ALMOST a billion-naira worth of medical interventions provided at the Federal Medical Centre (FMC), Abeokuta, Ogun State, during the pandemic may end up in rots except a quick decision is taken by the Office of the Head of Service of the Federation, The ICIR can report.
This is a result of the mass exodus of medical consultants and other health workers who left the FMC for oversea jobs in the United Kingdom (the UK) and Saudi Arabia.
Some of the equipment and facilities are: a digital analyser, oxygen cylinders, 20 respiratory machines, monitors, a 20-bed Intensive Care Unit (ICU), and an isolation centre to mention but a few. A big store contains some other items, not in use.
The existing ICU, for instance, cannot take more than four intensive care cases, yet there is a 20-bed fully equipped ICU rotting away due to the shortage of health workers.
Independent finding by The ICIR to the medical facility on May 9 revealed projects awarded at the hospital during the COVID-19 era were executed. But the apparent challenge remained the human resources to manage the sophisticated equipment.
From February to about May, one-third of medical consultants and other health officials who could have managed some of the interventions in the hospital had left for the UK and Saudi Arabia.
A simple estimate of the personnel stood at 50 in about the year’s first quarter.
“I cannot give you a figure but I know that close to one-third of consultants I had before already left”, the FMC medical director a professor, Adewale Abdul-Samiu told The ICIR during an interview at his office.
He added that “I know we were hovering around 150 but close to one-third of that had gone to Saudi Arabia or the UK for greener pastures. And the earlier the government looks into it, the better for the country.”
The trend has been a reoccurrence in most federal medical institutions in Nigeria. In April, the Nigerian Medical Association (NMA) frowned at the development when it pegged the brain drain to over 9 000 medical doctors just in two years.
According to the NMA President Professor Innocent Ujah, “the Nigerian health sector today groans under the devastating impact of huge human capital flight which now manifests as brain drain.”
A special series by The ICIR showed the increasing drift, as found in FMC, Makurdi, Benue State; the Obafemi Awolowo University Teaching Hospital (OAUTHC), Ife, Osun State; the University Teaching Hospital, Ebonyi to mention but a few. And sadly, at the expense of the already failing health system.
Recent data from the United Kingdom Nursing and Midwifery Council 2022 Report, as of March 2022, revealed at least not less than 7,256 trained nurses have left Nigeria for the UK in the last five years.
This is basically from March 2018 to March 2022. A breakdown of the data showed that in March 2018, 2,796 nurses of Nigerian origin made it to the permanent register of nurses in the UK. In March 2019, it rose to 3,021. By March 2020, it further grew to 3,684. In March 2021, it jumped further to 4,310; between the previous year and March 2022, the figure rose to7,256.
Among the top five nationalities, Nigeria ranked third after the Philippines and India.
These health workers are officially permitted to practice in the UK. But a more special concern is that not just the nurses are leaving the country but also experienced medical specialists, recognised as consultants.
Clear indications have shown the trend may not cease anytime soon. This is because of the obvious socio-economic and security situations in the country. The rising unemployment, insecurity, declining foreign direct investment, and drop in purchasing power are just a few. And the reality is that others are migrating to Canada and Saudi Arabia.
Nevertheless, The ICIR, while at the FMC in Abeokuta, confirmed the procurement and utilisation of the Digital Mammography Machine.
As contained in the Bureau of Public Procurement National Open Contracting Portal (NOCOPO), the plan was to verify the implementation of this project with one other summed at N106 million within the FMC. This is because just the two projects were uploaded on the BPP portal by the hospital.
But this reporter would later discover there were other federal interventions not captured by the Bureau. It is not sure why the omission, but fieldwork revealed the items as follows: the Construction and Equipping of an Intensive Care Unit (ICU), the Construction of the COVID-19 Isolation Centre, the provision of Medical Equipment and Laboratory and the Procurement of Medical Consumables. Hence, expanding the scope of the findings became inevitable.
Findings revealed the FMC’s 2020 procurements were in three categories – those made via federal government interventions of about N950 million, statutory budgetary allocation of N99 million and those funded through Internally Generated Revenue (IGR) of the FMC (N7.71m).
First, the N7.71 million contract funded through the FMC IGR was awarded for medical consumables (214 cartons).
The second was procuring and delivering the digital mammography machine pegged at N99 million. The equipment and medical consumables amounted to N106 million, as reflected in the BPP portal.
Nevertheless, on-ground findings revealed only N45 million initial deposit was paid to the contractor, with N54 million outstanding payment.
We had a severe challenge during the COVID-19 because the resources were not there, and we had a lot of cases, Olutunde Paula, the FMC Deputy Director of Procurement told The ICIR during the visit.
“One medical equipment called mammography was treated as an emergency because most of the COVID-19 cases were in dire need of the equipment.”
Third, the category would be about N950 million interventions made available through the health ministry.
This reporter sighted a letter, dated May 2020, from the hospital’s Radiology Department, where it requested the equipment. It was among documents pulled out to justify the COVID-19 emergency procurement.
Having granted permission to embark on emergency procurement, the procurement department subsequently advertised on the BPP’s website and wrote to Philip, JNCI and General Electric (GE) to ask if they could supply the equipment based on the requirements of the Public Procurement Act (PPA). But the director disclosed that only Phillip responded and eventually supplied the machine, satisfying all conditions.
“The successful bidder is the licensed representative in Nigeria,” he told The ICIR. Hence, fixing the sophisticated machine, he said, would not be a challenge should there be a need. He said this was among the reasons the contractor was considered for the selection.
It is public knowledge that President Muhammadu Buhari, through the BPP, had, during the pandemic, approved the emergency procurement method of public spending. Still, the only caveat was that the procuring entity must disclose its procurement plan and host it on the BPP portal.
Regardless, he disclosed Philip later agreed to accept the part payment due to a lack of funds as of the period. And the machine was delivered.
“We had a meeting, and they agreed. The equipment is currently about N140 million, but they agreed that once they supplied the equipment at N99 million, they would get their balance in our subsequent budgets.”
But as of the visit, The ICIR can confirm the FMC is yet to balance the payment. A check through the 2022 approved budget revealed the project was missing from the N1.7 billion total capital project of the hospital for the year. No budget line clearly established the N54 million repayment.
This reporter would later query why the outstanding payment was not made via the N950 million COVID-19 intervention. Still, the director disclosed the hospital was under no authority to do such but spend the money solely on the ICU, Isolation centre, and the PPE interventions agreed with the ministry.
Why digital mammography?
Digital mammography technology is majorly deployed for the early detection of breast cancer cells and other breast diseases. The equipment is increasingly in high demand due to Nigeria’s steady rise in breast cancer cases.
Experts recognised breast cancer as a leading cause of cancer deaths in Nigeria. A not-for-profit organisation working on cancer prevention awareness in Nigeria, Project Pink Blue, put the annual deaths to cancer at over 72 000 Nigerians.
According to the group, this figure might increase, given that “102 000 new cases are reported annually,” breast cancer accounts for 27 per cent of total cancer cases in the country.
“The estimated incidence for breast cancer is (27%), cervix uteri (14%), liver (12%), prostate (12%) and colorectum (4.1%). While estimated mortality for breast cancer is (20%), liver (16%), prostate (13%), cervix uteri (12%) and colorectum (4.4%). Breast cancer is now the leading cancer death in Nigeria, while liver cancer is the second and prostate cancer is the third.”
Research on breast cancer was published in the Pan African Medical Journal on August 28, 2020, and jointly authored by Julius Gbenga Olaogun, John Adetunji Omotayo, Joshua Taye Ige, Abidemi Emmanuel Omonisi, Olusoga Olusola Akute, and Olufunso Simisola Aduayi also established an increase in cases of breast cancer in the country.
The study was conducted at the Ekiti State University Teaching Hospital, Ado-Ekiti, Ekiti State.
It reaffirmed the spike in the number of breast cancer patients. It cited, for instance, the number of cases rose from 15.3 per cent per 100 000 in 1976 to 33.6 per cent per 100 000 in 1992.
But, the level of care to cancer patients has not been commensurate with the spike in the number of cases. The most common is breast cancer in women. There is also cervical cancer and often prostate cancer in men.
The country could only account for three cancer treatment machines despite the death rate. One of those – Cobolt, is located at the University College Hospital, Ibadan Oyo State, it was gathered. Again, it is described as relatively old technology. This implied that very few government hospitals in the country have the latest cancer therapy machine, the Linear Accelerator Machine.
Meanwhile, early detection has been widely suggested as an effective solution to the deadly disease.
At the FMC, for instance, at least 25 persons depend on the mammography machine weekly.
This implied about 100 persons in a month depending on the machine for cancer cell detection and invariably suggests the need to replicate the intervention across government hospitals in the country.
“We discovered that as of the period COVID-19 worsen several diseases including hypertension and cancer. So, the machine has been handy for many women with breast cancer,” Dr Ajayeoba Rotimi, head of the radiology department, disclosed.
“This is called low-dose radiation. The level of radiation it uses is much lower, but it is even more efficient because of its clarity.”
It is one of the most sophisticated in the South West Region, Rotimi told The ICIR. It can easily detect cancer cells, he added. “Cancer is one of the leading causes of death in Nigeria,” he reaffirmed.
Built, completed, equipped ICU but left to waste
On May 4, The ICIR inspected the ICU built by the hospital. It was meant to be a 10-bed ICU, but the FMC constructed 20-bed ICU. According to the procurement director, the decision was due to the increasing population of patients needing intensive care.
Aside from referrals from other smaller hospitals, patients visit from the neighbouring states and the Benin Republic.
Two officials from the hospital’s procurement department and one from the public relations unit led this reporter on inspection to verify the project delivery.
Unlike the OAUTHC earlier visited, the facility is tidy, friendly officials and littered with new projects, a few still under construction. But, the newly built ICU was under lock as of the visit. It took about 30 minutes for an official from the old ICU to open the new facility.
The newly purchased generator was still wrapped up outside the building, unconnected.
The entrance to the inner part of the facility showed neglect. The beds, window blinds, respirators and several other items found in the newly built intensive care unit were covered with clouds of dust and cobwebs. The railings as well.
This reporter counted at least ten beds on the ground floor of the one-storey ICU building. Other items include Oxygen cylinders, about ten respiratory machines, monitors, and other medical gadgets.
The same set of equipment and beds were found on the upper floor with about four offices of medical consultants with their names inscribed at the entrance. But not a single health official was found in the ICU building.
No clear sign established it would become useful anytime soon.
Meanwhile, the existing four-bed ICU is insufficient to manage the increasing number of patients. This implied the existing ICU was ‘overstretched,’ while the new remained useless due to a lack of workforce.
At least we will need ten nurses for the ten beds and one roving nurse, Bakare Aina, a female nurse who took this reporter around the facility disclosed. This applies to the other ten beds on the first floor. “We only have just seven ICU-trained nurses. So, we need professionals that will be effective. Not just ordinary staff.”
The number of only nurses required would thus amount to 22, aside from the consultants.
The ICIR also saw a newly constructed isolation centre with a laboratory attached but not equipped. It is believed the attached laboratory would prevent patients from being moved around the hospital necessarily.
One-third of my health workers have left for the UK, Saudi Arabia – MD
The MD shared the same position as the health workers earlier interviewed. They confirmed some of the independent observations made by The ICIR.
While meeting with this reporter, Abdul-Samiu reaffirmed the brain drain problem.
“One-third of my health workers have left for Saudi Arabia and Canada,” he told The ICIR.
Multiple sources within the hospital had earlier confirmed the mass emigration of health workers, including nurses.
“You will see someone today, and in the following week, you realise the person has disappeared. When you ask, you are told he had left the country,” a source in the hospital said.
It is public knowledge reason most health workers leave their jobs for oversea offers. Those who spoke with this reporter listed poor remuneration, poor motivation, increasing patients to health attendants, weak health system and work tools. Some of these challenges they listed were direct opposite in the foreign countries.
“One of them did a video call with me and showed his new apartment, ready-made tools, and list of patients he would attend to for the day,” an official of the hospital who has become an agent for the new trend disclosed.
As for recruiting new staff, the FMC boss announced deliberate moves to engage new staff. He had appealed to the head of the service of the federation to issue waivers for reemployment, but it no significant action yet.
“Quite a lot of our workers have gone to Saudi Arabia, affecting the health sector. And I think the committee of CMDs and MDs are seriously looking into this,” concerned Abdul-Samiu told The ICIR. “Only last week, they asked us to compile the list of consultants and health workers that have left our facilities abroad.”
The health official emphasised that only the head of service can give a waiver to employ more hands to man the facility.
“You can imagine if we say the people manning four-bed ICU are asked to man 20-bed. How will they cope? It will be fine if we have more hands for them to use. Otherwise, it is money wasted when you have the infrastructure and the workforce to work there are not available.”
The Radiotherapy dept was undergoing construction as of the visit, but he announced cancer treatment machines would be procured for the facility before the end of the year.
Better welfare, training opportunities solutions to brain drain
The MD of FMC asked the government to provide more funds to the health sector to discourage health workers from oversea jobs.
He called for proper welfare and increased capacity building for the health workers to acquire more skills.
“The government should be willing to get them trained because an average neuro-surgeon wants to travel to the UK, or US to get more training after graduation.
“I feel once they are helped, they will be willing to come back and work, and once the environment is suitable, the remuneration is good, there will be no point running out for greener pastures.”
I’m afraid the brain drain in the health sector will continue as long as the government keeps treating healthcare as a charitable venture and not as a business, Laz Eze, Founder, Make Our Hospital Work Campaign reacted as he shared a similar concern.
“Brain drain in the Nigerian health sector will begin to decline when the leaders believe in and patronise our hospitals,” he added.
“Every serious business owner does due diligence to make sure the customers are happy. They also give incentives to retain their most valuable staff. That’s how the health sector and our hospitals specifically, should be managed.”
Eze, a medical doctor emphasised that while the patients should be satisfied with quality services, the health workers should be made happy as well doing their jobs. “Unfortunately, our hospitals are not functioning optimally and the experiences of the health workers can be very depressing, especially in public hospitals. Many Nigerian medical professionals preferred to stay and work in Nigeria but are being pushed out forcefully by the largely dysfunctional health sector.”
To stop this, he advised the government to prioritise the health of its citizens, fund it adequately and manage available resources efficiently.
Justifying the 20-bed ICU, the FMC boss argued that FMC is the only tertiary hospital in the state which mostly serves as the last resort. This is a result of different cases of trauma, head injury, and strokes reported at the facility.
Prior to the intervention, the hospital often referred victims to smaller hospitals, even though it is a federal institution.
“But now, with the COVID-19 intervention, there is a 20-bedded we can boast of,” he said. “That is why I said if they could apply the same strategy to energy generation, it would solve many problems.”
Office of the Head of Service reacts
On Friday, July 1, The ICIR visited the OHSF to seek reactions on the urgent need to engage qualified health workers as demanded by the FMC MD but the deputy director of information at the Office, Ahmed Mohammed Abdullahi was not available.
By Monday, July 7, he told this reporter during another round of visits that the federal civil service commission employs fresh graduates from level eight but the Office of the head of service of the federation gives waivers depending on availability. This alluded to the MD’s position.
He emphasized that waivers are only given to parastatals, and agencies but not ministries.
Regardless, he advised the Medical Directors to apply for waivers as it is usually granted based on a request from the relevant agencies of government. And in this case, the federal medical centres and teaching hospitals.
“If they are complaining let them write,” he told The ICIR. “That is the truth, they should write to us and wait for the approval.”
At the Federal Ministry of Health, the Director of Information A.A. Chindado directed the reporter to the National Primary Health Care Development Agency (NPHCDA), and the Nigerian Centre for Disease Control (NCDC). But after insisting some of the projects were executed under the supervision of the ministry, he said he would need to seek permission from a higher authority.
He was told as the spokesperson of the ministry, he should know if N950 million was offered to the teaching hospitals in the country, and when exactly the ministry would replace medical consultants who left for greener pastures. He eventually advised the reporter to meet with the senior technical adviser to the Minister, a doctor, Chris Isokpunwu, who also was unavailable.
The Director subsequently advised the reporter to drop his questions and await feedback. On July 7, five days after, The ICIR reached out again but the director was said to have travelled out of town and the health minister out of the country. Hence, as of the time of this filing, no official response has been made.