Prof. Darlington Obaseki is the Chief Medical Director (CMD), University of Benin Teaching Hospital (UBTH). In this interview with Managing Editor/Acting Managing Director, Osa Victor Obayagbona, and Business Editor/Chief Economist, Teliat Sule, Prof. Obaseki highlights the transformations that have taken place at UBTH, and how the institution is moving towards becoming the leading provider of healthcare solutions in West Africa. Excerpts:
About seven years ago, you were appointed as the Chief Medical Director of UBTH. What were those deliverables that you set for yourself and to what extent have you achieved them?
By August 2024, I will be seven years in office. I came into this job with an attitude of humility, knowing that I need to grow on the job, learn as I work, and improve as a leader. I didn’t come with the attitude that I have the solutions like I was already made for this job. I may have the ingredients to be a very effective leader, but I have to do a lot of learning and growing on the job.
In terms of the ups and downs, first and foremost, before I became the CMD, I was a member of the management for two and a half years. So, I knew what the issues were. I knew where we were, and I had a clear idea of where we should be and I also came up with a plan on how to get there. Not just a plan in my head, it was actually a documented plan. So, we sat down the very first few months I came on board, my team and I drew up a strategic plan.
It was not just a plan that was done the usual way. I actually contracted an external consultant who was good at hesitance management to guide me in helping to formulate a plan. It has been a genius plan, a master move for me because UBTH is probably the busiest hospital in Nigeria, either private or public. And if we are not the busiest, we will be the second or third busiest because teaching hospitals in terms of the work we do and the number of patients we see per day.
We have close to about 500 patients in our wards. This is not a hype when we were at the peak like before Covid, we used to have about 650 patients in our ward on admission. Every day, we see about 1300 patients like today we saw about 1300 patients in our clinics. These are patients that come for consultation. Managing these huge numbers, I am not even talking about the schools yet. We have staff strength of about 4000, and a school population of about 5000. So, managing this huge number on a day-to-day basis is very challenging. You know issues usually come up, because you can actually work here for 8 years. What you are doing everyday you are very busy fighting fires. I used the word fighting fires for solving the problem as it comes. You come to work, I come to work 7:30 close to 7:00pm sometimes and you are very busy all day.
You will hear things like, there is no water in that ward, patients’ relatives are fighting the nurse, doctors and nurses are fighting that way, among others. This trunk has broken down. That is what this job can take from you but if you don’t have that plan, and take out time from day-to-day practical operational issues to focus on what I said I would achieve. How far have I gone? Every month, every week review your plan. So, that is what kept us here in this job that we have a strategic document.
You asked in terms of what I wanted to do, how far have I gone with them. The first thing about the plan is to have a SWOT analysis, to assess our strengths and weaknesses, the opportunities that we have and what threatens our growth. That was the state we found the hospital in at that time. A lot of people will not remember, I hate to talk about that time because I don’t want to disregard anybody. UBTH as at that time had frequent industrial actions. In 2016/2017, every other month there was always one strike or the other.
Unions were always coming out against the management and being a member of that management too, I knew what the issues were. So, one of the priority areas in the plan was staff welfare. We call it staff satisfaction not just welfare which includes their welfare, their working environment, their working tools and we clearly stated what were our strategic areas, strategic objectives, what our action plans were. We wanted to make sure we pay our workers all the emoluments as at when due. We wanted to make sure that everyone being owed was paid, and that was one of the first things we did in the first three months of assuming office.
That was one of the issues we had then, they were owing some people different allowances. We wanted to make sure that their working environment is befitting, their working tools are available. That when you come to work, you have light, water in taps not the one fetched with your bucket. That when you come to work, you have cotton wool, syringes, those were the things and we stated timelines for achieving those deliverables. At the end of this period, we would like to have this and that. For example, we said we wanted to have a staff bus for our workers to help their movements. So, those are the specific action plans and timelines stating what to do at each quarter.
We also have another priority area which is patience satisfaction. And under that we have different strategic objectives like your patience and experience how you want it to be like. How do we treat our outpatients? There is an area for outpatients, in-patient, operation, and emergency care. What we needed to do for example now emergency drugs, there should not be an outage of emergency drugs, we said it and we did it. Our ward managers are nurses, they should be able to do an inventory every day of our stock of drugs.
Our major challenge at UBTH is navigating from one building to another. If you go to private hospitals, it is one building and it is easy to go from one ward to another. Moving from here is a lot of work not to talk about a person that is sick. We needed to have a good navigating system like sign agents on the roads, walking aids, now we also give them carts to move patients from one place to another.
Same thing we did for manpower training and development. That is another strategic area we said we are going to look at. This focuses on training our staff, developing them, in the areas of research and technology. Lastly, we also said all those things, you can have great plans but to develop you need money. No CMD wants to do bad, it is just that there is no finance to do things. We strategized on how to raise funds to finance our plans.
We had a total of 169 specific action plans during my first tenure which were measurable and not nebulous. We had 6 priority areas and 19 objectives. For the specific action plan, we said in emergency care we will reduce the turnaround time of investigations to be less than 2 hours. It is specific, it is measurable. In some areas we didn’t put time but this one we put time. Like the one I just told you about to ensure that emergency trays are adequately stocked at all times and feedback provided daily.
Our other objectives are to maximize government funds, under which we will strengthen the budget preparation and planning process. Regularly monitor budget implementation and positively engage government agencies.
Another objective is to increase the IGR by 20% annually. We specify what we wanted to do there, commercialise some services and we have done that. We commercialised UBTH Group of Schools by May 2018.
Our vision is to make UBTH the leading provider of quality healthcare solutions in West Africa. That was where we started from. UBTH is not meant to be compared with private hospitals, and it is not meant to be compared with Nigerian hospitals. It was set up to serve the whole West African sub region. That was what Ogbemudia did here, as that was the vision he had. Now how do we get from where we are to where we should be? That is where the plan comes in. At the end of my first tenure, we had scored 60.8% (B). That tells you that we are honest with ourselves.
We should not forget that Covid 19 hit us in Nigeria in March 2020. Covid took us away from everything we had planned. If we had added Covid to it, our major achievement would be how we contained Covid 19 and that accounts for a lot. So, it has been a very interesting journey.
Your staff strength is about 4,000. So, how have you been able to cope with the ‘Japa’ syndrome – with many Nigerian nurses and doctors leaving for other parts of the world?
I think when we drew the second plan, we stated it there how we are going to handle the “Japa” syndrome. Our objectives under staff satisfaction in the second plan, 2021 to 2025 was to maintain a highly motivated workforce and to facilitate robust staff training in a conducive working environment. The second is to prioritise staff retention.
To develop a strategy to retain existing staff, we came up with plans for attracting high valued professionals that are willing to work with us. We have lost a lot of workers, especially nurses. Even four of my office workers have gone. Not just doctors alone, medical scientists, physiotherapists, operational therapists, in fact those ones have all left. Two resigned yesterday stating they are going abroad. We anticipated it. The advantage we have is that UBTH is located in a big city as a lot of people in Edo State and other states want to work and live in Benin City.
It is a miracle that our staff are still highly motivated to work. We are training at an institution. We train doctors, nurses, we train all cadres of medical staff, so that helps. The doctors in training are completely useful. Nurses on Interns are completely useful. We are the first hospital to approve internships for nurses. When they finish from their universities, then nursing was a new programme in universities. What we did was we tried to employ or accept as many as possible from that cadre of staff.
Sometimes in medical care, what you need are a few specialists and many young ones to do the running around. That is what has been helping us. Most of the younger ones under the supervision of the older ones which are now very capable are the ones really running this hospital. So, that blend of experience and youthful enthusiasm has really helped us. Luckily this current federal government, President Bola Tinubu has begun to address the issue of manpower shortage in teaching hospitals.
To recruit, the approvals that we need usually go through different offices. Last year, it took us 1½ or 2 years to get approval and the slots were not even many. Altogether, it was 200 or 199 slots. Now the new government has canceled all that and only the federal Ministry of Health’s approval is enough. The irony now is that despite the fact that we are short in staff, there are lots of doctors and nurses that are still out there looking for work.
There are lots of doctors looking for an opportunity to get into the teaching hospital setting so as to be able to do their residency programmes. Yes, there are vacancies, but because we don’t have the approval to recruit, then we can’t take as many as we want. But going forward, we will have a meeting with the Honourable Minister and they have assured us that the approvals will come faster now.
UBTH should be famous for some areas of specialties, what are they?
UBTH is a multispecialty hospital. We are specialised in doing everything that has to do with medicine. In New Benin Care (Natal care), we have the first and biggest natal care unit in Nigeria. That is the special baby care unit. I don’t think there is anyone as big as that in this country. It is almost full with new born babies. We are capable of looking at babies that are 500grams. We have nurtured babies to live from 24 weeks. Normal pregnancy is 36 weeks, so that is a 6 to 7 months baby or pregnancy. Historically it has been happening here, we are doing better now.
We are the first still the only teaching hospital in Nigeria that has done IVF. We have stopped now, but we did about 4 before we stopped. No other teaching hospital has ever tried IVF, that is test tube babies. We are the pioneers of it in this country. We are still the best in the country that is public hospitals not private hospitals because private hospitals are doing better things now I will concede. But in terms of IVF there is no other federal government hospital that has better IVF services than UBTH in this country. We are one of the pioneers of Minimal Access Surgeries. What we call keyhole surgeries. At UBTH for some surgeries, we don’t cut you open, we just key into you through your navel for example and remove your appendix without doing open surgery. We have been doing this for 2 years now, that is minimal access. We do it regularly here, even the gall bladder can remove it. If we remove it today you can go home today or maximum the next day, appendix same thing. Same thing with brain surgeries, we also have keyhole brain surgeries. If we are to operate on the brain you know, normally we will open the skull and use a drill but we no longer open the skull we pass through the nose. We are one of the leaders of Minimal Access Surgeries in Nigeria.
Same thing with urology. That is, the urinary tracks and the kidneys. We also have … machine. We are the pioneers, First, in the country to start. Where people have stones in their kidneys or urinary tracks, we call it kidney stone. To remove it, you have to open the person, open the kidney to bring it out. But now, we don’t do that much anymore. We use ultrasound and it shatters it then it comes out as debris. If you ask me to narrow it down, I will talk about natal care services, IVF services, Geriatrics. Geriatrics is the care of elderly persons in Nigeria. There is no other hospital aside from UBTH that has a special unit and ward for it. They are doing a fantastic job there.
Now we are training Elder Care Aides. These are the people that are trained to look after the elderly ones. All the good work we are doing in the ward here, we bring an old man here, we treat the person and the person goes back home into the same maltreatment, abuse, poor handling. The problem is the people taking care of them are not trained. So, we have taken it upon ourselves to train these people. We call them Elder Care Aides to take care of these people.
Our trauma care is probably the best in the country. We are level one trauma care center, emergency care both adult and pediatric are top notch and it is not just me it is the vision of our forefathers to set up an extensive emergency care unit where everything is a hospital within a hospital. It should have everything. It has its own city scan, ultrasound, lab, pharmacy, physiology therapy, centre and wards.
People that set up this hospital were not thinking of Nigeria alone because Benin is cited across borders, across networks of highways. There has never been training for emergency doctors in Nigeria. We were second after UCH in Ibadan to trained emergency doctors. They were the first to be accredited. Now we have seven to eight doctors who are dedicated to emergency care. We also have a lot of collaborations with teaching hospitals abroad too, who come around. We have had several white doctors who have come to work with us in the emergency care unit from abroad.
There is so much we are doing and so much we are yet to do. We are also known as the Centre of Excellence for Cancer Care. Our cancer treatment machine has been down but luckily, we just had a meeting with the Federal NSIA (Nigerian Soviet investment Agency) . They are giving us a new machine, hopefully by the end of this year or early next year we will have a new machine.
In March 2020, the Nigerian economy was shut down because of Covid-19. Do you think Nigeria’s healthcare system is adequately ready for an incident like Covid-19?
What I can say is that, we are better prepared now than we were in 2020. For example, at UBTH, we didn’t have an isolation ward. In our ICU, we didn’t have ventilators, we did have top notch equipment. So, one cannot totally compute the implication of a new virus but if it is with the same severity, as the one that happened before, all I can say is that we are better prepared now. We were not as prepared last time but we didn’t do that badly.
In spite of our better level of preparedness, Lassa fever and cholera still claim the lives of the people frequently. Why are we still having these incidents?
We need to understand that health and healthcare is not for hospitals alone. There are what we call determinants of health. The way you live, your environment, if you don’t maintain your environment, all these things will happen. The way we live in Nigeria predisposes us to all these sporadic and frequent outbreaks. So, the hospital is the terminal point. Before it gets to the hospital, there are other things we ought to be doing. Even our waste disposal practices, the way we control vectors (mosquitoes). I don’t see mosquitoes in my house because I don’t allow water to gather in my house. When I was younger, there were these environmental officers. Hospitals should be for those that after they have passed this level, some people must still fall sick. We have not got that whole concept right. Lassa fever is carried by rats, don’t you feel ashamed that you still have rats carrying diseases? If we know there is a rat in our house carrying disease, you want to tell me that as human beings with all the intelligence we have, we cannot control rats.
Raising IGR is one of your targets. In a situation where a cesarean operation is supposed to be a very common thing to do, people still go through a lot paying for it. How do you see this with the situation of what is going on in Nigeria?
I usually tell my people that UBTH was not set up to make profit. We were set up to recover costs. The cost we recover is the cost of materials we use because the government pays our salaries. For example, we don’t worry about how we will pay salaries. The issue is it is not about you alone, it is about the next patient, that is, sustaining the service for the next patient. If I am taking something from here to treat your wife, I should be able to replenish that thing. I will go to the market because the government doesn’t give us money to do that. There is no way UBTH prices will be more expensive than other hospitals but we also balance the need to sustain the services. It doesn’t make sense that you come to the hospital then we write something for you to buy from outside. I stopped it when I came on board.
In other hospitals till today, as you are entering the hospital they tell you to go and buy gloves. You buy your own gloves and keep, buy cotton bud, buy a syringe. But that compromises care because when you come and I say go and buy gloves and the doctor doesn’t have the gloves to treat you, the doctor will not touch or treat you until you get those items. The whole concept compromises lives. We don’t give anyone an excuse of saying I am not treating this patient because I don’t have this. What we also plead is that people should understand that these things are not given to us free. Our suppliers, if we don’t pay them, they will not give to us again. So, what we do at UBTH is cost recovery and not profit making.
Let me give you an example, there is a surgery we do here in UBTH that costs N150,000. Out there, it is N3.5 million for the same surgery. Some of those hospitals collecting that huge amount don’t have better doctors than UBTH. In fact, it is even our doctors here that go there to do it. People don’t see these things that we go through to make it affordable for them. The increase in IGR is not from an increase in costs that we charge, it is from an increase in utilisation and efficiency of the system.
Are there organisations, like NGOs in Nigeria that support students studying medicine at UBTH as is the case in developed countries?
As I said, we planned to raise funds from external sources in order to fund all our goals. When I say external, I mean external to the hospital and to the government. We visited a lot of people. So, it is in everybody’s hands to ensure that UBTH is working well. That was the message I was carrying then. I wouldn’t say I have too many success stories. I began to see that our people are not really that philanthropic in nature; they only pretend to be. If there is no political objective or motive, they don’t do things for free like that. That is my experience here. I am sorry to say, they have very little support for the local community.
The Heineken Africa Foundation in Amsterdam gave us a grant. I can’t remember the exact amount, to upgrade and buy equipment for our neonatal unit. If you go there now, you will see some of the equipment, the modern incubators in there. There is no other hospital that had it then. Based on that we also talked to some of our doctors that graduated from here living abroad. One of them and his mother sent in some items. The doctor, whenever he is in the country, comes to UBTH to teach our people here and donate things. He gave us an incubator in addition to the one given to us by the foundation.
We also got a grant from NLNG for the upgrade of our ICU. There are others as well.
