Professor Thomas Agan

The chief Medical Director, Professor Thomas Agan, of University of Calabar Teaching Hospital, UCTH, and the Chairman, Committee of Chief Medical Directors of Tertiary Hospitals in Nigeria was interviewed on challenges facing teaching hospitals in the country.

You have been in office for about five years. We know that as an administrator you must have challenges, one of which is the issue of staff salary. How have you have been coping?

The truth of the matter is that the UCTH does not owe staff salary. In October, November and December 2016, we had a shortfall which was a national challenge. In fact, the first two hospitals to be affected were the Federal Teaching Hospital, Irua and the Federal Medical Centre, Yenogoa.
You are also aware that at the beginning of last year, the Federal Government reduced personnel allocation to Ministries, Departments and Agencies ,MDAs, by about 10 per cent and most of us who knew this told our staff that we were going to have shortfall and that they may not receive October salary. Some of them thought we were unserious. I was even blackmailed that I put their money in MMM, and I dont know what MMM means. I wont do that, you dont touch peoples money as they have wives and husbands who depend on them.
Luckily, the Federal Government corrected the shortfall because money was sourced and paid to all MDAs that had shortfall, including teaching hospitals. So when people say we ate their money, going around blackmailing us that we put funds in MMM, I look at them and  laugh because there is no truth in it. UCTH and most teaching hospitals  across the country are not owing staff salary.
What about salary and promotion arrears in  the university teaching hospital system?

Promotion arrears in the teaching hospital system date back to 2013 when IPPIS came in. The Federal Government has not been paying promotion arrears since 2013. In 2013, they made part, payment, promotion arrears for 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 have not been paid. Government has calculated it, it is in the budget office and all that is needed is for the Federal Minister of Finance to give 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 salary arrears and promotion, what of the area training of doctors- what has your administration been doing about it in terms of sponsorship?

When you talk of sponsorship, there hasnt been budgetary provision for sponsorship. At a time we were paying sponsorship from personnel allocation but we were stopped. For instance, if I am given N6 million to manage this teaching hospital- this overhead is  supposed to take care of diesel supply- a truck load of diesel of 40,000 liters is how much? It is almost N12 million. Then you talk of other things. You need to buy stationery, you need to do repairs, you need to maintain, and you need to do all kinds of things. The overhead cannot carry the head. So for now, we owe resident doctors sponsorship allowance and we are appealing to them to exercise patience, by Gods grace, government will take into consideration some of these things. Some of these things are things that if we look critically inwards, we can resolve.
Recently, you tried to do away with outsourced services in UCTH. Was it an internal decision or the decision came the Federal Ministry of Health?

The decision to outsource services is a government decision- some of the services being rendered by staff were outsourced. The staff affected include security personnel, cleaners, laundry. The implication is that a contractor will now bid and then recruit people to come and do those jobs. Unfortunately, something went wrong and since 2009 till date government has not been funding it. So, there 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 pay 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 expunged. So, we are owing part of 2013, 2014 and 2015. As I am talking, many of them have taken us to court while some have assaulted us physically, and some have even gone as far as assaulting our family members.
As of November 2016, we are owing about N229 million to outsourced companies. As Chairman of the Committee of CMDs, I have written to the Minister of Finance to authorize the payment because it is their right, not a privilege.
Lets talk about infrastructural development in  UCTH. Could you let us know how far it has been in terms electricity, the state of the theatre, the toilets and bathrooms?

When you talk about infrastructural development, it has been very slow because of the dwindling economy. Recession is affecting everything in this country. I can tell you that from when I took over in 2011, we had capital budget of about N600 million, out of which only 52 per cent was released. In 2012, we had about N400 million, out of this only 48 per cent was released. In 2013, out of about N400, only 38 per cent was released. So it has continued to dwindle.
This hospital was constructed in 1977 and, somewhere along the line, it was  abandoned and then hoodlums removed the glasses, the roof and everything. Well, we have moved in but it is not possible do what we should do. We couldnt develop because you can give what you dont have.
Besides infrastructure, electricity bill is one of our  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 a 515 KVA generator mounted inside the laboratory and it can supply electricity to the entire hospital. It is just that I dont like them to do that because it can break down easily. We also have a 500 KVA generator mounted at the theatre which supplies light to the theatre and some parts of the hospital. Recently we contemplated acquiring a 200 KVA generator only for the radiology department because the equipment there are very sensitive- they cannot withstand 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 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 from drug revolving fund or from anywhere, must go to the 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, not that they are not being paid. Sometimes I hear stories outside and they 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 fully. 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 of CMDs. Doctors allege that the committee is responsible for the crisis in hospitals. What crisis are they talking about?

The crisis the doctors keep raising is that the CMDs dont cooperate with them, they dont discuss with them. Every staff is staff and as a chief executive, you dont just come and open the books and announce on television and radio that government has sent you 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 need positions are the people who instigate crisis in 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.
The Minister issued a directive on the detention of patients following inability to pay hospitals bills. As the Chairman of the Committee of CMDs, what is your response?

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 dont have the money. Now we insist that anybody that comes must pay deposit unless the person comes unconscious, and they are paying. Nobody should deceive you that they dont have money; they will tell the public that they are being detained but they are not being detained by anybody.
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