Despite Lagos having the highest internally generated revenue in the country, PUNCH investigations show its oldest hospital is still operating in old structures and facilities decades after establishment, JANET OGUNDEPO reports
One would not expect to see within the premises of the oldest General Hospital in Lagos State, the sight of an elderly patient being carried in a wheelchair down a flight of stairs.
But this sight was what greeted PUNCH Healthwise during a recent visit to the Department of Family Medicine at the General Hospital, Odan, Lagos State.
The elderly woman, dressed in a multicoloured native dress and a fiery red headgear sat calmly as a hospital porter, dressed in lilac, deftly pushed the wheelchair down each down step of stairs.
Another man, it is unclear whether he is a hospital staff or a relative, dressed in a cream shirt and brown trousers held the chair at the base and facilitated the back-breaking downward movement.
The senior citizen’s relatives crowded the landing of the stairs with their hearts in their mouths waiting for the safe landing.
While this was going on, the movement of other users of the stairwell, who were noticeably a mix of still agile elderly patients and middle-aged adults, was stopped.
Thankfully, the elderly woman was carried safely to the ground floor, but from her facial expression, such an experience was one she would never want to have again.
Undoubtedly, the lack of a ramp in that department, made the elderly woman go through a distressing movement while in a healthcare facility.
The 131-year-old hospital
Old and new buildings beside each other. Photo: Janet Ogundepo
Information from the Internet and the recent writings of a retired Chief Consultant Surgeon of the hospital, Dr Joshua Adebusoye, stated that the hospital was formally established as a Military Hospital by the British Hospital in 1893.
This date is one the hospital is proud of as ‘Established in 1893” is written on a rectangular signboard that sits at the old entrance of the hospital.
The hospital, located at Odan, on the popular Broad Street in the Lagos Island Local Government of the state, is the birthplace of some notable people in the country.
The hospital became the Lagos State’s government on May 7, 1967.
PUNCH Healthwise also learnt that many celebrated medical doctors passed through the hospital including, the first Specialist Surgeon and Director of Medical Services of Nigeria, Samuel Manuwa and former Minister of Health, Michael Majekodunmi.
However, the 131-year-old hospital still conducts its day-to-day activities in new and old infrastructural amenities.
Instances of the new begin at the main entrance of the hospital which bears the mark of a modern, security-conscious hospital.
It also continues right into the premises as the first building on the left is a state-of-the-art specialist centre.
Buildings that can be seen within a 90-degree are all new and modern. But nestled within these buildings are old and some unmaintained infrastructures.
A tour of the premises by PUNCH Healthwise further confirmed the synchrony between the old and the new buildings.
In 2023, Nigeria’s health index according to Statista, was 158 out of 167 countries.
The health index measures the extent to which people are healthy and have access to the necessary services to maintain good health, including health outcomes, health systems, illness and risk factors, and mortality rates.
Despite the demand for increased funding, the 2024 national budgetary allocation for the health sector is about five per cent. This contributes to the underfunding of the sector.
The infamous elevator
The hospital, a few months ago, came into the limelight due to the elevator accident that led to the death of a House Officer, Dr Vwaere Diaso.
On August 1, 2023, the elevator of the doctors’ residence at the hospital plunged at 6:50pm while Diaso was in it.
Information from the panel set up by the state government to look into the case revealed that the doctor did not die immediately after the crash but was trapped in the plunged and damaged elevator for an hour before being extracted and provided medical care.
In a statement signed by the state’s Permanent Secretary of the Ministry of Information and Strategy, Olumide Sogunle noted that after several attempts to resuscitate the doctor failed, she was pronounced dead at 8:59pm.
Several doctors who expressed their displeasure about the incident online and to the media noted that several letters of complaint and requests made to the hospital authorities about the faulty elevator fell on deaf ears.
An old tweet by the Medical Guild, on January 12, 2020, stated that the doctor’s quarters “has a non-functional elevator and no running water. Doctors who live on the 10th floor including pregnant women climb the stairs multiple times daily.”
However, Sogunle stated that the crashed elevator was newly installed in 2021.
The government stated that it has sacked and blacklisted the facility managers and suspended the General Manager of Lagos State Infrastructure and Asset Management Agency, Adenike Adekanbi.
Governor Babjide Sanwo-Olu
A few days after the doctor was buried, the Lagos State Governor, Babajide Sanwo-Olu, announced his visit to the hospital on his Instagram page, where he mentioned that speaking to the house officers present at the hospital and “they gave me an insight into their needs, and I gave my word that we have already got on it.”
PUNCH Healthwise, in a visit to the 10-storied doctors’ residence, discovered that for five months, doctors in the residence had to take the stairs to their apartments because a new elevator was yet to be installed.
PUNCH Healthwise noted that the entry and exit area to the lift was barricaded with a three-pieced black marine construction board.
A larger poster “Restricted area, construction site. No unauthorised access” alongside other words, numbers and symbols were pasted on the board.
When PUNCH Healthwise contacted the state’s Commissioner for Information and Strategy, Gbenga Omotoso and the Permanent Secretary for the Ministry of Health, Olusegun Ogboye, they both insisted that the contract to replace the lift and renovate the building had been awarded to the contractors.
But no sign of renovation or billboards proposing the beginning of renovation on the premises could be seen at the time PUNCH Healthwise visited the place.
Old dental, chest clinic infrastructure
Old and dilapidated Dental clinic. Photo: Janet Ogundepo
The buildings at an almost immediate left turn upon gaining entrance into the premises are all old and dilapidating structures.
This building houses the Dental and Chest Clinic
PUNCH Healthwise observed that the patients for the Chest Clinic sat on old and worn-out wooden benches with no backrest, placed under a makeshift shed.
Outside of the department where the water tank is placed are moulds of algae displayed on the building’s walls.
At the entrance to the Chest Clinic, the walls are a mixture of algae and faded cream paint.
Some hospital staff who appeared to be health attendants also sat on plastic chairs using old and broken tables.
The ring to hold the water hose in case of a fire was rust and bare of the pipes.
Other adjoining buildings which appeared to be offices were dimly lit and contained old wooden chairs.
Interestingly, the Dental Clinic building is occupied by both the Federal Dental Clinic and the Lagos Dental Clinic.
This implies that the building is shared by both the federal and state-owned dental clinics.
However, the Federal Government owned clinic was painted blue and sported a modern roofing sheet while the state-owned part still had the brown roofing sheet, algae-dotted walls and broken window panes.
Old gate: Shelter from the element
At the former entrance of the 131-year-old hospital, rests a signpost at the rooftop of a wavy concrete slab roof.
“Lagos State Health Service Commission. General Hospital, Odan, Lagos State,” was boldly written.
Next to it are the words which reflect the pride and badge of honour of the hospital, “Welcome to the Premier General Hospital in Nigeria. Established 1893.”
Following it were six phone numbers which seemed to be that of a GLO line with a new number series beginning with 0815, rolled out in 2010.
When PUNCH Healthwise tried two of the displayed phone numbers, it rang and a female voice responded on both occasions.
During the second attempt, a hostile female picked up the call but refused to confirm whether she was with the Public Relations Unit.
But at the old entrance with the signboard sat several cars.
The old but seemingly well-maintained gate was locked and some workers, one of them in the lemon jumpsuit-clad highway sweepers, could be seen taking a nap under the shade provided by the slab.
A walk into the old entrance from the new gate showed a man dressed in plain clothes, supposedly a security guard, asleep on a bench.
The building directly in front of that gate seemed abandoned and empty and discarded materials and grass, decorated the space beside the building.
The old and the new
Interestingly, the Eye clinic, which appeared to share the same building but different entrances, with the accident and emergency ward, is a newly built structure.
While the entrance into the eye clinic had a ramp, a barricade and a handhold, there was no staircase, leaving all users of the building with no choice but to carefully move up or down the ramp to avoid falling.
Just behind and next to the eye clinic is an old building painted lilac. This building houses the Department of Physical Medicine and Physiotherapy.
Although renovated, the chairs in the waiting area were old wooden benches.
Arguably, this is an irony for a department entrusted with the care of a patient’s physical health whose chairs do not support the recommended sitting posture.
Thrash within the premises. Photo: Janet Ogundepo
Relics of the past
Buildings at the back of the Eye clinic were all old bungalows painted in cream and brown.
While these bungalows housing different departments bore marks of being built at the same period, each of them bore different marks of their maintenance level.
For example, of these sets of buildings, only the Voluntary Blood Donation Centre seemed to be freshly painted.
It is unclear whether the entire building belongs to the blood donation unit as only a portion of the building seems to be freshly painted and with new models of air conditioners.
The adjoining office, however, has two old air conditioners fixed to a portion of the windows. The fascia, band under the roof edge, is missing, leaving the brown zinc roofing sheet at the mercy of caving in during a windy period.
The other bungalow is left with peeling paint on the walls. By the side of the building is a readable tag, “Sir Chief Norman Williams Alley.”
Aside from a “Telephone call” post on the wall, it is unclear what is being done in the building.
Glimpses from the past
A copy of the recommendations for the upgrading of the hospital infrastructures and affiliations written by the retired Chief Consultant Surgeon was obtained by PUNCH Healthwise.
The doctor recommended the demolition of some of the old buildings and the construction of new and relevant structures suitable for a teaching hospital.
“The main Hospital can be raised one or two Floors but this needs to be with the knowledge of the Architect. The Architectural and Landscaping Plan is in the Archives of the Colonial Office which was updated in 1925 or so. This is to be checked to make this a pleasant establishment when fully reconfigured,” Adebusoye noted.
Going down history lane on the development of the hospital, he recalled how efforts to make the hospital a teaching hospital were thwarted, noting that the hospital could still be reconfigured into a teaching hospital.
With nostalgia, he stated, “A Hospital like the Lagos General Hospital, this large, (over 200 beds) with many specialists in various fields and over 100 years old ought to have been a real treasure and a Teaching Hospital to be proud of.
“Many of its Consultants became Professors and Associate Lecturer/Examiners to the Teaching Hospital on account of their qualifications and quality of service…Almost all the Specialties that are there and have been for decades.”
From his words, the desire for the hospital to become a standard hospital of reference in Nigeria and to be at par with other old hospitals abroad is seen.
Stakeholders respond
On his part, the former president of the Pharmaceutical Society of Nigeria, Olumide Akintayo, blamed the state of the hospital on the lack of seasoned administrators.
Pharm. Olumide Akintayo
He also noted that the country has been accredited as one that contended with its infrastructural deficit of over $1tn range, noting that of that figure, the deficit in the health sector is about $250m.
The stakeholder in Nigeria’s healthcare further expressed concern at the government’s appointment of untrained and unprepared managers in the sector.
He asserted that the lack of the health administration to oversee the management of staff and resources contributed to the situation.
Akintayo said, “What are the pedigree and antecedents of physicians whom the government endorses responsibilities to? Many times, it is not entirely the fault of physicians who misbehave.
“It is the fault of those who enforce them with responsibilities they are not trained or equipped for. An average healthcare provider is trained in an area of core competence.
“Just like healthcare providers have their areas of core competencies, we have people who are trained to administer healthcare services and they are called healthcare administrators.
“ In the 80s and my first few years as a graduate of pharmacy, the people who headed our hospitals were core health administrators and effective managers of men and resources. And that is what we have lost and that is why we designate those eras as the golden eras in our healthcare sector.
“The beginning of the infrastructural deficit in our healthcare sector has to do with the people who manage the resources. It is not enough to provide money, though the healthcare sector does not have enough in terms of allocation, the little you have, what do you do with it?”
He further noted that the refusal to accept a broader team concept with the right competence to deliver healthcare services would further cause failure in healthcare planning and policy making.
Akintayo decried the appointment of only physicians in the Lagos State and Federal Government Ministries of Health, stating that this plan stifled the inputs of all health personnel and favoured some particular sectors.
Proffering solutions, the former PSN president said, “If you want to get it right, the proper thing would have been to allow a health administrator to be in charge, who would call all the different professionals and technocrats in the health team to give input on how their respective departments can be well run in the unfolding or unbundling of a new General Hospital, Odan.
“And so for instance, there would be a new pharmacy department, a new consulting room where people can have the benefit of pharmaceutical care, local manufacturing and compounding of some of the basic essential medicines within the hospital walls, most modern equipment and how they can be available, among others.
“However, physicians who head the hospitals must have additional administration and healthcare management skills.”
The drug expert asserted that the state and FG should reconsider their decision to allow only physicians to head the hospitals.
He urged the government to ensure that the right array of experts was put in place in the healthcare management system.
“Funding is key. Despite the over-celebrated and hyped budgetary allocation to healthcare, it is still a miserable five per cent. This is certainly not good enough and that is why we will continue to contend with the infrastructural deficit because they can be fixed,” Akintayo said.
Introduce sustainable financing – CSOs
On his part, the Chairman Board of Trustees of the Public Health Sustainable Advocacy Initiative, Ayo Adebusoye, noted that most hospitals in the country lacked sustainable financing to ensure proper maintenance of their buildings.
Ade Adebusoye
He, however, emphasised that the hospital due to its age-long status needed to be upgraded to a teaching hospital.
“The way the investment can go in is by targeting and supporting the Health Insurance Scheme, Ilera Eko, which is on. The whole idea of insurance is that only a fraction of people use their insurance and so the pool of funds that comes in, because of the huge catchment General Hospital in Lagos has, if they can ensure maximum enrolment, then there can be an influx of funding, which can be used to ensure that a lot of these can be renovated.
“Of course, there is still the need for funding from the government to ensure the structures are in place but there is the need for understanding that the hospital should be upgraded into a teaching hospital,” the PHSAI chair said.
He also condemned the lack of building maintenance culture in governmental organisations.
The public health reform advocate further emphasised the need to upgrade old and impractical infrastructures still present at the facility to new and modern ones.
He called for sustainable financing, investment and prioritisation of the healthcare sector in the country.
Adebusoye, who is also a senior attorney, further applauded the approval of one per cent of the state’s consolidated revenue fund as an equity fund to cover health insurance for the poor, stating this served as increased funding for healthcare.
“Up till now, our financing of health is suboptimal, so there is a huge funding gap. Even the World Bank has said that beyond infrastructure, investment in human capital development, health, and education, brings economic growth. Our political leaders need to have the mindset that healthcare is not an expenditure but an investment and the sooner they realise that, the better.
“It is not about just building hospitals, it is about maintaining them with skilled health workers who can manage them. Health is one of the sectors that have high recurrent expenditure because there are different overheads to be paid for, the human services, equipment, drugs and are high intensive things,” he added.
He advocated the holistic onboarding of every Nigerian on the NHIS and the payment of tax as a way to further generate financing for the healthcare sector.
‘Lack of ramp disappointing’
In her response, the Executive Director of HACEY Health Initiative, Rhoda Robinson, called for better resource management and maintenance of the old buildings pending the allocation of funding to carry out a complete overhaul of such buildings.
Rhoda Robinson
She lamented the underfunding of the health sector, stating that the lack of funds hindered the revamping of old structures in the hospital.
Robison added, “For a hospital not to have a ramp for wheelchair access is disappointing. I would rather give them the benefit of the doubt that it was a design omission which I believe should be immediately rectified.
“With the recent increase in a call for inclusive public infrastructure, I believe this should be done soon, and it would also be our responsibility to raise awareness on hospitals, and the parts of the hospitals, that do not support wheelchair access.
“For some hospitals, it may take serious infrastructural changes to include wheelchair access to and on all floors, but I believe it should be prioritised.”
No plan to demolish old buildings – Commissioner
When contacted, the Lagos State Commissioner for Information and Strategy, Gbenga Omotosho, stated that the hospital had been renovated, adding that the contract had been awarded for complete renovation.
“Hospitals at Harvey Road, Yaba, in Isolo, Ebutemetta and Odan have been renovated. That particular building (Doctor’s residence in Odan) has been given to a contractor for renovation and installation of modern facilities that were not there before so that what happened there won’t happen again,” he said.
When PUNCH Healthwise mentioned visiting the facility recently without the presence of ongoing renovations or an erected signboard by a contractor, the Commissioner stated, “Maybe the contractor has not moved to the site but everything has been put in place for rehabilitation. The Lagos State government has spent a lot of money on the hospitals.”
In his response to the presence of old structures, Omotoso stated that there was no promise to demolish the buildings except to renovate them.
‘Renovation in phases’
Reacting, the Permanent Secretary of the Lagos State Ministry of Health, Dr Olusegun Ogboye, stated that the renovation was ongoing in phases.
When asked about the progress of the installation of a new lift in the Doctor’s residence, he stated that the contract to replace the lift and renovate the building had been awarded.
“What I can tell you now is that the award has been given for the replacement of the lift in that building and a contract has also been awarded for the complete renovation of that building (the Doctors Residence),” Ogboye said.
Further responding to questions on why the presence of old poorly maintained buildings and equipment, the PS stated that plans were in place for a complete renovation of the hospital in phases.
Reacting to the lack of ramps in the building housing the Department of Family Medicine, Ogboye initially insisted that there were ramps throughout the buildings on the premises, but when presented with evidence of its absence in the department, he pinned the situation on a possibly architectural or engineering problem in the decision to put a ramp.
He promised to follow up on the buildings without proper infrastructure in the hospital.
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