July 30 - August 5, 2017 Abuja and Uyo, Nigeria Conference on World Class Healthcare System in Nigeria A Perspective in Education, Health and Medicine Conference Summary This summary captures a six-day (6) programme that included healthcare facilities assessments, presentations, workshops, interactions with key-opinion leaders in the Nigerian healthcare system, interactions with business and community leaders. These interactions sought to understand key areas of focus and the best approach to creating a sustainable healthcare system where Nigerians can Live, Work, Play, Learn and Heal. The event brought together over 120 healthcare providers, business executives and members of the community from Nigeria and Germany to share their experiences and to address current and future development challenges on both demand and supply side of healthcare delivery system in Nigeria. It also provided a valuable networking opportunity and set the stage for further cooperation between Nigerian and German educators and healthcare providers. It provided an opportunity for the visitors from Germany to traverse Nigerian cityscape, townscape and village-scape which enabled them to experience why Primary Healthcare facilities in Abuja was significantly different from those in Akwa Ibom State. The conference began in Abuja with a visit to the German Ambassador to Nigeria- His Excellency, Ambassador Bernhard Schledgheck, followed by a visit to three hospital facilities in the Abuja area and an interactive discussion with leaders of UNICEF Nigeria. The team preceded to Uyo the capital city of Akwa Ibom state where four more hospital facilities were visited. A visit to the host community provided a much needed relaxation and a unique experience to the visiting team of professors, advisers and consultants which marked a crowning moment for their visit. It concluded with a set of presentations of real world cases describing noteworthy challenges and issues relevant to the conference theme, specifically on: women health issues, the quality of life in Niger Delta region, challenges of cancer and other oncological cases, under five morbidity and mortality, implications of oil and gas exploration, investment resources in health and education, UKE capability for world class health and ethics for sustainability. The key take-a-ways from the conference and visits included confirmation of high prevalence of communicable and non-communicable diseases, the high demand for healthcare services at all three levels (primary, secondary, and tertiary), government as the dominant supplier of healthcare solution at all levels, aging and poorly maintained and equipped healthcare infrastructure, inexperienced and overworked healthcare workers, lack of health insurance program for the general public to access and afford healthcare (only Federal employees are covered under the National Insurance Health program), cash only payment method before services are renders. Details of deliberations on these topics and other activities are described in the daily segments below. Sunday, July 30, 2017 UKE professors travelled to Nigeria for the first time and arrived at the Nnamdi Azikiwe International Airport, Abuja. Sunday was a highly anticipated day because of the arrival of the following three UKE
professors: Prof. Dr. Dr. med. Uwe Koch-Gromus, Dean of the Medical Faculty of the University of Hamburg (UKE), Germany. Prof. Dr. med. Ansgar Wilhelm Lohse, Vice-Dean, and Chairman of all the Medical Departments of the Medical Faculty of the University of Hamburg, (UKE), Germany Prof. Dr. med. Frank Norbert Riedel, Foremost Pediatrician, Former Medical Director of the Altona Children's Hospital, Hamburg, Germany. Upon arrival, they were met by Dr. Ikoidem Ibanga, who volunteered to arrange and manage the team s stay in Abuja. Dr. Ikoidem escorted the professors to SV CHROME hotel where they were greeted to a dinner reception along with other team members. The above is a picture taken during the arrival of the team at SV Chrome hotel. In the picture from left (L) Dr. Foster Ndubisi, Dr. Emmanuel Umoh, Mr. Armin Huttenlocher, Dr. Isaac Amos, Prof. med Frank Riedel, Mr. Kenneth Etokakpan, Prof. med Ansgar Lohse, Prof. med. Uwe Koch- Gromus and Dr. Ikoidem Ibanga. Monday July 31 st 2017 - The day started with a meeting with the Ambassador of the Federal Republic of Germany to Nigeria, H. E. Ambassador Bernhard Schlagheck in the premises of German Embassy, Abuja, Nigeria. The team was received by the Ambassador who greeted everyone and proceeded to deliver a brief speech about the synergy between T&G and UKE collaboration. He remarked that T&G has discovered what many other Nigerian companies are yet to understand. That instead of investing money in Nigeria, most Nigerians tend to put their money in places like Dubai. He indicated that the effort by T&G and UKE will have mutual benefits for both countries, Nigeria will derive the benefit of a world class healthcare system, and Germany will gain knowledge of diseases they have not seen before. Dr. Isaac Amos responded by appreciating the Ambassador for accepting the courtesy call and his encouraging statements towards the project. The big take-away here was the overwhelming support that the Ambassador showed towards the project and his willingness to help see the project to fruition. The highpoint of the courtesy call was marked by the Ambassador witnessing the signing of the Memorandum of Understanding (MoU) between T&G and UKE to collaborate on the Thompson & Grace Medical City Project. Dr. Isaac Amos signed on behalf of T&G while Prof. Dr. Dr. med. Uwe Koch-Gromus signed for the UKE. The MoU signing was also witnessed by Prof. Dr. med. Ansgar Wilhelm Lohse, Prof. Dr. med. Frank Norbert Riedel, Mr. Otobong Amos, Mr. Ekemini Amos, Dr. Emmanuel Umoh, Dr. Forster Ndubisi, Mr. Armin Huttenlocher, Dr. Idonesit Sandy Udoh, Mr. Kenneth Etokakpan and an embassy staff. Next, the team visited the National Hospital at Abuja. We met with the Director of Clinical Services Dr. Oluwole O. Olaomi. Dr. Isaac Amos introduced the team and stated the reasons for our visit - to learn from your challenges, experiences in the delivery of healthcare services to Nigerians; and to create a platform to share knowledge between the two countries.
The director described the National Hospital as operating on a system without a system. If you want to start anything great, start from Nigeria because everything we need resides in our archives. Basic challenge is powerelectricity. We have 3 of 500KVA generators to run the operations. We use two trucks with 66,000 liters (sixty-six thousand liters) of diesel to run the facilities 24 hours. The critical areas are supported by UPS to ensure continuous care. Another problem area is the frequency of voltage fluctuation. Water is available and safe in Abuja, the hospital has 5 boreholes. The pictures inserted in this paragraph were taken with staff members at the National Hospital, Abuja. Payment for service is mainly cash. Insurance is for Federal government staff (approximately 5% of the population of employee). Even this insurance is not secured because the intermediaries may decide not to pay the hospital for a very long time. Policy requires the hospital to provide care for patients; the hospital has to find a way to collect funds thereafter. To pay, patients must be threatened before they can comply otherwise they will walk away leaving debts of millions behind. The manager shared that payment in private hospitals will be different because some of the people unwilling to pay do travel abroad and pay for services. Currently, the hospital, pharmacies, laboratories are supported by the revolving funds (seed money) with a mark-up of about 10% based on volume to survive. One of the biggest challenges is the Internal Displaced Persons (IDPs), take advantage of the hospital as indigents for free services. The hospital is staffed with over 100 consultants and 250 resident doctors. Available infrastructures and patient load make it attractive for doctors to work at this hospital. The medical program is six years. Junior resident 3 years. Neurosurgeon program is 8 years. The hospital works with a Gogola Medical School to absorb the student doctors for residency. The wards are made up of four categories: 6 bedded rooms that charges NGN30,000.00 4 bedded that charges NGN50,000.00, 2 bedded charges NGN75,000.00, and private rooms requires a deposit of NGN200,000.00. Private intramural practice is also encouraged for doctors to bring their patients and use the facilities for a fee after operating hours. These prices are set by the hospital based on what the hospital spends. After the meeting one of the staff members gave us a tour of the hospital including pediatrics ward, reception, registration area, adult ward and other facilities. At UNICEF we are received by Dr. Garba Safiyan the Healthcare Specialist and Dr. Modibo Kassogue, Immunization Manager. The two representatives described their role in trying to help the Ministry of Health increase childhood immunizations and thereby reducing infant mortality in the country. They informed our team that currently the average rate of immunization in the country is about 16%, and that some regions are as low as 6%. They discussed the problems to be routed from both the demand and supply side of services. On the demand side, lack of education, information, and cultural believes were key factors. The supply side factors were inadequate funding, lack of qualified professionals, negative political influence, poor communication, lack of equipment and transportation to communities. The UNICEF team stated that any group needing to help must begin with the establishment of Primary Health care Center (PHC OR PHF) facility that is networked with other facilities, locations and regions. They also stated their willingness to work with any team to ensure the supply of adequate vaccines and other consumables. UNICEF s visit provided noteworthy opportunities for a follow-up visit. Tuesday, August 1, 2017 - Our next visit on this day was to the Primary Health Center at Kuchingoro, Abuja. Here we were received by the Community Health Worker who provided tour of the facility. The team observed pregnant women and children being processed for clinical check-ups and immunizations. We observed health monthly record of statistics that ranged from 160 patients in January to over 700 in June 2017 period. While power is an issue for most healthcare centers in the country, this center is
supported by Solar power in the day and diesel generators at night. There are two resident doctors available to support the center on rotating basis. The center is also networked for referral with the National Hospital, Abuja and the University Teaching Hospital, Gwagwalada. The take-away from this Primary Healthcare Center for all of us was that it was well equipped and managed to support all the key functions for family medicine and disease control. In the Picture is Prof. Dr. med. Frank Riedel talking to nursing mothers at the Health Center. Although it was along ride to the University of Abuja Teaching Hospital, Gwagwalada, the experience of touring many of the facilities and conversing with specialists was very beneficial. We were able to witness long lines of patients waiting for primary care services, visited the pediatric ward, the laboratory, emergency room and gathered an opinion of a student doctor about the hospital. Generally, this hospital catered for the general population especially those with government sponsored insurance program-nhis. This was our last hospital visit in the Abuja region. From here the team drove to the Abuja Airport, where we boarded a Dana flight to Uyo, Akwa Ibom. Upon arrival at Uyo, the team went directly to the project site at Afaha Obong, Abak. At the site, visitors were received by workers and enthusiastic villagers around a hanger built to store project materials, equipment and office space for contractors. The site project manager Engineer Uduak Akpoho conducted a tour of the facility and showed the team some of the block molding activities in preparation for the first building soon to be constructed at the site. The team was driven to see the borrow pit, which will be part of the Specialty Hospital buildings location. After the tour the team was invited by the project Community Liaison -Rev Fr. Christian Dominic Usungurua to his compound for a meet and greet with the elders and other members of the community of Ikwek village. In the presence of the villagers, the three German Professors (Drs. Koch-Gromus, Louse, and Riedel) together with a TGMC German Adviser (Mr. Huttenlocher) were honored and decorated with Annang traditional attire. This act of recognition marked the highlight of the day as the foreign team was connected with the locals through a common bond of identity in dressing and sharing of wine and meal together. The day ended with the team checked in to the Le Méridien Ibom Hotel & Golf Resort, Uyo Akwa Ibom for diner and rest. Wednesday, August 2, 2017 On this day, the primary agenda was to visit several health facilities in Akwa Ibom State to understand health services offerings near the proposed hospital project. We visited a total of four facilities beginning with the University of Uyo Teaching Hospital (UUTH),Uyo. Here we were received by the Deputy Chairman of Medical Advisory Committee (DCMAC) Dr. Uwemedimbuk Ekanem and directed us to a conference room where we met and interacted with the Chairman, Medical Advisory Committee (CMAC, who also acting for the Chief Medical Director (CMD) Dr. Isaac Udo and other members of management staff. This teaching hospital is a 400-bed federal health institution providing tertiary level of health services. Dr. Udo shared with the visiting team some of the challenges faced by the hospital to include lack of
physical space to grow, lack of funding, equipment and human resources. After a series of questions and answers, Dr. Udo promised to work with the T&G team to enhance health services in the Nigeria. Dr. Ekanem conducted a tour of the hospital giving the team an opportunity to see the facility, equipment and interviewed some of department heads. Overall, this hospital provided the depth and insights about the level of care absorbed and the gaps that need to be filled. The second facility visited this day was the Community Health Center, Ikot Ebo, Etim Ekpo LGA. This was a primary healthcare facility that serves several villages in the local government and is approximately three miles from the T&G project site. The Local Government has responsibility for managing the operation of the center. We were received by the resident nurse, health-workers, the Community Chief and the villagers. After a welcome message read by the resident nurse, we had a tour of the small facility and observed extensive deficiencies ranging from dilapidated building, lack of electricity, and extremely poor hygiene for a health facility. The lack of electricity meant that vaccines obtained from the Local Government headquarters were managed with ice packs that rendered the vaccines wasteful if not used before the end of the day. The take-away from this facility was that this facility cannot support the health needs of the community because it appears abandoned by the owning entity (the Local Government Authority). It also informed our team the need to prioritize and expedite the building of a primary healthcare facility at the T&G site to provide services to the villagers and also establish a lasting connection with the community. Our third visit this day was the General Hospital, Ikot Ekpene, where we were received by the Hospital Medical Superintendent Dr. Etiese Bassey Okodi, the hospital Secretary and the Matron. Dr. Okodi briefed the team on the duties of the hospital as a secondary healthcare facility. He indicated that the over 200-bed hospital is networked with primary care facilities and that they receive and treat patients from all over the state. The hospital has a staff strength of about 80 health-workers including physicians. They collaborate with several NGOs for AIDS and other infectious diseases control. The last facility visited on this day was the General Hospital at Eket also called Emmanuel Hospital. This hospital is about one hour away from the T&G project site. It is also a 200-bed secondary healthcare facility that caters for general and family healthcare services. We were received by one of the interns who stood in for the Medical Superintendent, but were unable to answer the team s question. However, the intervention of another member of the staff helped provide the team with needed information on the challenges until the substantive Medical Superintendent walked in and provided the bird's eye view information bothering on lack of equipment, and the lack of skilled technical personnel. The team left the General Hospital to The Grace Garden Apartments at 22/23 Frank Akpan Street, Eket where we were received and served dinner by Mr. Ekom Udo, the General Manager of the hotel facility. This provided a much needed rest and relaxation after a long day of going from one hospital to another. The team ended the day back at the Le Méridien Ibom Hotel & Golf Resort, Uyo, Akwa Ibom to prepare for the next day s presentation and workshop sessions. Thursday, August 3, 2017 This was the day for thematic presentations by select members of the Healthcare Community, Business Sector, and Community leaders at the Le Méridien Ibom Hotel & Golf Resort, Uyo, Akwa Ibom. The conference was chaired by Prof. Abel Onunu of University of Benin who was very optimistic and welcoming about the prospect of a world class healthcare system in Nigeria and encouraged all participants to contribute towards its success. This day also was highlighted by the ceremony for the signing of Partnership Memorandum of Understanding (MoU) between T&G and UKE
previously done on Monday, July 31, 2017 t at Abuja. The ceremony was designed to allow the two parties to publicly exchange the signed MoU certificates before the people of Akwa Ibom State as seen in the above picture. The flow of the thematic healthcare presentations began with the vision and objectives for Thompson & Grace Medical City and the scope of the Conference on World Class Healthcare System in Nigeria presented by Dr. Isaac Amos. Dr. Amos stated that the vision of Thompson & Grace Medical City is to become the leader in health care, medicine, research and education in Africa. For this reason, Dr. Amos emphasized on the need for individuals, corporate organizations and governments to collaborate to create a sustainable healthcare system where Nigerians can Live, Work, Play, Learn and Heal. This clarion call set the stage for a presentation on the current Healthcare situation in Nigeria as defined by the prevailing Education, Healthcare Delivery System and their implications on Medical practices. The presenter outlined the trends using statistical profiles to illustrate the risks associated with communicable and non-communicable diseases in the country. Prof. Emmanuel Ekanem, the presenter, concluded that Nigeria is undergoing epidemiological transition, characterized by decreasing but still high levels of communicable diseases and increasing levels of NCDs. That the technical ability to manage the new emerging epidemiologic profile is rudimentary and that Public-Private partnership to create education and systems to manage this challenge is imperative. Providing a world class education and healthcare system requires significant amount of capital expenditure. Dr. Ini Urua of African Finance Corporation (AFC) presented on Capitalizing on Project Financing for Delivery of Education and Healthcare Infrastructure. He identified several project financing options available, but emphasized that a combination of equity and debt financing options are most common. He concluded by stating that AFC offers a unique value proposition as an Africa-focused international finance institution covering three complementary service areas: project development, financial advisory and principal investing. Dr. Udeme Ekrikpo Consultant Nephrologists presented the topic of Economics of Oil and Gas Exploration and the Health/Social implications on the Nigerian population. In his presentation Dr. Ekrikpo, showed how oil and gas pollution causes harm to humans through inhalation of volatile components of crude oil/ gas, dermal (physical) contact with crude oil, ingestion of contaminated water, and ingestion of contaminated food. Some of the complications of oil/gas in the human systems were listed as: Pulmonary usually acute, Bronchospasms (may require bronchodilators), Chronic obstructive airway disease, Cardiovascular Increased risk of hypertension in cross-sectional studies, Renal Higher serum creatinine levels in chronically exposed individuals, Acute kidney injury in high concentration exposures, Hematologic Decreased red and white blood cell counts, and Neurologic confusion, headaches, polyneuropathy, lethargy, tremors. A presentation on business sustainability, the standard of living index and the healthcare system was made by Mr. Nsikak Ekure. The presenter emphasized the need to ensure community buy-in and collaboration with government entities to ensure that competitive feelings are stemmed down or eliminated He spoke on the need to ensure that there is adequate and affordable demand for the planned healthcare facilities and services. He stated that the benefits of a sustainable business include but not limited to: Saving money, boosting of market share, creating of green-collar jobs, and attracting/retaining employees. To sustain the Medical City project Mr. Ekure recommended that emphasis must be placed on balancing environmental, social, financial risks factors with business opportunities. The subject of understanding women health issues and the level of complications in the Niger Delta, and Africa was delivered by Prof. Saturday Etuk, Professor of Obstetrics and Gynaecology. He categorized women health issues as a spectrum, ranging from Pediatric gynecological issues to adolescent sexual and reproductive challenges, and peculiar problems of reproductive aged women through to the problems of post-menopausal women. Dr. Etuk
highlighted several women health issues common among Niger Delta women. Some of the issues are rotted in unhealthy sexual behaviors which results in high rate of STI s including HIV/AIDS, unwanted pregnancies, unsafe abortions and its complications. After taking in a great deal of challenges from the aforementioned presentations, Prof. Dr. Dr. med. Uwe Koch- Gromus, Dean of the Medical Faculty of the University of Hamburg (UKE), Germany introduced UKE, its global experiences and capabilities to provide a World Class Medical System for Thompson & Grace Medical University and Thompson & Grace Specialty Hospitals in Akwa Ibom, Nigeria. Prof Koch highlighted UKE s capability to include 80 interdisciplinarily working clinics and departments, 9,600 employees, of which 2,400 are doctors and scientists, 3,100 therapists and nursing staff and a 1,571 beds hospital. He also listed the vasious medical departments, the medical curriculum and the reserach capability of the university as key to deliverying successful Medical Univerity in Nigeria. He ended by stating that a team of nine doctors have signed on to work on the T&G project in areas of collaboartion to include: Student exchange program (imed), Rotations for residents, Scientific collaborations, Health Care Research, Neuroscience, Cardiovascular Research, Immunology, Hepatology, Oncology, and Hospital Management / Process Optimization. The next presentation was an introduction of Department of Paediatrics in UKE, its global experiences and capabilities to provide a World Class Paediatric Program for Thompson & Grace Medical University and Thompson & Grace Specialty Hospital in Akwa Ibom, Nigeria. This presentation was made by Prof. Dr. med. Frank Norbert Riedel, Foremost Pediatrician, Former Medical Director of the Altona Children's Hospital, Hamburg, Germany. In his presentation, Prof Riedel laid out the problem of under-five mortality, the causes and how UKE plans to tackle the problem through T&G medical education and hospitals. That the UKE capability will be harnessed through consultation and support in actual planning of building and structure of MCC, Primary Health Care on construction area, Start running of medical service, Education and training of personnel, Pediatric Curriculum of Medical School, Introducing specifities in care, Scientific exchange and research cooperation and Regular consulting Friday, August 4, 2017 A courtesy call was made to the Akwa Ibom State Commissioner for Health- Dr. Dominic Ukpong. Dr. Ukpong and his ministerial staff received the team as seen in the picture in left and commended the team for their sacrifice to bring superior and sustainable healthcare program to the State of Akwa Ibom. The UKE team proceeded to fly back to Germany after the visit. Conclusion: A journey of collaboration between two entities with common interests sealed by a common memorandum of understanding and witnessed by a highly esteemed Ambassador of Germany to Nigeria. A journey of curiosity to understand the compelling medical, health and educational challenges/issues in institutions, teachers, providers, students and the workers from Abuja to Akwa Ibom Nigeria. A journey that made it possible for the people of Ikwek village in Akwa Ibom, Nigeria to share their great tradition of leadership with visitors from the city of Hamburg, Germany with smiles and cheers. A journey that caused us to assemble for eight hours, discussed, questioned and shared knowledge on how to proceed towards a world class medical university in Nigeria. A journey that informed the team that beginning with a primary care facility will take T&G to its destined vision. Great journeys are those that are managed with measurable objectives UKE & TGMC are great with defined objectives. Next steps UCM visits TGMC for logistics and strategic concepts planning, stay tuned
REMARKS: Prof. Abel Nze Onunu, conveyed his gratitude to all participants, particularly session moderators, panelists and presenters in his capacity as conference chairman. He extended his thanks to the organizing committee, and Thompson & Grace Group for their efforts in creating an interactive discussion sessions to elicit ideas for a world class healthcare facility in Africa. Special thanks went to the guest Professors from the University of Hamburg, University of Calabar, University of Uyo and University of Benin. Additional remarks from the planning team went to all the healthcare institutions and staff for their time and support of the program - National Hospital, Abuja, University of Abuja Teaching Hospital, Gwagwalada, Primary Health Center at Kuchingoro, Abuja, UNICEF Nigeria, Abuja, University of Uyo Teaching Hospital (UUTH),Uyo, Community Health Center, Ikot Ebo, Etim Ekpo LGA, General Hospital, Ikot Ekpene, General Hospital, Eket and the people of Afaha Obong community. A special thank you went to the Akwa Ibom Commissioner for Health Dr. Dominic Ukpong, management team and members of his staff for granting the team a courtesy call, and for recognizing the value that Thompson & Grace Specialty Hospitals can add to the healthcare services in Akwa Ibom state. For additional information on the Thompson & Grace Medical City Project, go to www.tgmedicalcity.com This summary was prepared by the TGMC Project Management Office team. (It is, in part, based on notes recorded by Dr. Emmanuel Umoh, excerpts from several presentation slides and photo images captured by Andrew Okeleke s team during site visits). STRATEGIC PARTNERS: