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LAGOS, NIGERIA.     Sunday, May 02 2004





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Management Crisis At The National Hospital

Last month, President Olusegun Obasanjo sacked both the British managers, (International Hospitals Group (IHG) and board of the National Hospital, Abuja, thus terminating the management contract signed with the IHG in October 2002.

In place of these bodies, the President has set up an Interim Management Committee (IMC) headed by his Senior Special Assistant on National Assembly Matters, Mr. Musa Elayo Abdullahi and charged it to get the hospital to international standard within three months. President Obasanjo wants the IMC to "fix the hospital to a standard where I, the Vice President, the secretary to the Government of the Federation, the ministers and top government officials will receive treatment instead of going abroad."

President Obasanjo had sacked the IHG managers and the National Hospital's board led by Professor D.B. Musa sequel to the recommendations of a presidential panel inaugurated last October to assess how far the hospital's managers had met the set goals since taking over the administration of the institution.

The Management Service Agreement (MSA) between the Federal Government and the IHG in respect of the National Hospital Abuja was for 10 years, effective from the date of signing, "but subject to a two-yearly review by the client based on managers' achieving defined targets as contained in the approved Business Plan..." But barely a year-and-a-half into the MSA, Government sacked the managers and disbanded the hospital's governing board apparently following the damning report and recommendations of the panel that assessed the British managers, one year after the agreement.

According to the assessment panel, the National Hospital conceived as an "apex tertiary health care institution, a centre of excellence", has become "a bottomless pit, with little to show for it by way of palpable improvement in the quantum and quality of care." Besides, the report noted that the sacked management, which assumed duty in October 2002, "did not provide its own business plan ab initio and was not altogether enamoured with the KPMG's Hospital Business Plan."

On finances, the panel reported that the annual management fee payable to the IHG was about N700 million in the first two years, but stressed that the financial sustainability of the project/contract cannot be achieved by the start of the third year as set out in the MSA, given the profile of the IHG managers since the commencement of the contract.

On the other hand however, the panel also blamed the government for approving several payments for the project in the past 18 months but was unable to release all funds as at when due. It said: "Going by the experiences of releases in 2003, rather less than 40 per cent of funds requested for 2004 is likely to be eventually released. The managers have, not surprisingly, made much capital of this lapse as they are always waiting for further release of funds or for permission to incur expenditure." The panel also observed the "anomaly" of appointing board membership "based on representation from geopolitical zones rather than corporate expertise."

All things considered, what the Federal government has done with the IHG and the board is an indication of its inability to manage anything, successfully including a hospital. The easy resort to sacking and reconstituting interim management boards points to a fire brigade approach in the running of an important health institution like the National Hospital. Besides, what is happening at the National Hospital is a true reflection of the horrible state of the health sector - in terms of poor funding and management.

It is all the more curious that the President is the one directly speaking and acting on the matter, and not the health minister. This either shows the confusion in the health sector or portrays the President as having a vested interest in the matter. Afterall, the National Hospital cannot be said to be beyond the brief of a health minister.

From all indications, it can only be inferred that the National Hospital is being run as another parastatal, prompting the appointment and dismissal of its boards at will by the President himself. Incidentally, this attitude accounted for the stifling bureaucratic processes in funds approval/disbursement which hampered the job of the IHG managers, as pointed out by the Presidential panel.

A cause and effect analysis of the fate of the IHG managers would show that the close attachment of the government, especially the Presidency, to the hospital contributed to its inability to be self-sustaining. For, in addition to non-approval/release of funds to the hospital managers, top public servants, peddling their influence, may have been enjoying the services of the hospital without paying their bills. Nigerian public officers are, afterall, used to enjoying virtually free of charge, the services of all government agencies.

Yet, the National Hospital Abuja is set up to at least break even by charging fees and ploughing the proceeds into its growth and maintenance. It is not enough for the President to stress the expected high standard and usefulness of the hospital to top public officers but also necessary for him to admonish such officials to pay their bills.

When it is recalled that the appointment of the IHG managers in 2002 was widely criticised because they are foreigners, it is not impossible that their operation was sabotaged or deliberately hindered by some entrenched local interests. Their abrupt exit has once again translated into a heavy financial loss to the country which has from all accounts, not faithfully kept the terms of the accord with the IHG team. For how long then, will the Abuja National Hospital remain a drain-pipe and a guinea pig in the management of the crisis in the health sector

  • This is why the current trend, including the so-called Interim Management Committee (IMC) is unacceptable, because it is not likely to achieve anything within the three-month target set for it. Moreover, the new body like the others before it is made up largely of politicians rather than core health professionals.

    It is equally surprising that the government is battling with one hospital - National Hospital Abuja - when virtually all other health institutions across the country, from primary to tertiary levels, have almost completely collapsed. The government should go beyond the need of its topmost officials and strive to address the problems of the health sector in a more holistic manner.

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