There Is Need For Energy Solutions In Nigerian Hospitals To Have Better Healthcare System – Professor Ahmed Ahidjo, CMD-UMTH

There Is Need For Energy Solutions In Nigerian Hospitals To Have Better Healthcare System – Professor Ahmed Ahidjo, CMD-UMTH

Energy remains one of the most challenging things in managing health institutions in Nigeria. This is because of the inadequate quantity that we required and also because of the inadequate quality of energy as required. As long as we are moving in the direction we are now, without changing the system the way it should, it is very unlikely that we will give the optimum healthcare to the society. These were observed by Professor Ahmed Ahidjo, CMD, University of Maiduguri Teaching Hospital (UMTH) during an Exclusive Interview with NEWSng in Abuja. James Bwala and Lazarus Balami sent except:

Q: Thank you for having us Professor. May we know you?

My name is Professor Ahmed Ahidjo, I am a Professor of Interventional Radiology.  I am from Askira/Uba local government area of Borno state, in northeast Nigeria. To be precise, I am from a village called Yimirgo. I did my early primary school at Yimirgo Primary school after that I moved to Government Secondary School Uba where I did my form one to three.  In those days, they would choose the best student to go to science schools. I was chosen to go to WAKA Biu science school to complete my secondary school. From there I went to ABU Zaria then it was the school of Basic Studies, where I did my A levels. I return to Borno state and register at the University of Maiduguri to study medicine. Thereafter, we started the residency training programme – that is the Post Graduate medical training to become a Consultant. I was at the West African College of Surgeon faculty of Radiology and also the National Post Graduate College of Nigeria bagging two fellowships with specialization in Radiology. 

Immediately after that, I felt the need to further my education, so I went to the Medical University of Vienna in Austria where I studied Interventional Radiology and became the first person in the West African sub-region to do interventional Radiology. I was also at the University of Washington to further study interventional Radiology as a specialty. I completed that study within a year and returned home to establish interventional Radiology in Nigeria.

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Administratively, I was Head of Radiology Department at the University of Maiduguri and University of Maiduguri Teaching Hospital for almost ten years. I became the pioneer Head of Radiography Department to start training of Radiographers in the 19^th Northern states. I also became the Deputy Provost College of Medical Sciences for a period of two years. Thereafter, I became the Provost, College of Medical Sciences University of Maiduguri. I was also the secretary National PostGraduate Medical College of Nigeria in charge of Radiology training in the country for a period of four years in Lagos.  From there I became the Chief Medical Director –UMTH. Within the period I also worked at the World Head Organization’s Headquarters in Geneva in Charge of all the Radiology devices globally with 198 member countries. I was also a Research Scholar at the Uniformed Services University of Health Sciences in Maryland. Since becoming the CMD for over three years now I have been working in the office.

Q: There are so many reports of your achievement in the hospital especially at the managerial levels. Do you mind sharing your experiences and any Managerial skills to have informed the flow of your administration at UMTH?

Yes, thank you. I studied Leadership in health from Washington University. That is the qualification I had in management. That was before I became the CMD and this is one of the most respected managerial courses across the globe in healthcare. However, skills sometimes you learn over a period of time. From the beginning I have been in the leadership position. Since my student days, I was a student’s union leader and at residency I was ARD President. I was also Chairman of the Consultants, so I have been in the union side, in administration and then I started as Head of Department and I moved up to the peak professionally to become the Provost of the College without jumping post. I went step by step and I have taken all the posts I am supposed to take to rise to the top. So, in addition to the qualification, I was actually along the line of practical skill acquisitions in management positions. So that is why sometimes when you are managing a system, you get conversant with those systems.  It became easy to manage them. If you are talking as a Head of Department, I was a Head of Department for ten years and I know what it means to be one. If you are talking as an ordinary doctor in the hospital, I know what it feels to be one. I know what it takes to be one and I know the duties of one. If you are a nurse, I have interacted with one. If you are a Radiographer, I have interacted with them. So, you get all these skills over decades.

Q: Tell us more about the difference between being CMD and the ordinary staff in the hospital or any?

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There are a lot more differences. When you are from the position of the ordinary staff of the hospital you look at things from one angle and when you are from the position of a unionist, you look at that from another angle. When you are an administrator, you also see things from the administrative position. So, very few people may be lucky to have exposure in all these so that they can have a holistic picture. Most of the time as an ordinary person, you know the idle thing to be done. You want the idle thing to be done in material of how or which is the way that this thing is ought to be done that is not your pain. All you want is that if they are doing this in London, you want it to be done in Maiduguri. As a unionist, you have all the laws in your head. The circular said we should pay this. The constitution said this is what is to be done. It is our own rights and it should be done. Now as an administrator, you look at the laws, you look at the loads and you also look at the resources. Then you now look at how to manage it. So, if you take all the three, you will have the bigger picture of how the ordinary man views things, how the unionists view it and how practically you are there to solve all these problems. So, as an administrator, you have a bigger picture to solve them. That is what makes the difference in the way people look at things, the way people perceive things and the way people talk about things.  Most of the time, if you do not have the complete knowledge and clear picture of any issue you are unlikely to give good judgement.

Q: Healthcare is one of the most important foundations for development but it also requires huge resources to run it. Tell us about the Nigerian health system and the Hospitals?

Thank you very much. We all know healthcare is one of the most important foundation pillars in any development. There is no system or community or society that develops without a good health system because it is only when you are healthy that you can be productive. And as long as you do not have a healthy population, the population will not be productive. As long as they are not productive there is no way you can prosper as a society. So, we must understand the value of healthcare in the economy of any nation. A sound healthcare system provides a good platform for economic development. They are directly proportional. If you look at the graphical representation, you will agree that it is a linear relationship between healthcare and economic development. So spending as a nation in our healthcare is very important and not only spending but spending wisely. Everybody knows that it is easy to spend money. If they give you money and you enter a supermarket, you can spend it the way you want it. But at the end of the day, if you come out of that super market you asked yourself. Have I done a proper need assessment before I go in? Did I buy the things that I really need and not the things that I want? You evaluate your purchases whether your spending is on your real needs and anything that you do, if you want a proper development you must lay a foundation. There is no way you can expect a child to start running without first sitting and crawling.

Q: So, did you hinge on that theory to change the system in your hospital and change the story as it is today, talking about the UMTH model?

As I was saying, if you have a child and you want that child to start running without learning how to sit and how to crawl, he will fall down. So, for any system to work very well, you must do your homework.   Do I have a proper foundation for that system? If you do, move ahead! It’s easy.  You can now have a sound system at the end of the day, but as long as you do not have a proper foundation it is very unlikely that you can make an impact. And anything that you do, if you do not have a proper assessment of what you want to achieve you are unlikely to meet that goal. When I was about to come in as the Chief Medical Director, UMTH, the first thing I did was to look at the data of the hospital for the period of ten years.  I do not want to talk to anybody about anything yet. I know data does not lie and I went for the data.  I can say clearly with clarity of mind, the current registrar, Nigerian Health Record Board Mr. Babagana is the person I approach for data.  He was the Head of the Department of Medical Record in the hospital. I met him and said, Babagana gave me the health record statistics of this hospital for a period of ten years. That was before he became the registrar of the council. He gave me the data of the hospital for ten years. I refused to talk to anybody; I sat down and looked through the data. I knew how to do statistics, I can analyze data. I have known this for a long time. I know Excel, database management and SPSS, so statistics is not a problem. I put all the data and analyze the most commonly diagnosed diseases in the hospital (UMTH). I look at the most commonly perform operations in UMTH , the most common killer disease, the most attended clinic , the wards that always has bed occupancy 100% all the time, departments that has few patients that their beds has no patients, the structure of the A and E, how many patients come in a day, or a month.

These are what I analyzed before I became the CMD-UMTH. So, I established some statistics on what needs to be done to make the hospital a holistically acceptable and advanced institution. I finished all that before I became the CMD.  So, all I needed to do after becoming the CMD is to implement what I have done. I will give you an example, the Department of Medicine for example, the non-surgical department. They have the Male and Female medical wards that one everybody knows. I realized that all the time there are no free beds in those wards. Each time they would phone me to say that there is no bed in the wards and therefore that became an issue. I now went back to the statistics and asked the staff, who are the people occupying these beds and they said mostly they are patients with stroke. You know if you admit a patient with a stroke, they can stay up to two or three months because it is a long term disease and not like malaria which is a short term disease. There are also diabetic patients, they are also long term chronic diseases, and they stay in the wards for a long time. There is also nephrology –Kidney disease patients. Once admitted they stay for a long time in the hospital, they occupy the beds. So, this tells me where to expand and I said ok, if it is Kidney disease patients that occupied the beds, if it is diabetic patients that occupy the beds, if it is stroke centre patients that occupy the beds , the first thing is to build a dedicated Kidney centre with admission facilities and take them off the wards. I realized 30% of the patients in the medical wards are Kidney disease patients, so if I remove 30% from the medical wards, I will have a free bed. That is what moved us to have an 85 beds extension of the Kidney centre.

Again I looked at the next inline; I discovered it was struck related cases. Stroke also occupies 30% of the bed space in the medical wards and we are building the first stroke dedicated centre in the whole of West Africa, a 150 bed capacity for the first time anywhere in the West African sub-region. I challenge anybody to check this if there is ever anything like this except at UMTH. So, by doing this, already 60% of the beds in medical wards are free. So, nobody will come and say to me that there are no beds again in the medical wards. This is just one example. Let me also give you the example with A and E. The A and E when I came, it was a five bed crash room and that means only five patients can be put on a couch for emergency assessment.. If you bring 30 patients or 100 patients then the patients have to be kept on the floor. So, I said now what option do we have? And we came up with the idea of building a trauma centre.

We built a 150 bed capacity trauma centre. So by moving the trauma away the other A and E will be for only emergency cases. Now by moving the bulk of the patients to the trauma centre, you have solved the problem. But again we knew that during crises period’s trauma is associated with for example, villages being burnt and what have you. So, burns are associated with trauma and the trauma centre cannot care for burns. So we decided to establish a burns centre – a dedicated centre for the treatment of burns. Now the next thing is, if you treat these patients that have sustained injury and they are disabled, how do you rehabilitate them? That is what prompted us to build a N1.3 Billion Physical Rehabilitation Centre so that by the time these patients lose a leg or arm; they can be given an artificial one and continue with their normal lives without people even knowing. All these are examples of needs assessment, which we were able to undertake at the UMTH.

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On the other hand, the hospital was built purely as a tertiary hospital. There are no provisions for primary and secondary services in the UMTH by planning, because it is a tertiary hospital but these days there is no way you can run away from patients coming directly to the hospital. There is no way you can run away from NSIH patients. We have almost 22, 000 registered; there is no way you can run away from retainer-ship. So, there is a need to have a standard GOPD. We are prompted to have the largest GOPD in Nigeria. Thirty doctors can consult at the same time. We have 30 consulting rooms and it makes life easy for everybody. This is what is lacking and we have solved the problems. The whole of the northeast there is no centre for treatment of Cancer, they have to go to Zaria or Sokoto or Abuja which are also epileptic.  So by establishing a Cancer centre it means all our patients from the villages – Magumeri, Monguno and others do not have to go to Zaria. Imagine telling a villager from Azare or Magumeri to move to Zaria and he may have a two months waiting period. It is like telling him to go and die. He may not have the resources and even if he has the resources moving there is very difficult for such patients.   So, we established the multi-billion naira Cancer centre. What I was doing in the hospital was based on scientific data. It is not that I go and ask this or that because I know that human beings are subjective in their assessment but data do not lie. That is how we were prompted to do what we did. That is how we were prompted to move the hospital from being a 630 bed capacity hospital to the current 1200 bed capacity hospital. LUTH has 850 bed capacity hospitals; UCH is 1000 and it used to be the largest. The UMTH today is the largest hospital in Nigeria with 1200 bed capacity and all the equipment associated. If I mentioned a centre it means a centre with all the associated equipment. 

Q: These of course are without challenges; can you share some of the challenges you have in the hospital building it to the largest in Nigeria today?

Well, there are general challenges, there are local environmental challenges, and there are institutional challenges. There are various forms of challenges if you want to classify these challenges. If you recall when I was talking I talked about a proper foundation for any system to thrive. There is no institution that will succeed without the basic infrastructure. This is talking about Energy, Water and Clean and a good environment that is secured. These are non-negotiable. For us to go to where we are targeting to go– ‘The Freedom City’ as I call it, we must have all these in place. No matter what we do, if we do not have the supportive basic infrastructure, it will be very difficult for the system to be where it wants to be. Secondly, the staff attitude is another challenge. People are used to working in a small system, now they have expanded the system where administration becomes a bit difficult. But one has to come up with a system that will checkmate them. In doing this, I set up a new department of clinical governance. This new department did not exist before now.

The aim is to ensure that the patient is the king in a hospital environment and he obtains all the services that are required to his normal stage and every person in the hospital environment is supposed to do his job in the way it is prescribed in the public service rules. This is the work of this new department. We have got the approval; I established it and we are on the course of sending them abroad because there is no similar large department in the country now.  Their job is to ensure staff perform their duties in accordance with the rules. The third challenge is the changing pattern of our economy. If you plan something today, tomorrow is a different scenario in the market. That is a big challenge. You can have a plan with somebody today or you award a contract to somebody today and you are expecting him to deliver it but he goes to the market from the time of planning to the time of execution everything has changed. He will run away because the business is no longer profitable for him. You try to call him, he will not come and you will be wasting time trying to pursue him rather than constructing similar things that are of benefit to society.  So, you have to make a decision whether to go on pursuing such a person or to go ahead to make an impact in other areas of needs. So, this changing market dynamics is affecting a lot of things in developing a system. Also I really want to ensure that the people that are supposed to do their work outside the institution that they do it in the way that is constitutionally right.

Q: Talking about the economic situation of the country, the changing dynamics, how do your patients meet up and what are the gains or losses?

Well, this is similar to what I have been saying about the changing dynamics in the market. For example, let’s say the patients are supposed to pay this and that and maybe it is done yearly or in two years’ time or three.  Today, everything in the hospital setting the government has put it as a revolving fund. The government is no more giving the hospital money to buy drugs, X-ray facilities and day to day running costs. That is expected as a revolving fund from you to continue your operations. Now, what it means is that you have to involve contractors to supply these things to the hospital at a price. The hospital charges are fixed and yet the contractor brings in things in line with the current market price. So you may reach a situation where if a billing system of an institution is done maybe in 2019 and you are now in 2022. What the patient is paying may not be half of the price the contractor is supplying because that bill was made based on the market price of 2019. If you change it frequently, society will begin to hit you hard and say that you are not sympathetic to society. If you keep quiet, you are running the system and not paying the suppliers. So, that is where you have the challenge and maintaining balance in the hospital for sure and institution like our own, we are not a profit making organization. This is very clear.

We are not supposed to charge one kobo more than what is obtainable in the market.  So, we are not making money for anything, but again I am not having any money for subsidies for anybody.  If the billing system is done in January 2022 and suddenly there is a rise in the items if you did not change the billing system, it means that you are subsidizing a patient and that means who is going to pay the balance. This is a big challenge. Again, many people may not know that there is the procurement law of the land and they have prescribed clearly for any Federal Government Institution where we operate there is certain amount of money that it has to be in a contract form that is why today you may go the UMTH and you may found that the amount you pay for a paracetamol is more expensive than what you get across the road because it is the law of the land that you buy the drugs through contract system. The contractor will expect some amount of money in addition to his cost for the services provided and you are expected to pay the taxation. You pay 5% withholding tax, in some circumstances you pay 7.5% VAT and then 1 % stamp duty. So, in most items – that is non drugs item, you are paying 13.5% more because of taxation. This is not to talk of the amount the contractor is demanding for his services. These are the challenges that need to be addressed so that there will be some level of ease in our operations.

Q: What are you doing currently to meet up with these challenges?

There are so many ways to address these challenges. We may choose to review our billing system frequently like the naira and the dollar is changing in the market, but the outcry will be very loud. Many times, we have to go out and meet with nongovernmental organizations in order to have some help.  When they help we add it to the pool and that will bring the price to a lower level otherwise we will be operating at negative because we cannot pay the contractors.

Q: You also talked about challenges of electricity in the hospitals. What is the management doing about it, especially at UMTH, looking at the size of the hospital and what is expected that the government, organizations or well-meaning individuals should do?

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Thank you very much. Energy remains one of the most challenging things in managing health institutions in Nigeria. This is because of the inadequate quantity that we required and also because of the inadequate quality of energy as required. As long as we are moving in the direction we are now, without changing the system the way it should, it is very unlikely that we will give the optimum healthcare to the society using this energy that we have. Generally, there is a need for the government to look at how to optimally or how best to supply energy in this country, especially the hospitals and health institutions in general. Providing that electricity I think will do well to the whole of the country and not only the healthcare system. Once energy is supplied to the country, the healthcare institutions, it means the services will be there. From the experience I had in the past few years, energy is one of the most difficult things that we are supposed to have in the whole of the management of the hospital system in Nigeria. If the government provides energy to the hospitals, that will ease a lot of things. Many countries do that and this is one of the most needed infrastructures in Nigerian hospitals. If they cannot provide, at least let it be subsidized because it is going to be very difficult looking at the way we charge our patients now. 

To pay for the best electricity supply is what we needed to have the best in the hospitals. But where is the money? For example, the gross IGR of my hospital in April this year was Forty-two million (N42, 000,000.00) and Diesel alone gulps Sixty –Seven million and Five hundred thousand (N67, 500,000.00). This is not practicable. The best way is to look at how to assist these hospitals with energy supply. If the National grid cannot give priority to hospitals, let independent power plants especially now that diesel is very expensive, gas generators be provided to healthcare institutions – the Federal ones and let them buy the gas. That will help a lot because buying gas plants may be too expensive for the federal healthcare institutions for now. If the government can procure these big generators and give it to these federal health institutions and let them use gas to supply the energy that they need, this will really alleviate the system otherwise virtually most of the hospitals in this country have cut the energy supply hours because of the hike in diesel price. There is a need for us to look into energy solutions in our healthcare delivery system. Let the government key into this in an attempt to give the hospital the needed energy so that they can give the needed healthcare in line with the National strategic healthcare plan for Nigeria.

Q: Finally sir the award, you received a prestigious award from the National Productivity Centre where Mr. President was in attendance and so much was said about you and the award. How would you share your feelings on this?

Thank you so much but I really cried that day. Maybe I will start with that. I cried because of two things. There is a hope for a poor person; there is a hope for the hopeless in the country. I look at my background. I come from a remote village in Askira/Uba local government area of Borno state. Still the population is so small, I went to the local primary school and the local secondary school and a local university. I rose to become a Professor and as a Medical Doctor, I attended a peak that I will have a handshake with the President. It means there is hope for anybody that can work hard to reach his peak and be recognized best for his hard work. I cried inside the banquet hall of the Villa. After having a hand shake with the President and I left, I did not know how but tears were running down my cheeks. I am nobody and I came from nowhere and because of hard work, I am having a handshake with Mr. President. 

Secondly, I cried because I wish my father was alive because we are the first generation in our family to go to school. Our Parents did not go to school.  I wish he would have seen the benefit of taking us to school. So, the award is a thing of joy but not for me alone. I as a person can never get the requirement that culminated into this award. There are many people involved and I only lead the team. One of the areas for recognition is that I am the first person to introduce Interventional Radiology Service in Nigeria and the West African sub-region. This is also as a result of the government sponsoring my training. Without the government sponsoring my training in Austria it is unlikely that I will get the skills and it is unlikely that I can impact the skills. Although my training in the United State was purely sponsored by the United State, at least the beginning was done by the Nigerian government. Again, the award was as a result of the work I have done at the Maiduguri Teaching Hospital; therefore, I am not alone in this as there are so many people involved. From my hospital staff, from the state government, from the political class, from the nongovernmental organization, from the federal government and so many people are involved to ensure it is successful. Without my own staff there is no way we can do a proper planning package to achieve what we have achieved. Without funding it would have been only a pipe dream to have executed the projects in the hospital and without skills and knowledge, we may not have people that would have made this a reality. So, it is a general thing and that is why I said all that have been involved in the successes we have achieved, I dedicated the award to them.

There Is Need For Energy Solutions In Nigerian Hospitals To Have Better Healthcare System – Professor Ahmed Ahidjo, CMD-UMTH