Lagos is not allocating enough funds to healthcare, officials said. Despite that, not all the allocated funds are released.

On a Thursday in August, an elderly woman gripped her daughter’s hand for support as they slowly descended the stairs. They had just seen a doctor at the Medical Out-patient Department (MOPD) in a one-storey building of the 131-year-old General Hospital, Odan, Lagos State.

Onlookers outside the clinic’s waiting area watched the frail patient’s hesitant steps with empathy. The hospital does not have facilities for people with mobility issues or special needs.

“We have been coming since last week for cardiovascular reasons. People her age should be attended to downstairs, but unfortunately, their MOPD is upstairs,” the daughter said, declining the reporter’s request for their names.

One of the onlookers, Kazeem Babalola, 65, escorted a family member to the facility. He said he had used the hospital since he was a kid

“It ought to have developed beyond this as the oldest hospital in the state. Instead of properly renovating and equipping it, they patch and paint. Last year, if you remember, a doctor died at the doctor’s quarters. It was a preventable death caused by negligence.

“A state like Lagos shouldn’t be managing buildings over 100 years old. What if this old woman falls?” Mr Babalola said.

The general hospital was founded in 1893 as a British military hospital and was strategically located between Broad Street and Marina on Lagos Island. It was handed over to the Nigerian government on 1 October 1960, Nigeria’s Independence Day, and later to the Lagos State government on 7 May 1967 after the country was split into 12 states by the military administration of Yakubu Gowon.

The incident Mr Babalola cited involved Vware Diaso, the medical doctor killed when an elevator crashed from the 10th floor at the hospital’s doctor’s quarters in August 2023.

Ms Diaso was on internship at the hospital and had less than two weeks to complete the mandatory one-year programme.

Her colleagues accused the hospital management of ignoring complaints about the faulty elevator.

The Medical Guild, an association of doctors working in general hospitals and teaching hospitals in the state, later revealed that the elevator was installed by a contractor who did not have an “elevator system installation certification.”

The state government subsequently sacked and blacklisted the facility managers in charge of the hospital and suspended the general manager of the Lagos State Infrastructure and Asset Management Agency (LASIAMA) following recommendations by a panel that looked into the accident.

When PREMIUM TIMES checked precisely one year after the incident, the elevator had not been fixed. However, a signpost outside the building stated that Julius Berger, a leading construction company in Nigeria, had been contracted to rehabilitate the 10-storey building. The project duration is 36 weeks: April 2024 to January 2025. The government has yet to disclose how much it awarded the contract to the company.

Renovation, maintenance

Records show that the state government spent N1.23 billion on renovations and maintenance at the hospital between 2021 and 2023. Yet, a tour of the facility revealed many structures in disrepair.

The Lagos State Public Procurement Agency (PPA) records showed that HK Designs Limited was awarded a contract for “completion of renovations, renovations and scheduled maintenance.” However, the contracts did not clearly state which parts of the hospital were fixed, raising questions of accountability and transparency.

However, the same contractor carried out the renovation of the general kitchen, pharmacy store/dispensing, laundry, and “provision of entrance welcome centre first and second perimeter fence” for N272 million.

Afolabi Benson*, a senior doctor at the hospital, told PREMIUM TIMES that it is underfunded and poorly maintained, making it unconducive for the workforce and patients.

“That doctor’s quarters is 20 years old, and some of the buildings you see here are over 100 years old. HK Designs is only in charge of a few projects.

“The areas with a touch of grey are the only places HK Designs has touched. Those are the periphery because when you are driving outside, those are the ones you see close to the road until you enter the hospital.

“What the management is doing is patch things here and there. What the hospital requires is a decisive, massive, definitive, purposeful overhaul, not patch and patch that,” he added.

HK Designs Limited is a private company registered on 7 February 2005. Buraimoh Sikiru is listed as its owner in the Corporate Affairs Commission (CAC) status report.

However, when PREMIUM TIMES visited the registered address at Osolo Way, Ajao Estate, Lagos, it was occupied by a sales firm.

A nearby bureau de change claimed the company had moved to Canal Close, but PREMIUM TIMES could not locate it.

Insufficient bed spaces, inadequate equipment

Speaking with PREMIUM TIMES, Misturah Damilola lamented insufficient bed space at the hospital’s casualty and emergency medical services unit.

Ms Damilola said she took her over-70-year-old father to the hospital in August for seizures, but he was attended to outside and at the reception and spent two days without a bed.

“I saw many other patients who also had to be treated outside because of the same lack of bed space,” she said.

Three doctors who spoke with this newspaper also bemoaned the state of the hospital’s equipment.

“General Hospital Lagos, with nine surgical specialities, barely has three operating theatres,” Seun Abiodun*, one of the doctors, said. “You don’t even have a full complement of anaesthetic machines for these theatres. We have an intensive care unit (ICU) that cannot be used because they didn’t provide the needed equipment, ventilators, etc.

“These are distinct areas of surgical practice, and you can imagine. How can nine specialities share three spaces, for example, if they have an operation to perform? But patients won’t understand this; they will only complain about the dates and postponement, and it will look as if it is the doctors who are postponing the operation,” Mr Abiodun said.

Another health worker told PREMIUM TIMES that the intensive care areas do not have monitors. “Emergency room barely has enough vital sign reading equipment to keep a close visualised monitor of every patient in there,” the source said.

According to Blessing Adebayo*, another health official at the hospital, the pathology and laboratory department lacks essential equipment like haematology analysers, which are vital for counting and identifying blood cells.

She said the department also does not have Seminal Fluid Analysis to expedite patient care.

Underfunded?

Lagos is Nigeria’s richest state by a distance. Its internal revenue in 2023 was about a third of the total internal revenue of all 36 states and Abuja, and it was more than that of all 19 northern states combined.

However, a review of Lagos State’s budget performance report over the last five years reveals that healthcare has not been its topmost priority. Enough money is not allocated to the health sector and even the allocations are not sufficiently financed.

Although allocations to the health sector have increased, they are below the Abuja Declaration’s recommended 15 per cent of annual budgets.

Abuja Declaration (2001) is a pledge by African Union countries to increase government health funding.

Only five out of 36 states in Nigeria met this threshold in their 2024 budget: Kano, Kaduna, Yobe, Abia, and Bauchi states allocated between 15.02 per cent and 16.46 per cent of their budgets to health.

In contrast, Lagos State allocated 7.6 per cent (N119 billion) to health from its N1 trillion budget of 2023. It allocated 7.3 per cent in 2022 and 6.2 per cent in 2021.

Allocated funds not financed sufficiently

The Lagos General Hospital received N752.6 million out of the N924.3 billion original budget in 2021, N793.4 million out of N1.2 billion in 2022, and N868.9 million out of the N1.58 billion original budget in 2023.

The Lagos State budget performance for the second quarter of 2024 reveals that the Ministry of Health has received N46.5 billion, representing 28.7 per cent of the total budget of N162.1 billion allocated to it for 2024.

In comparison, other ministries in Lagos State received significantly higher total budget allocations for 2024, including the Ministry of Finance (N556.4 billion), Ministry of Transportation (N209.6 billion), Ministry of Works and Infrastructure (N206.9 billion), and Ministry of Economic Planning and Budget (N237.4 billion).

This disparity raises concerns that healthcare is not accorded priority in Lagos.

“There is gross underfunding and underutilisation. The budgetary allocation is not enough, yet it is not made available for use,” one of our sources said.

Staff shortage, heavy workload, deaths

At the hospital’s pathology unit, a healthcare worker conversing with a colleague expressed frustration about the increased workload, stating that a single person was doing the job of two.

In July, the state Commissioner for Health, Akin Abayomi, echoed this sentiment and said the state had a shortage of approximately 30,000 medical doctors.

The brain drain phenomenon has further depleted the state’s healthcare resources, leaving the remaining doctors overstretched and vulnerable to burnout from long hours.

“We’re being overstretched due to brain drain, leading to diabetes, hypertension, stress, and burnout. Those who stay behind work passionately, and their efforts must be appreciated,” Aliu Azeez*, a senior health official in the state, said.

Mr Azeez highlighted the consequences of understaffing, including extended working hours and fatalities among doctors due to overwork.

“We recorded fatalities in almost every hospital in Lagos in the last two years as the brain drain worsens. General Hospital Odan lost one person this year; in Ikorodu, two people died last year; at Badagry General Hospital, a doctor died last week; and Alimosho recorded three or four in one week. These are all related to overwork.”

In March 2024, the Coordinating Minister of Health and Social Welfare, Muhammad Pate, said Nigeria has only 55,000 licensed doctors to serve its growing population of over 200 million.

 

Mr Pate said that in Lagos, the population of doctors was about 7,600 and 4,700 in Abuja.

 

The situation in Lagos and Abuja is, however, still better than in most other states.

“The doctor-to-population ratio in Abuja is 14.7 per 10,000 population; in Lagos, it is about 4.6, even though the average is 2.2 by 10,000,” the minister said.

However, on 13 August, President Bola Tinubu approved the National Policy on Health Workforce Migration to manage the exodus of health workers from the country.

As Mr Pate announced, the policy is a comprehensive strategy to manage, harness, and reverse health workers’ migration.

He added that the policy will also encourage the return of professionals to Nigeria through attractive incentives and reintegrate them into the nation’s health system.

Policy vs reality

Moruf Abdulsalam, chairman of Medical Guild Lagos, observed that the “policy framework is very vague.”

According to Mr Abdulsalam, to reverse the brain drain, the government must take decisive steps to address contributing factors like “economic prosperity, insecurity, poor remuneration, poor and stiff working conditions, and lack of incentives like mortgage, car/house, etc.”

“For now, there is nothing in it for the Nigerian doctors. It only seeks to encourage those in the diaspora to return to suffering on the ground. How possible do you think that is?” he said.

Speaking about General Hospital Odan, Mr Abdulsalam said it has been plagued by years of neglect but noted plans to revamp the facility.

He said, “Lagos State has about 28 general hospitals spread across all local governments and Local Council Development Areas (LCDA) except for Ojo local government, whose general hospital is presently under construction. These facilities are under the direct management of the Health Service Commission.

“The General Hospital Odan is the oldest of them all, bequeathed to the Lagos government when the state was created. It has no doubt suffered some neglect and structural depreciation over the years, but we are aware of a phased plan for renovation and revamping that has taken forever.

“Part of this structural decay is what affected the doctors’ quarters at the hospital with the resultant tragic elevator crash which claimed the life of our late colleague, Dr Vwaere Diaso.

“However, since that incident, construction works are presently being undertaken by Julius Berger to renovate the building and by OTIS to replace the damaged elevator.”

“Lagos is responsive but can do better”

Dankuwo Oyenuga, a senior registrar in obstetrics and gynaecology at the general hospital and former Vice President of Medical Guild, Lagos, said the healthcare situation in Lagos has improved over the last two years, but “there is still room for more progress.”

Mr Oyenuga said the state’s willingness to engage in dialogue shows its commitment to improving the welfare of healthcare staff.

He said: “Infrastructure and staff attitude has improved, and remuneration has increased, including a recent hike in hazard allowance. The government has responded to advocacy efforts and is trying to address concerns, but it can still do better.

“Improved working conditions, housing, and benefits can help reverse brain drain and encourage healthcare workers to stay. A proposal for mortgage options for housing and cars has been made to the government.

“While there is still work to be done, the government’s responsiveness is a positive step forward.”

Footnote: The asterisked names were changed to protect the sources from victimisation

The story was supported by the Centre for Journalism Innovation and Development (CJID) funding.