THE 20-year-old Federal Medical Centre (FMC) Jalingo, Taraba State, currently has fewer than 15 consultants in its workforce and cannot render certain services, the facility’s Medical Director, Aisha Adamu, has revealed. 

Adamu said the hospital had at least 30 departments and other units.  

The immediate past president of the National Association of Resident Doctors of Nigeria, Uyilawa Okhuaihesuyi, told The ICIR that tertiary hospitals like the Jalingo FMC should have at least three consultants in each department to guarantee effective service delivery.

Last year, three consultants who worked in critical departments left the facility. They were in anaesthesia, intensive care unit (paediatrics) and family medicine departments. 

The federal government had just equipped the intensive care and the anaesthetic sections of the hospital. But the consultants abandoned them and headed for Saudi Arabia.

Four other doctors also left the hospital recently to pick jobs abroad.

Consultants are expert health professionals who support hospitals’ operational efficiency. They help in policy formulation, implementation, training of less-experienced staff and general administration of health facilities.

Conducting some procedures and using some equipment largely depend on their expertise.

Our reporter found out from the facility’s staff that other cadres of professionals who got jobs abroad resigned from the hospital, and more are willing to go.

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Consequently, there are essential services that the hospital cannot render.

It lacks specialists to interpret some of its tests, and there are types of equipment that it does not have the human resources to handle.

“We don’t have the specialists to interpret some of those things. We have a well-equipped ICU, but we don’t have the resident and anaesthetic (to manage it),” Adamu, the medical director, said. 

She noted that replacing workers who leave the hospital does not come easy.

“You have to go through some processes. You have to go through the Federal Ministry of Health to the Head of Civil Service of the Federation, the Budget Office, Federal Character Commission before you get a replacement. That will take a year. That is the process we are in now to make sure that we replace a lot of them.”

The hospital complements its inadequate consultants with visiting specialists who come around for about a week and leave. 

Footing their hotel bills remains a challenge for the hospital’s management.

Checks by our reporter showed that the nearest tertiary hospital to the Jalingo FMC is the FMC Yola, Adamawa State.

The FMC in Yola is more equipped and has more specialists.

Suppose the Jalingo FMC makes any referral to the FMC Yola; it will take the patient over four hours to get to the facility because the Jalingo-Yola Road is very dilapidated.

There is a distance of approximately 150 kilometres between the two towns, which should be less than a two-hour drive if the road is good.

Background to the story

In response to COVID-19 and the state of low preparedness for the pandemic in Nigeria in 2020, corporate organisations and individuals donated billions of Naira to purchase equipment and revamp the nation’s health sector.

Nigeria, which recorded its first case of the disease on February 27, went on to lock down some states on March 30, as infections from the virus soared nationwide.

Among other measures, President Muhammadu Buhari constituted the Presidential Task Force on COVID-19 and approved emergency procurements of pharmaceutical and non-pharmaceutical measures to combat the pandemic.

The bulk of the country’s spending on the disease was from the Nigeria Private Sector Coalition Against COVID-19 (CACOVID) Relief Fund, donated by corporate organisations and individuals.

As of June 2020, 181 corporate organisations and individuals had contributed N30.2 billion to the fund.

At the end of the year, the government spent N38.59 billion from it, part of which was N49.65 billion (N49,652,400.00) approved for the Jalingo FMC for emergency procurement of medical equipment.

The government awarded the contract to Sheriff Integrated Healthcare Ltd. The procurement, awarded in 2020, had a completion target of 28 days.

Checks by The ICIR showed that the Corporate Affairs Commission registered Sheriff Integrated Health Care Limited on September 17, 2013, with registration number RC 1142482. But its status is inactive, meaning that it has failed to fulfil certain obligations with the commission.

The company has its office at plot 334, Cadastral ZoneB3, Wuye District, Abuja.

Its owners are Shuaibu Bala, Muhammad Sheriff Mu’azu Bala, Mairo Mohammed Garba Bala, Mu’azu Bala, Mairo Mairo Mohammed Garba Bala.

The Public Procurement Act 2007 recommends competitive and open biddings for public contracts. It is unclear if there were competitive biddings for the contract, given that it was an emergency procurement.

The hospital’s officials conducted The ICIR’s journalist round an isolated ward they said the Nigerian Centre for Disease Control (NCDC) built for the facility.

The Minister of State for Health Olorunnimbe Mamora commissioned the building in February 2021.

Meanwhile, the NCDC, which gave out the contract to procure medical equipment for the hospital with the COVID-19 intervention fund, did not list what to be procured on the NOCOPO website. 

The hospital’s management, however, showed the reporter the list of items the contractor (Sheriff Integrated Healthcare Ltd) brought to the facility in a waybill/delivery note. The bill was dated November 24, 2020.

 The reporter saw some of the devices. However, there was no label on them to prove that the hospital got them with the COVID-19 Intervention Fund.

The reporter saw some equipment donated by some organisations to the hospital. They had the names of the donors.

At the FMC Makurdi, Benue State, and the FMC, Yola, the reporter saw labels on the equipment/devices procured with the fund.

Some of the equipment at the FMC Jalingo’s isolation ward were electric beds, oxygen concentrators and one large fire extinguisher.

 The building has female, male and paediatric wards, a mini theatre, three rooms for suspected infectious disease cases, a laboratory, a boardroom, changing rooms for caregivers on duty, among others.

The facility also has a close circuit television that enables health attendants to monitor patients in different rooms from an office.

Facts on how and why specialist doctors and other health professionals quit Nigerian hospitals for overseas jobs

Acute shortage of consultants, otherwise known as specialists, is not peculiar to the Jalingo FMC.

Last month, this newspaper reported how consultants and other health workers resigned and shunned new equipment procured for various departments at the FMC Makurdi. 

The ICIR had reported in August 2021 how hundreds of doctors thronged a popular hotel in Abuja when the Saudi-Arabia-based recruiter needed only seven.

Similarly, in October that year, the newspaper reported how the nation lost nearly 9,000 doctors and other health workers to the UK and other countries in two years.

Multiple reports show that the caregivers leave the country’s shores because of high incentives abroad and poor pay in Nigeria.

 Other reasons are the sector’s underfunding by the government which results in poor health infrastructures, incessant strikes by doctors and other health workers, inter-professional rivalries, the generally poor state of the nation’s economy and pervasive insecurity.

For instance, out of the Federal Ministry of Health’s approved budget of N724.9 billion (N724,924,440,307) for 2022, the FMC Jalingo got N5.8 billion (N5,891,300,309) for both its capital and recurrent.

But for many buildings currently under construction at the hospital, the facility may not pass for more than a general hospital when compared with hospitals in other parts of the country. 

In its report detailing how salaries and costs of running offices gulped 73% of Nigeria’s 2022 health budget, this newspaper reported how Nigeria’s proposed N16.4 trillion Appropriation Bill provided funding that fell short of the Abuja Declaration.

In the appropriation bill, the percentage budget for health (N766.15 billion, inclusive of GAVI grant) is 4.67 per cent of the proposed national budget, which is far too low to the Abuja declaration’s commitment.

This newspaper had reported in December 2021 how the country lost nearly 300 working days to strikes by doctors and other caregivers in eight years.

Nigeria’s worrying health indices

Analysing Nigeria’s health system under President Buhari’s six-year leadership in May last year, The ICIR reported that for many years, the country had consistently contributed nearly a quarter of the global malaria burden.

According to the WHO, 20 per cent of all global maternal deaths occur in Nigeria.

The 2013 National Demographic and Health Survey shows that infant and under-5 mortality rates were 69 and 128 deaths per 1,000 live births, respectively. But, in 2018, the infant mortality rate reduced to 67 deaths per 1,000 live births, while under-5 mortality rose to 132 deaths per 1,000 live births.

The maternal mortality ratio was 576 maternal deaths per 100,000 live births in 2013. In the NDHS 2018 report, it was estimated at 512 maternal deaths per 100,000 live births.

Some communicable and non-communicable diseases in which Nigeria has a significant lead globally are HIV/AIDS, tuberculosis, cholera, typhoid, Lassa Fever, hypertension, cancer and diabetes.

At an estimated 215 million, Nigeria is currently the seventh most populous nation in the world.

Data on Nigeria’s health facilities and how they impact Taraba State 

There are 39,920 operational hospitals and clinics in Nigeria, and Taraba State has 944 of the facilities. The Jalingo FMC is the only tertiary hospital in the state, and one of the 53 federal hospitals in the country.

According to the Federal Government’s website keeping hospitals’ records in the country, Taraba State has 803 public and 141 private hospitals. There are 903 primary and 40 secondary health centres in the state.

Rather than offer the tertiary level of care for which the government created it, the Jalingo FMC provides all levels of care, including primary and secondary.

“We are a comprehensive hospital. We offer primary, secondary and tertiary because of the non-functioning of the surrounding support system (hospitals). Basic diseases like malaria, diarrhoea and the like will not come if we have functional primary health care. But we still see those cases at our out-patients departments and accidents and emergencies,” said the hospital’s medical director.

The state has sixteen Local Government Areas and a landmass of 54,470 km², the third-largest in the country.

With a 2.29 million population in 2006 census, Taraba state current estimated population is 5.09 million, using the Nigerian 2021 annual population growth rate of 2.58 per cent.

Data on doctors working in Nigeria

The Medical and Dental Council of Nigeria (MDCN) is the agency of government regulating the medical practice and keeping doctor’s data in Nigeria. There is currently no data on the doctor’s population on the agency’s website.

In 2018, the former Minister of Health Isaac Adewole said Nigeria had no “serious shortage” of doctors. But the reality on the ground says otherwise.

Adewole had said: “There is no serious shortage of doctors in Nigeria. People are free to disagree with me, but I will tell you what the situation is across Nigeria and many other African countries.

“The data obtained from the Medical and Dental Council of Nigeria as of May 30 revealed that 88,692 doctors are registered in their books. Of these doctors, only 45,000 are currently practising, and that gives us a ratio of one doctor to 4,088 persons.”

He said the ratio of one doctor to 4,088 patients in Nigeria was better when compared to other African countries.

“Compared to many other African countries, the ratio is not bad, for example, in South Africa, it is one (doctor) to 4,000; in Egypt, it is one to 1235; in Tanzania, it is 1: 14,000; in Ethiopia, it is one to 1 to 118,000, in Kenya, it is one to 16,000, and in Cameroon, it is one to 40,000.”

Additional challenges at the FMC Jalingo

The facility lacks some major equipment, namely radio diagnostic items, CT Scan and MRIs to diagnose serious ailments like cancer. 

It is yet to get an oncology section for managing tumours such as cancers. It can only conduct basic investigations on the conditions. It does not have equipment for advanced investigation on the diseases.

Apart from equipment, many of the hospital’s departments lack functional offices. 

The facility also suffers from a power outage. Its medical director said the hospital spends millions on purchasing diesel and petrol motor spirit (PMS) to power the facility.

Marcus FATUNMOLE

Marcus bears the light, and he beams it everywhere. He's a good governance and decent society advocate. He's The ICIR Reporter of the Year 2022 and has been the organisation's News Editor since September 2023. Contact him via email @ mfatunmole@icirnigeria.org