The poor condition of the State House Clinic, Abuja, mirrors the horrible state of Nigeria’s health system in terms of medical facilities, personnel and even quality of government attention to healthcare delivery system.
The clinic’s inability to provide quality health care to the President, his family, and staff of the State House has been called to question by many, including Nigerian first lady, Aisha Buhari, despite its status, funding and expectations by Nigerians and those who conceived and set up that facility.
BusinessDay findings show that none of the President’s immediate family member and many workers at the Aso Villa receive medical care from the clinic. Late Chief of Staff to the President, Abba Kyari’s trip to a Lagos health facility where he was treated for a Covid-19 related ailment before his death, as well as the recent decision to fly the President’s nephew, Mamman Daura outside the country for medical treatment, many say, confirms the poor capacity of the Clinic and in broader terms shows lack of strong political will to provide quality health care for Nigerians.
Available data indicate that Nigeria loses over $1 billion annually to medical tourism in the face of poor revenues and low foreign reserves. Over 1000 persons, especially the rich and influential, seek medical treatments outside the country annually.
Rowland Aigbovo, president, Nigeria Association of Resident Doctors (NARD), Abuja branch, lamented, “Nigeria is yet to prioritise health.”
He attributed the current challenges at the State House Clinic to lack of confidence in the country’s health system by the first family. “They don’t believe in the system,” he stated, adding, “They have forgotten that the health system in the countries they go to are well organised, no inter-professional rivalry and they are devoid of political manipulation.”
Aigbovo also attributed the lack of patronage of the health facilities by government officials to lack of confidence in Nigerian doctors and the health system.
“These government officials go out to access health care in other countries and they know how health services are carried out in those countries, they also know the type of facilities used there. In some cases, Nigerian doctors working in those hospitals are the ones who treat them.
“So, critical investments are necessary for the sector if Nigeria must benefit from health tourism.
“As we speak, most government hospitals in Nigeria don’t do heart transplant. Where they are done, they are done by foreigners, because we do not have the facilities.”
For the health system to function effectively, government must provide infrastructure, well-motivated manpower and conducive environment, he noted, noting, “There are competition everywhere, most Nigerian doctors are just waiting for international air travels to be restored. Very soon, we may witness mass exodus of more doctors.”
He recalled how several years back, “the Saudi Arabian First Family came to Nigeria to access health care.” The situation is worrisome considering the huge budgetary allocations to the Clinic amounting to N13.586 billion in the past five years.
Although it was not clear if the entire funds were released, a breakdown of the allocations show that in 2015, the Clinic got N3.94 billion and N3.87 billion in 2016.
This was followed by another allocation of N3.20 billion (N331m Capex) in 2017 and N1.03 billion in 2018, though it was cut to N823.44 million in 2019 and N723 million in 2020.
Despite these huge allocations, BusinessDay checks show that the condition of the Clinic makes it difficult for the first family and many other people who are entitled to patronise it due to lack of essential drugs, adequate personnel and even the necessary equipment.
Aisha Buhari, irked by the poor conditions, had expressed deep concern over how the country had been losing out on the $15.5 billion global medical tourism on account of gross negligence of the health care sector.
Narrating her ugly experience aboard the Presidential Jet from a medical trip to the United Arab Emirate, Aisha Buhari tasked health provider on the need to address the nation’s health sector challenges. In her words: “I recall hosting the private healthcare providers earlier in the year and we had a very productive engagement where the issue of building the capacity of Nigeria’s health sector was the major focus, and funding was discovered to be the major challenge.
She called on the healthcare providers to take the advantage of the Federal Government’s initiative through the Central Bank of Nigeria (CBN) guidelines for the operation of N100 Billion Credit Support for the Healthcare Sector.
“This will no doubt help in building and expanding the capacity of the Nigerian health sector and ultimately reduce medical trips and tourism outside the country,” she noted.
The first lady had also in 2017 berated management of the State House Clinic for “not taking care of the facility despite of huge budgetary allocations” and had called for a probe of the hospital management, saying the facility lacked basic amenities.
Confirming the poor situation of that facility during the 2019 budget defense, Jalal Arabi, former State House permanent secretary, told lawmakers that the Clinic required a facelift.
“A general renovation would go a long way in supporting staff to deliver excellent medical support to patients,” a staff had equally said.
Further checks reveal that nothing much has changed, despite these genuine concerns.
Disturbed by the condition of the hospital, the Senate Committee on Federal Character and Intergovernmental Affairs, during the 2021 budget defense, asked officials of the State House to put its clinic in order and equip it to ensure that President Buhari would have no need to travel abroad for medical treatment.
Defending the N19.7 billion budget for 2021, out of which N1.3 billion was proposed for the State House Clinic, chairman of the Committee, Danjuma La’ah, pointedly challenged the permanent secretary of the State House, Tijani Umar, to explain how the funds would be expended.
La’ah insisted that the President and other top officials of his government should no longer be flown abroad for medical treatment.
President Buhari’s first term in office was punctuated by medical trips to the United Kingdom. Between 2017 and 2018, he travelled abroad at least thrice for medical reasons. One of the trips lasted for over 100 days.
The President, himself, in 2019 lamented that Nigeria was losing too much to medical tourism, urging stakeholders to come up with a solution.
The Clinic, which was receiving a face lift at the time BusinessDay visited, has rather restricted its services to only selected government officials working in the Presidency following the President’s directives that it should “revert back to its original purpose.”
BusinessDay gathers that the Clinic, which provided treatments for about 32,000 patients annually, now attends to less than 100 patients per month. The Clinic now has consultants and resident doctors, but has cut down drastically on training programmes for Interns due to inadequate funds to pay them, it was gathered, he added.
Medical experts who spoke to Businessday, believe that Aisha Buhari’s trip to UAE to seek treatment for a neck-related issue may not have been necessary if State House Clinic, designed to care for the First Family’ health has not been moribund over the years.
They blamed Nigeria’s current low rating in health care services and partly attribute it to poor funding.
In the wake of the global coronavirus pandemic and as oil incomes thinned out, the initial 2020 health budget of N44.5 billion was reduced to N25.5 billion.
Nigeria’s health expenditure per GDP over the years continued to decline from 5.1% in 2003 to 3.8% in 2017, and is currently nowhere near the 15% global standards.
For Henry Ewunonu, a health rights advocacy expert, lack of capacity in the health sector is a big issue, noting, “The capacity issue is a major challenge. When a team went to the budget office to seek more funds for the sector, they were told that the Ministry of Health had to return about N3.5 billion unspent funds to the Federal Government in 2018. And this was part of the Capital budget.”
Ewunonu advocated for the adoption of the zero budgeting system he said would ensure funds were matched with listed projects to avoid such issues. “Nigeria lacks capacity to utilise funds budgeted. So, I think zero budgeting arising from needs assessments, from ground zero, will determine how much is needed. What we have is the envelope system, where budgeting is not based on properly verified costs.
“These health institutions cannot warehouse funds and must return them at the end of the year if they are unspent.”
He also blamed the absence of strong political will to drive infrastructure development in the health sector for some of the observed challenges.
Ewunonu, who noted that Aisha Buhari has been a strong advocate for health sector development, noted that she “needs to do more than talking.
“If you recall, Maryam Abacha used her Family Support programme to influence the construction of the National Hospital. In other developed countries there would have been a Centre of Excellence by now for whatever ailment President Buhari suffered from, which takes him out for medical treatments.”
Elder statesman, Tanko Yakassai, in his assessment of Nigeria’s health sector development, said the government lacks strong political will to drive policies in the sector. “The inability to effectively utilise funds budgeted for health is a clear indication that our problems is beyond unavailability of funds. The question is, how have they applied the available funds, are we working to developing local drugs?
“Only recently, we were told that India donated drugs worth $50 million to African countries including Nigeria, for treatment of COVID-19 patients. Yet, we claim to be giant of Africa.
“Yes, the First Lady has been at the forefront in raising alarms over the poor state of infrastructure, but nothing has been achieved beyond just the ‘noise;’ she needs to do more.
“We need her to do more. We appreciate her efforts, because she is indeed qualified to be Nigeria’s number one health ambassador, but we need to see more actions in the health sector.
“Other countries are taking away our doctors from us because they are being offered better remunerations and conducive environment to practice.”
Executive director of the Civil Society Legislative Advocacy Centre (CISLAC), Auwal Ibrahim (Rafsanjani), blamed what he described as “misplaced priorities” for the challenges in the health sector.
Ibrahim lamented that while there are “two doctors per 1,000 citizens and 0.5 beds per 1,000 citizens,” Federal Government places more priority on seeking medical care outside the country.
“The President has not demonstrated enough strong will to develop the health sector. Look at the N7 billion budgeted for Presidential jets and generators at the Villa, you will know that they prefer to go outside the country for health care,” he said.
