INVESTIGATION: Why Lagos govt’s N5.6bn cardio-renal centre remains grounded, in terrible state
The Lagos State Cardiac and Renal Centre, Gbagada, a multi-billion naira health facility, is presumed to be one of the signature legacies of the administration of former governor Babatunde Fashola, neglected by his successor, Akinwunmi Ambode.
But unlike others, the abandonment of this facility has come with a huge cost, especially with the rising statistics of Lagosians, and indeed Nigerians, who are battling with various cardiac and renal diseases.
PREMIUM TIMES’ investigation has revealed real reasons the ‘super tertiary hospital’ has been grounded since June 8, 2016, when the concessionaire- Renescor Health LLP, pulled out of the management deal.
The facility, according to the state’s ministry of health, was built at a cost of N5.6 billion. But since its contract was awarded in 2008, it had been mired in controversies over allegations of overinflated quotations, poor civil work, among others.
The infighting involved some key stakeholders including Mr Fashola, Mr Ambode and the promoter of the contractor- Deux Project Limited – Tunji Olowolafe, among others, which further compounded the messy situation.
Though skeletal services had commenced at the facility in 2014, it was officially inaugurated on March 18, 2015, few weeks to the expiration of Mr Fashola’s second term in office. It was aimed at halting the rising cardio-renal cases, its attendant costs of capital flight and the challenges Nigerian patients were going through to access care abroad.
What the statistic was
At the beginning of the new millennium, the World Health Organisation (WHO) announced that non-communicable diseases (NCD) would in no distant future account for more than 75 per cent of deaths worldwide.
It had estimated that by 2015, about 20 million people would die from cardiovascular diseases, representing 30 per cent of total world death.
In Lagos State, which was already assuming the status of a megacity, the signs were ominous early enough. In 2012 alone, the state’s secondary and tertiary health institutions were reported to have managed 22,785 hypertension cases. By 2013, the number had jumped to 23,203.
The state’s immediate past health commissioner, Jide Idris, had once complained about what he termed pressure on the state’s meagre resources by the piling lists of patients seeking government’s assistance to be flown abroad for treatment of such cases.
For instance, in 2013, a Nigerian singer and producer, Babatunde Okungbowa, popularly known as OJB Jezreel, was flown to India for a kidney transplant. His first wife, Mabel, had donated a kidney while philanthropists, especially artists, contributed the required money to salvage the embattled star.
According to one of his childhood friends, who craved anonymity, upon OJB’s return home, he required constant and affordable check-ups in a specialist hospital.
“However, due largely to the poor expertise at some Nigerian hospitals he visited, his condition began to deteriorate again,” the source said.
In 2012, about 18,000 Nigerians, representing 47 per cent of Nigerians who visited India, had done so for medical reasons with an estimated cost of N41.6 billion in foreign exchange.
Research by the British Broadcasting Corporation (BBC) had also stated that in 2013, Nigerians spent $1 billion on foreign medical trips for the treatment of various forms of illness in different countries abroad.
Breaking down the statistics further, Price Waterhouse Coopers, in its 2016 report, said of the $1 billion spent annually on medical tourism by Nigerians, 60 per cent goes into the treatment of chronic diseases in key areas of oncology, orthopaedics, nephrology and cardiology.
Arresting the situation had informed Mr Fashola’s decision to establish the centre.
Early signs of fraud
In 2008, when the contract was awarded to Deux Project Limited, there was no evidence of competitive bidding processes.
Speaking on the procurement process leading to the contract award, a source at the state’s ministry of health who requested not to be quoted, said the procurement act had not been fully domesticated in the state then.
The source said; “What was in vogue was just the tenders’ board and cabinet’s approval. Deux Project Limited. since the days of former governor Bola Tinubu, was almost the state’s sole contractor, especially in the health sector.
“It constructed and equipped all the maternal and childcare buildings across many general hospitals in the state. It also built the Bola Tinubu Diagnostics, a private diagnostic centre located within the Lagos State University Teaching Hospital (LASUTH), Ikeja, and its burns unit located inside the general hospital, Gbagada.”
Apart from construction and equipment, PREMIUM TIMES also learnt that the company was also in charge of facilities’ maintenance at the various public hospitals in the state.
“So at the time, it was not surprising that the same company was awarded the construction of the centre which was meant to be the first of its kind in West Africa,” the source added.
Meanwhile, according to the state’s health ministry, apart from the purchase of equipment and installation, the building construction was originally awarded at the sum of N1.4 billion. But soon, and without cogent reasons for variation, an increase of N796 million, more than half of the contract award cost, was approved and paid to the contractor.
However, neither the government nor the contractor has been able to give reasons for such variation. Though government through the health ministry promised to make the reasons for such variation cost available to our reporter, it did not, after many weeks.
The contractor on its part bluntly refused to talk, saying it had, and still has nothing to do with the project.
For the equipment of the centre, which was handled by the same contractor, N3.4 billion was approved and paid.
Meanwhile, a similar facility, facilitated by one of the America-based Nigerian medical expert who had pulled out of the Lagos cardiac and renal centre, Kamal Adeleke, had cost far less.
Following challenges posed by poor infrastructure and managerial lapses, Mr Adeleke had in 2014 pulled out and joined others to establish Tristate Heart and Vascular Centre, in partnership with Babcock University, Ilishan-Remo, Ogun State.
In 2016, while conducting journalists round the facilities located within the university’s campus, Mr Adeleke explained that 75 open heart surgeries had been conducted at the centre, with a 98 per cent success rate. He said the whole centre had cost N2.4 billion, adding that the bulk of the money was spent on equipment, infrastructure and consumables.
In 2017, two of Mr Adeleke’s trainees at the hospital, Ifeoluwa Adewoye and Mirabel Nwosu, were recorded to be the first set of cardiovascular interventionists trained in Nigeria, who performed a procedure known as cardiac catheterisation.
N5.6 billion facility defective
In spite of the huge resources spent, so many defects, including cracks in the wall, damaged machines, electrical problems, had been identified by the concessionaire.
In an exclusive interview with PREMIUM TIMES, the former chief executive officer of the centre, Babatunde Green, said the air conditions installed at the theatres were also found to be incapable of ventilating the installed facilities including N540 million worth catherisation machine.
“We also experienced a major power challenge, especially with the electrical earthing system. There were a whole lot of issues which we tried to salvage but we received no support from the state government,” said Mr Green, a professor and former managing executive at the Connecticut State-owned veteran hospital, United States of America.
PREMIUM TIMES learnt that installed elevators were also not ventilated, making it risky for patients to be transported through them to theatres. Also, out of 24 dialysis machines installed, only 17 were in good condition when the concessionaire took over.
A senior government official, who asked not to be named, also confided in PREMIUM TIMES that challenges faced by the project might not be unconnected with “Mr Olowolafe’s conflicts with former governor Tinubu, whose support had transformed the company’s fortune for good.
“Aside from other offences, Olowolafe was also against the choice of former governor Ambode as the successor to Fashola. He was fingered as one of those who oiled the opposition’s machinery against Ambode’s choice as the party’s candidate,” said the official.
PREMIUM TIMES could not establish those claims and Mr Ambode refused to speak on the matter.
PREMIUM TIMES, however, learnt, the contractor’s relationship with the state government, its major patron, was completely severed.
The government withdrew all existing facility management contracts being handled by the company and stopped further dealings henceforth. The company has since not remained the same with hundreds of its workers laid off.
Meanwhile, since 2016, when the concessionaire pulled out, apparently out of frustration, all the facilities, including two operating theatres, two heart-lung machines, two anaesthetic machines, blood and fluid warmers, cell saver machine and three intra-aortic balloon pumps, have continued to deteriorate as they have since been locked up.
Also lying fallow are two laminar flow theaters for kidney transplant surgeries, 19 critical care beds comprising five intensive care unit (ICU) beds, 10 critical care unit (CCU) beds, four recovery room beds, cardiac catheterisation lab, 64-slide CT scan machine, trans esophageal echocardiography machine (TEE), X-ray machines, ECG laboratory machines, ultrasound machines, among others.
It is also on record that barely one week after the centre’s shutdown, OJB on June 14 died, after his condition had degenerated due largely to poor management.
OJB’s wife, Mabel, who is very devastated by the development, refused to speak to our reporter. She has since taken over the care of her two kids, while the other two wives had reportedly gone their separate ways.
The situation is the same for many families whose breadwinners had succumbed to the sting of these chronic diseases.
During the commemoration of the 2018 world kidney day, the President of the Nigerian Association of Nephrology (NAN), Ebun Bamgboye, had told the audience that Nigeria was carrying the largest burden of kidney disease in the world.
As reported by the News Agency of Nigeria, Mr Bamgboye said; “In Nigeria, it is estimated that every year, the incidence of kidney disease is 100 per 1,000,000 population. The number of new cases of kidney failure we see every year in the population of 170 million is 17,000.
“If you put all the patients on dialysis across the nation together, they are less than 2,000, if 2,000 people are only on dialysis and 17,000 need it, when they don’t get it, they will die.”
He said in his St. Nicholas Hospital, one of the elite private hospitals in Lagos, about 120 new patients of renal diseases are recorded every year, with an average of 10 new cases every month.
Concessionaire, workers narrate ugly experience
Though the chairman of the board of Renescor Health LLP, Ladi Awosika, said he wouldn’t want to open an old wound, Mr Green, after weeks of being on his trail, reluctantly spoke to our reporter.
Similarly, apparently due to a backlog of unpaid salaries and allowances running to between six and eight months, many of the ex-workers at the centre rebuffed advances for an interview by our reporter.
A few of them, including Ridwan Akinrinade, a nurse who worked at the centre’s coronary care and high dependency unit; Femi Adewole and Lekan Oluwole of the account department, expressed how their hopes were dashed unexpectedly.
According to one of them, the centre’s opening in 2014 was such a big relief to many patients, and particularly the elites, including OJB and the chairman of premier lotto limited, otherwise known as ‘Baba ijebu,” Adebutu Kessington, who thronged the centre for checkups and other ancillary services.
To show his excitement, in March 2015, few days to the March 18 official inauguration of the centre, OJB had joined other patients, staff and stakeholders at the centre to mark the year’s world kidney day in grand style.
Hope dashed too soon
Speaking on his experience, Mr Green, who had managed the veteran hospital in the U.S. for 26 years until he was headhunted in 2015 to salvage the situation at the centre, said he had always wanted to return home to give back to a “country that gave me scholarship to study abroad.”
He blamed his ugly experience on the cold attitude of the Ambode-led administration to the centre.
He said; “My childhood friend, who was then the LASUTH CMD, Wale Oke, had convinced me of my need at the centre to salvage it. At the time, apart from managing a state hospital and teaching in a university, I was also on the advisory board of health to the government of Connecticut. I had also been part of the design of the Obamacare programme. So leaving all these to return home was a difficult decision to make.
“Former Governor Fashola’s words also lifted me. He said he wanted us to make the place suitable for everyone, regardless of status, so that if he was sick he would be proud to be managed at the centre. So I gave all within my power to ensure we ran a smooth system. But things didn’t work. When workers declared strike, I used my personal resources to pay workers, while my own salaries were not even paid for many months.”
Mr Green explained that he resumed work at the centre on November 1, 2015, and exactly one month after, the centre commenced 24-hour service. “I ensured that 20 of the dialysis machines were fully operational and got the dialysis fee reduced from N40,000 to N30,000. I had a plan of reducing it to N20,000 within my two years of operation because it is free in places like South Africa and the US,” Mr Green said.
Also speaking, the duo of Adewole and Oluwole said they regretted their experience at the centre.
“We staged protests, petitioned the government and even went as far as the public defenders’ office, but I can tell you that till date our monies remain unpaid,” Mr Oluwole told PREMIUM TIMES.
On his part, Mr Akinrinade said; “Enthusiastically I had left Reddington hospital in 2014 for the centre, little did I know that just because it glitters does not make it gold. During my 17 months stint with a team of expatriates, majorly Indians and Nigerians in the diaspora, I saw a waste of talents and resources.
“Professionals who were arguably the best available in the country at that time and expatriates left the employment due to frustration, and today, we are all scattered all over the world helping other economies.”
Renescor Health LLP plans ex-workers’ payment
But, few weeks after our reporter spoke to the concessionaire on the matter, ex-workers were requested to report to an office in Surulere, Lagos, to sign for payment of 40 per cent of their arrears.
The message, reportedly sent through a consultant requested them to come along with their identity cards and employment letters. But some of the workers, who spoke to PREMIUM TIMES, have queried the rationale for the 40 per cent payment, while they were asked to sign for full payment.
Ex-Governor Fashola reacts
Speaking through the chief press secretary during his administration, Akeem Bello, Mr Fashola said the former health commissioner, Mr Idris, would be the most appropriate person to speak on the matter.
Mr Bello, however, requested for a mail detailing issues to be responded to by the former governor, especially when the matter of the huge variation cost was raised.
But, rather than answering the questions as promised, Mr Bello’s response read as follows; “Thanks a lot for your revert with the questionnaire below after your initial contact and my suggestion that the most appropriate person to speak on the Project in question should have been the Commissioner for Health who served in the administration of Mr Babatunde Fashola SAN and also had the privilege of serving in the same capacity in the administration of Mr Akinwunmi Ambode.
“However, against the backdrop of the fact that a Government is essentially made up of institutions designed to endure and outlive the tenure of individual Office holders, I’d like to refer you once more to the institutions of the Lagos State Government statutorily entrusted with the responsibility of keeping records that should help answer the questions below as regards the Lagos State Cardiac and Renal Centre, Gbagada.
“In this regard, the Office of the Secretary to the State Government which supervises the Cabinet Office that keeps the records of the various State Executive Council decisions on the Centre and indeed other decisions will be your best bet.
“It may interest you to note that various Projects and Policies of the State Government at the period first receive thorough consideration at the State Executive Council level through Memos presented by Commissioners and Special Advisers before being approved and implemented. So enquiries for the appropriate exco records and a follow-up with the Commissioner(s) that presented the Memos then would be helpful to your investigation.”
Ambode declines comment
When our reporter called the chief press secretary to Mr Ambode during his administration, Habib Haruna, he declined to comment. He said the former health commissioner and special adviser on health would be in the best position to talk on the matter.
“I can’t tell you anything about that issue, my brother. Speak to those I just mentioned instead,” Mr Haruna said.
Meanwhile, the former health commissioner, Mr Idris, who served the previous three administrations in the same capacity, has evaded all opportunities to speak to our reporter.
In June when our reporter called, he agreed to speak and advised the reporter to call him as soon as he arrived Lagos from Abuja for the purpose of the interview. But as soon as the reporter landed in Lagos as agreed, Mr Idris’ phone number was never available for more than three weeks.
Sanwo-Olu steps in
In response to the freedom of information request addressed to the governor and other concerned authorities, PREMIUM TIMES learnt Babajide Sanwo-Olu, the incumbent Lagos State governor, was shocked by the development.
Thus, at a meeting held with the stakeholders in the health ministry on Monday, July 1, he mandated the officials to meet with our reporter and lay bare the facts of the matter.
On Tuesday, July 2, a team of officials of the ministry comprising the director of healthcare planning, research and statistics, Emmanuella Zamba; head, project monitoring and implementation, Abiodun Oduwole, and deputy director, public affairs, Tunbosun Ogunbanwo, said the government was committed to reviving the project, and so would not want to dwell on the past.
According to them, challenges posed to the contractor during the civil work had caused delay for the installation of the imported equipment.
“The delay led to the expiration of warranty on those equipment, and the unforeseen circumstances led to the breakdown in the public-private partnership initiative because it was a learning curve for all of us,” said, Mrs Zamba.
Meanwhile, Mr Sanwo-Olu, during his visit to the victims of the recent Ijegun fire incident at the burns unit at the general hospital, Gbagada, inspected the centre.