership, paucity of ideas and alienation of the senior doctors/HOD’s in the day-to-day running of the center are issues that must be addressed.

National Hospital Abuja is presently a 200-bed hospital. Though it attracts a substantial population of the elite as its clientele whose demands could be ridiculously unrealistic on occasions, the script of the center in the resent past even up to today, cannot but attract a poor-pass mark from even the most generous of examiners. All the woes of the center are traceable to the leadership, the CMD, who calls the shots. NHA needs an efficient manager of men and resources, a disciplined man whose life and actions speak louder than the queries he issues. The next CMD must be strong physically and morally.

He should be prepared to step on erring toes without being limited by professional, paternal or ethno-religious sentiments. He should be ready to work and break for NHA to resurrect to the dreams of the founding fathers. He should have known NHA from inception, its failings, its bad story of stunted growth and blinded visions from infancy. He should not be a pro-establishment man who accepts everything he sees in the name of stability which in this case, would be likened to the peace of the graveyard.

President Goodluck Jonathan GCFR set the pace in this regard recently when he appointed a radical former ASUU President to lead an ailing national institution. Can he look deeper from within and without for a man or woman who is very allergic to failure, who commands respect of colleagues, possesses international clout that would attract the desired international affiliations as the world has become a global village.

He should have a ready certificate of performance as nothing supercedes experience.NHA needs a humane man who would holistically look at welfare issues especially accommodation and not merely leading them out likes sheep to the platter to mortgage institutions. The next NHA CMD must take a straight but objective decision about the modality of private practice by members of staff. No one can serve two masters at the same time with equal loyalty and dedication.

It is immoral to steal government’s time; this practice abounds presently today in the hospital. This CMD should have courage to resign should he be sabotaged by the Board or Government. He should have enough shame as to be disturbed by the negative image the hospital is attracting even in places like the Wuse market.

The next NHA CMD should be ready to examine the past events in the hospital, call it probe or any other name. Erring people must pay for betraying the aspirations and hopes of Nigerians. Someone told me that I’m recommending a search for an angel but I know convincingly that Medical men and women with these qualities are available locally here and in the Diaspora. Let us look for him.