We Are Surmounting Our Challenges – UCTH CMD

Posted on January 27, 2017

Prof Thomas Agan, the Chief Medical Director (CMD) of the University of Calabar Teaching Hospital (UCTH)and Chairman, Committee of Chief Medical Directors and Medical Directors of Tertiary Hospitals, speaks about issues affecting tertiary hospitals such as the agitation by resident doctors, the high cost of running hospitals, the necessity of including tertiary hospitals in TETFUND among others and how all these are being surmounted.

 

You have been in office for about five years, we know that as administrator you have some challenges that you have been facing in the UCTH here, one of those issues is the issue of salaries . Would you let us know how you have been coping with payment of salaries especially the backlog, if any, within the UCTH?

The truth of the matter is that the UCTH does not owe any single staff salary. In the month of October, November and December we had shortfall which was a national matter. In fact, the first two hospitals to be affected were Federal Teaching Hospital Irua, in Northern Edo and then Federal Medical Centre, Yenagoa. You are also aware that at the beginning of last year the Federal Government reduced personnel allocation to all Ministries, Departments and Agencies (MDAs) by minimum of 10 per cent and most of us who knew this told our staff that we are going to have shortfall and that they may not receive October salary. They took us unserious. I was even blackmailed that I put their money in MMM, I don’t know what MMM means. Such is not possible because you don’t touch people’s money as they have wives and husbands who depend on them. Luckily enough, the Federal Government of Nigeria has corrected this as money was sourced and paid to all MDAs that had shortfalls, includingTeaching Hospitals. So when people said we squandered their money, going around blackmailing us, I look at them and just laugh because there is no truth in it.Teaching Hospital in Calabar and most Teaching Hospitals in this country are not owing.

What about the arrears of salaries and promotion arrears of workers within the University system?

Promotion arrears within the Teaching Hospital system dates back to 2013 when IPPIS came in. The Federal Government has not been paying promotion arrears since 2013. In 2013 they made some part payments, while 2014 to 2016 have not been paid. Even the promotion that was done in 2016 in most Teaching Hospitals including Calabar, the report has not come out from the Federal Ministry of Health. The implication is that we depend on our supervisory ministry, and if money is not given to you how do you pay? For now, 2014, 2015, 2016 and part of 2013 promotion arrears has not been paid. The government has calculated it, it is in the budget office and all that is needed is for the Federal Minister of Finance to authorize cash-backing. The government is doing their best to ensure that civil servants in the health sector do not suffer unnecessarily because it is their right not a privilege.

Outside the salary arrears and promotion, what about the area training of doctors. What has your administration been doing about it in terms of sponsorship?

When you talk of sponsorship there hasn’t been any budgetary provision for sponsorship. At a time, we were paying sponsorship allowance from personnel allocation but we were stopped. For instance, if I am given N6 million to manage this Teaching Hospital- this overhead is actually supposed to take care of diesel supply- a truck load of diesel of 40 thousand litres is how much? It is almost N12 million, then you talk of other things. You need to buy stationeries, you need to do repairs, you need to do maintenance, and you need to do all kinds of things. The overhead cannot carry the head. So for now, we owe resident doctors their sponsorship allowance and we are appealing to them to exercise some patience that by God’s grace the government will take into consideration some of these things. Some of these things are things that if we look critically inwards we can solve.

Recently, you took a decision of trying to do away with outsourced services in the Teaching Hospital.  Was it an internal decision or from the Federal Ministry of Health?

The decision to outsourceservices was that of the government. Some of the services being rendered bystaff were outsourced. Some of the staff were security personnel, cleaners,laundry and many others. The implication is that a contractor will now bid for it and then recruit people to come and do those jobs. Unfortunately, something went wrong and since 2009 to date government has not been funding it. So, there is no budgetary provision for outsourced services. We were funding from internally generated revenue. Between 2009 and 2012, we were paying from personnel. In 2012, ICPC invited some of us and gave us stern warning over it and even wrote to us that we were liable to be jailed if we paid that way. It came to a point where we were asked to pay from capital allocation and as the budget is coming out it is deducted. So, we are owing part of 2013, 2014 and2015. As I am talking with you many of them have taken us to court while some have assaulted us, and some have even gone as far as assaulting our family members.  As at November 2016 we were owing about N229 million to outsourced companies.  As Chairman Committee on CMDs, I have written to the Minister of Finance to authorize the payment because it is their right not a privilege.

Let’s talk about the infrastructural development within the UCTH. Could you let us know how far it has been in terms electricity, state of the theatre, rest rooms and bathrooms? 

When you talk about infrastructural development, it has been very slow because of the dwindling economy. The recession is affecting every nook and cranny of this country. I can tell you that from when I took over in 2011we had capital budget of about N600 million. N600 million, and out of this amount only 52 per cent of it was released. In 2012, we had about N400 million, out of this only 48 per cent was released. In 2013, about N400 and only 38 per cent was released. So it has continued to dwindle. Now, this hospital was constructed in 1977 and somewhere along the line it became abandoned and then hoodlums removed the glasses, roofs and everything. Well, we have moved in but it is not possible to do what we should do. We couldn’t develop because you can’t give what you don’t have.Besides infrastructure, electricity bill is one of the greatest challenges. In fact, we pay almost N6m monthly. And in the absence of public power supply, the generators are functioning very well. We have 515 KVA generator which is mounted inside the laboratory and it can supply light to the entire hospital. Just that I don’t want them to do that because it can break down easily. We also have a 500 KVA generator that is mounted at the theatre which supplies light to the theatre and some parts of the hospital. Recently we contemplated getting a 200 KVA generator for only the radiology department because the equipment there are very sensitive- they cannot withstand erratic public power supply. Due to this off and one, the equipment there break down easily, so we are working on that and we will get it right soon.

Let me take you back to some of the issues patients have been complaining about. One is the issue of drugs revolving in the hospital. How functional has that scheme been?

You know too well that when the Federal Government introduced the Treasury Single Account (TSA), every money generated whether it is of drug revolving fund or from anywhere must go to TSA. There is nothing special about TSA, so any money that is going there is utilized. Secondly, if you generate N5,000 and you are looking for N10,000, from which subhead do you get that money? If the pharmacy generates N5,000 and they are looking for N10,000 where do you get the money from? The drug suppliers claim that the hospital is owing them, the hospital cannot owe you. Suppliers are being paid. Sometimes I hear stories outside and it gets me very offended- that because they are owing GRF, who is owing GRF? Is it the Teaching Hospital or government? We are paying and we will continue to pay. Anybody who is being owed will be paid completely. I have vowed that this 2017 I want to clear as much as possible all debts owed to some of these people so that I will have peace. When I am leaving I leave in peace.

Let me take you back to the issue of the Committee on CMDs. Doctors had alleged that the Committee is responsible for the crisis in hospitals. What crisis are they actually talking about?

The crisis the doctors keep raising is that the CMDs don’t cooperate with them, they don’t discuss with them. Every staff is staff and as a Chief executive you don’t just come and open the books and announce through television and radio that government has sent you some money for this or that. It is administratively wrong. Sometimes people have to know the basics, it is not everything you analyse to staff. Worse still, people who seek positions are the people who instigate crisis in the hospitals.They are not only instigating resident doctors, they are instigating other staff. They blackmail you; write petitions to EFCC, ICPC, Police headquarters, media, every nook and cranny of the world. I have told doctors nationwide that I am ready to solve their problems as long as they are ready to stop striking unnecessarily. I will join the Federal government to solve their problems which are very minor as far as I am concerned. Abroad you pay school fees to be trained as a resident doctor. In Nigeria government pays you and trains you. As far as I am concerned it is a privilege and not a right because they are paid salary.

Patients in the hospital are complaining of increase in charges, is the increase commensurate with the services they get?

Teaching hospital is the last hope of every man. We have three tiers of hospitals- primary, secondary and tertiary. A tertiary hospital should handle complicated cases and not malaria, not headache, not typhoid. But you can see that this hospital is virtually for every Tom, Dick and Harry. When I came on board in 2011 a packet of cardboard used to cost N600 but today it is about N3000; the other one we use to call vickream used to be N1000 today it is between N7000 and N8000 and yet the cost of treatment has not changed despite the high cost of materials. As for Gloves we used to buy a packet of it for N500 it is now in thousands. Inflation has caused things to increase by over a hundred per cent. If you continue in the name of say you will not increase, how do you manage the system? There is no way the cost of treatment will not increase if not the hospital will break down completely. For me, we have not even increased; we are even trying to lobby the Federal Ministry of Health to beg them to see the possibility of increasing the cost of treatment. And I can tell every patient that my doors are open 24/7 for anybody who has complaints. Meet me I will resolve it. I may not have the opportunity to go round to see every patient. Already, we have a public complaints unit here. So if they can complain, they may not bring it up. As you complain, send an advance copy to me. We have a SERVICOM unit. I am advising members of the public to avail themselves of the services of this unit.

Sometime ago you issued a statement advocating that Tertiary hospitals should be included in TETFUND, how far has it been?

Yes, we did and I can tell you that the National Assembly is looking at the matter very critically and very soon they will be a public hearing in the Senate. Once that is done to include the Tertiary hospitals in TETFUND, it will take care of the infrastructural development, training, research and other things. I have said it quite often that over 80 per cent of students who come from medical school must pass through Tertiary hospital. We train postgraduate doctors, we train nurses and other staff. So, are we not a tertiary health institution? So why did they eliminate Tertiary hospitals? Section 7 sub sections 3 (1) of that Act specifically says a sharing formula should be the ratio of 2; 1.5; 1 for Universities, Polytechnics and Colleges of Education. However, we have presented the white papers to the House of Representatives Committee on Health Institutions through the Minister of Health with a view to amending Section 7(1) Sub-Section 3 of the Act to read thus: the distribution of the Fund, shall be in the ratio of 2:1:5:1: between Universities, Tertiary Hospitals, Polytechnics and Colleges of Education.  I give you an instance, the University collects school fees from students, the students come through here and use our consumables. The University does not contribute to consumables these students use. It is unfair for tertiary hospitals not to be included in TETFUND.

The Minister issued some directives on detention of patients following inability to pay hospitals bills. As Chairman of the Committee on CMDs, what is your response to that, are you people ready to comply?

The truth of the matter is that people are not ready to pay; it is not that there is no money to pay. Nigerians want to be treated free, not that they don’t have the money. Now we insist that anybody that comes must pay deposit unless the person is brought in unconscious. And they are paying. Nobody should deceive you that they don’t have money; they will tell the public that they are being detained but they are not being detained by anybody.

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