Decay of Health-Care System in Anambra State – Nigeria
By Odenigbo Chidi Anyaeche
The health-care system in Anambra state has decayed to an alarming degree that government owned hospitals are now a place of death rather than a place of treatment. The state government has surrendered its divine duty in providing twenty-first century health-care for the citizenry to the elements.
Readers are invited to read the article below culled verbatim from the on-line edition of The Daily Independent newspaper of Thursday February 12, 2009 in support of the above paragraph.
Anambra State Hospitals: A Litany of Decay
By Okey Maduforo, Correspondent, The Daily Independent (Awka)
The clock had just struck 3:40a.m. When the silence of the early morning was jolted by the heavy fast deep breath of Mrs. Onyenwe. The husband, who was far asleep on the floor of their bedroom, scrambled up to behold his wife in labour. Mr. Ephraim Onyenwe managed to gather all that his hands could touch and sped off with his wife to the hospital.
Before the midwives at the maternity ward could complete preparations for delivery, light went out and darkness fell across the hospital premises. They used a touchlight to find their way into the labour room while the search for bush lamps commenced.
The Night watchman at the security post of the hospital offered his lamp and the midwives went to work. The child was delivered but couldn't cry. It was even delivered at eight months and efforts to make it take in air proved abortive. The forceps were not there and there were no gas and medical facilities to save the innocent child.
At exactly 6:45 a.m. Mrs. Helen Onyenwe asked for her baby but the reply was not what could be given to a woman in her condition. The story was not only pathetic but devastating as the child could not make it. The baby did not survive and the embattled couple had to go home with the baby's cloths and a dead child.
Akwata Junction, Awka, on Enugu-Awka-Onitsha Expressway, is one of the dreaded accident spots. A lorry carrying a bulldozer was descending from the NNPC mega station end of Awka enroute Arroma Junction when the driver lost control of the vehicle and rammed into the mini stores and Okada Park at the Akwata Junction killing over 32 persons and injuring 17. The men and officers of Federal Road Safety Corps (FRSC) stormed the scene of the incident with medical personnel. The wounded were taken to Amaku General Hospital, Awka, but they were shocked to their marrows that there were no medical facilities at the Casualty Section of the hospital to attend to the victims. Before they could be relocated to Regina Ceali Hospital, Awka, three of the victims gave up. Dr. Stephen Akpati, Chairman, Anambra State chapter of National Association of Government General Medical and Dental Practitioners (NAGGMDP) is used to reading newspapers and listening to radio and television stories. But Akpati has stopped listening to radio news. Once the signature tone heralding the news hour is aired Akpati will angrily switch off the radio. His reasons are that the stories being told in government radio bulletins are at variance with what are in the thirty General Hospitals in Anambra State. "The travails faced by most patients at these hospitals were similar to what Onyenwe and the men of the road safety corps experienced," Apkati said. For more than four months now Akpati and his colleagues had been on strike and the general hospitals, in fact, had become mere consultancy houses and death traps.
According to Silva Chukwuogo, a freelance columnist on health matters, "our data have shown that over thirty-eight persons have died due to no access to medical services. Government is of the view that Anambra people depend on private hospitals. But this is not true. Only ten percent of the population in Awka depends on private Hospitals and a great number of others go to general hospitals and others depend on traditional medicine. So that accounts for the number of deaths as a result of the strike by doctors."
But Akpati disagreed with Chukwuogo, contending that the strike was not for mere increase in take-home-pay but the level of infrastructural decay in the government hospitals. Akpati further accused the State Government of abandoning the secondary health and concentrating on the tertiary health sector, which he said, is improper. He noted that the industrial action was also to press home the need for the payment of 22 percent increase in basic salaries of government doctors, which most states have paid.
"We had embarked on strike when the former governor, Dr. Chinwoke Mbadinuju, was in the saddle following the directives of the National Salaries, Income and Wages Commission."
A directive dated August 13, 2002, and signed by Dr. K. Nkumah, a permanent secretary, further stated. But the letter signed by the then, Head of Service (HOS) in the state, Mrs. Elsie Ikemefuna, announced the approval of state government for increase which included all senior public servants on level 17 from the office of the governor to clerk of the Assembly excluding the doctors.
When the doctors protested, government insisted that the 22 percent increase was for HATISS IV which is only meant for Federal Government workers.
But the then permanent secretary of the National Salaries, Incomes and Wages Commission, Mrs. A.M. Rufai (MNI), who signed the letter on review of allowances for health professional on behalf of the chairman stated that it was for all health workers both in the state and federal level, adding that the increase should be done based on the respective minimum wage status of state.
When Dr. Chris Ngige came into the saddle the matter was resurrected. The meetings and consultations that lasted as it were, was inconclusive. According to Dr. Luis Akah the then head of service, Mrs. Elsie Ikemefuna in memo to the governor, misinformed Ngige that the doctors had forfeited the 22 percent payment which made it impossible for the then governor to pay. Governor Peter Obi took over with yet another cat and mouse relationship with doctors.
Also the agreement reached at the end of negotiations between government and the state chapter of the Nigeria Medical Association (NMA) in August 2001 further deepened the woes of the doctors as the matter remained hanging. It was agreed, among others:
"That the arrears of 150 percent increase in Call Duty Allowance totaling N19.5million should be paid in three installments; First installment of six (6) months arrears, amounting to N9.7million should be paid along with August, 2001, salaries.
The balance of the arrears to be paid in two other equal installments of N4.9million in October and December, 2001, along with the doctors' salaries for those months; that the Hon. Commissioner for Health should include in his Ministry's Supplementary Estimates the N80.2million required to pay 4 percent of Basic Salary per Unit Call for 2001. This is necessitated by the approval of the allowance on June 19, 2001, and the fact that the said approval was not anticipated and was therefore not included in the Year 2001 Estimates. The amount has therefore to be approved by the State House of Assembly before its appropriation."
Akpati also lamented that despite all meetings and negotiations held between the doctors and state government, the memorandum of understanding reached in October 2, 2008, was not considered by government.
It was agreed that "the state government should commence the payment of rural posting allowance of 20 percent of annual basic salaries to all doctors in the service, beginning from January 2003," he said. He further stated that it was agreed "that the state government should commence the payment of journal allowance of N22, 500 per annum to all doctors, beginning January 2003; that the state government should commence the payment of 10 percent of individual doctor's annual basic salary as inducement allowance, beginning January 2003. And that the state government should expeditiously provide utility vehicles for major government hospitals and clinics to enable them function optimally; that the state governments should, as a matter of urgency, improve the work environment of the state hospitals." While the industrial action lasted, the doctors took a look at the state of General Hospitals in Anambra State.
Chairman of Nigerian Medical Association (NMA) in the area, Dr. Obi Nwosu, took a swipe on the budgetary provisions for the health ministry. "No serious government can have a sustainable health policy with two percent of the total budgetary sum for the health ministry. There is no visible sustainable policy in place and what the World Health Organisation (WHO) stipulated is 16 percent minimum of the total budgetary appropriation. The two percent made available translates to N1.5 billion," he noted.
Nwosu further stated that, "though it is commendable of government to establish a teaching hospital at Amaku General Hospital, Awka, it is more of a research, teaching and treatment centre based on referral directions of doctors. It cannot take the place of secondary health care. We, the members and executive of NMA in the state are totally in support of the industrial action embarked upon by our colleagues (NAGGMDP) in Anambra State for the resuscitation of our health sector. The plight of these people also affects other medical personnel in the health sector."
According to the head of Enugwu Ukwu General Hospital, Dr. Luis Akah, "our hospitals, such as the Enugwu Ukwu General Hospital are more of shadows of themselves. You will continue to write memos for renovation and rehabilitation until you retire as a doctor. In Ajali, the power generating set has been out of use for eleven years until the Orumba North and South council areas contributed money to put it in service and gave us diesel.
"The Nwandu family is currently refurbishing parts of Enugwu Ukwu General Hospital. Some of the hospitals have one doctor and some doctors are there on lease. There is a collapsed building at Amanuke Hospital in Awka North. We do not have impress or any money to run the hospitals. When we make about N250, 000, government will come with one financial directory that we should return 70 percent of the sum to government. When Governor Obi visited the hospital he told me that our strike was becoming politically motivated and I was shocked."
The plight of Anambra health sector is further deepened by imminent danger of running out of medical doctors. About 115 doctors at the creation of the new Anambra State joined the health sector and today they are left with about 70, who would be retiring in the next two to three years. Meanwhile the 20 house doctors at the Onitsha General Hospital have left, and a committee was set up to investigate what happened. Dr. Akah said that the house doctors had to go due to poor payment.
"They were being paid one third of what their colleagues are paid in non-oil-producing states. Government is aware that they are not well paid and paying them means that they would be receiving the same salary with the principal Medical officers. Even the government announcement of establishing a cardiac centre and renal centre is not true. There is no such equipment at the Onitsha General Hospital. All that we see are mere sign boards," he remarked.
But Commissioner for Heath, Prof. Amobi Illika dismissed the claims of his colleagues.
According to him, there has been a progressive increase in budgetary allocation to the health sector since Obi became the governor which, he said, has made it possible for the ministry to carry out its obligations to the people, including immunisation, fight against tuberculosis and HIV/AIDS.
"The crux of any health institution is the quality of staff. All health institutions in the state had lost their accreditation by the time Governor Obi assumed office and the administration had to start the upgrading of the health facilities from the scratch and at present, many General Hospitals have been accredited by the Nigerian Medical and Dental Council for the training of house doctors.
"We also gave money to the Missionary hospitals in the state which enabled them to regain accreditation after they were de-accredited by the Nursing and Midwifery Council of Nigeria. The state government has also improved facilities at the Psychiatric Hospital, Nawfia and posted a specialist there and to date, 15 specialist doctors have been employed by the state government," he said.
While acknowledging the fact that doctors should earn good salaries and are entitled to the 121/2 percent recommended for doctors, he argued that there is also the need to provide amenities in the hospital which, he said, is what the state government is doing in all the General Hospitals in the state at present.
According to him, the main grouse of the striking doctors was the decision by the government to employ specialist doctors in the system, adding that such specialists were needed to improve health care delivery in the state. He said that there are 124 doctors in the employ of the state which, according to him, is one of the highest in the South East, while their take home pay is also the highest in the zone.
Similarly, the claims of upgrading the hospitals have set the duo of Dr. Chris Ngige and Peter Obi at daggers drawn. A statement by Charles Amilo, Director, Ngige Campaign Organisation, has for instance put a lie to the claims by the government.
"The fallacies contained in the health claims in the said release are very sinister and treacherous. The administration has consistently claimed to have secured accreditation for the Onitsha General Hospital. Nothing can be further from the truth. The issue of Onitsha General Hospital re-accreditation was tackled head-on by the Ngige administration. The claim that Dr. Ngige, an accomplished health administrator in the Federal Ministry of Health, Hospital Services Department, before his voluntary and meritorious retirement in 1998, did nothing for Amaku General Hospital, Awka, is not only laughable but smacks of total mischief or ignorance, on the part of those who run the government in Anambra State. If Dr. Ngige, a well-trained medical doctor, reputable and erudite, health systems manager who oversaw the conversion of the General Hospital at Owerri and Queen Elizabeth Hospital at Umuahia into Federal Medical Centres with full accreditation in 1994/95, and the General Hospital Nnewi's metamorphosis into a Teaching Hospital in 1993/94, supervised the infrastructural and personnel development of the University of Nigeria Teaching Hospital (UNTH) Ituku/Ozalla Enugu, as the permanent site of the old UNTH at Enugu 1996/98, and his high flying health records, does not know the need for a good health services outfit for the State, then who will?
"For the avoidance of doubt, Dr. Ngige and his cabinet met a de-accredited Onitsha General Hospital when they came by June 2003 but toiled day and night with the limited resources available to them, to recruit consultants, General duty doctors, nurses of all cadres, pharmacists, laboratory scientists, radiographers, physiotherapists as per the shopping list given to the Government by the then Dr. Ezeani-led Medical and Dental Council of Nigeria (MDCN) in September 2003, and by July 2005, the poor personnel situation had been addressed, while the House Doctors staff quarters, a new OBS/GYNAE theatre and wards were built, General wards and consulting rooms were also rehabilitated by a medical company, Giovani Nigeria Ltd.
The accreditation was restored in July 2006, three months after Gov. Obi assumed office, and after Ngige left, and this was ignorantly misconstrued by Obi, to mean that MDCN likes his face and so brought back the earlier withdrawn accreditation. What a pity!!! For further information, Dr. Ngige did his housemanship in this particular hospital, between June 1979 and June 1980. Hence it is part of his Alma matter," the statement added.
