11th July, 2014
Kazeem Ugbodaga
Cardiac and renal diseases constitute a growing health burden globally, with millions of people dying each year, according health statistics. Sub-Saharan Africa accounts for growing cases of cardiac and renal failure due to poor medical facilities to cope with the huge demand. Most cases of cardiac and renal failure cannot be treated in the country, with expertise sought outside to treat the few opulent people who can afford the high cost of treatment.
In Nigeria, cardiac and renal failure is a common phenomenon, killing many people. This is as a result of lack of a purpose built renal specialist centre in the nation to cater for the growing demands of hapless patients.
In Lagos, cardiac and renal failure, few years back constituted a burden. Most cases were treated outside the country. In a bid to address the issue of unavoidable death arising from cardiac and renal failure, the Lagos State Government decided to take the bull by the horns and build a Cardiac and Renal Centre in Lagos.
At a well attended state-wide diabetes and hypertension screening programme, 20 per cent and five per cent of clients had hypertension and diabetes mellitus respectively.
This gave rise to the construction of the Cardiac and Renal Centre at the Lagos State University Teaching Hospital Annex at Gbagada General Hospital, Lagos, southwest Nigeria. The state government, through the Ministry of Health considered it appropriate and timely to have a befitting cardiac and renal centre following increasing number of patients with end stage renal failure, periodic nature of the cardiac and renal missions limiting the number of beneficiaries as well as the need to conserve the financial resources currently being expended in the management of patients with renal and cardiac problems in foreign countries.
The facility which is designed to handle heart and kidney related disease also offers out-patient services, diagnostic services, ultrasound, CT scan, echo cardiography, stress electrocardiography, laboratory services, fluoroscopy, ocular investigation for complications from hypertension, diabetes and renal conditions, haemo-dialysis for acute and chronic kidney diseases with 24 dialysis machines, admission for all cardiac conditions that requires hospital stay, critical care in intensive care unit (ICU) and high dependency wards, cardiac catherization, non invasive cardiology, open heart surgery, renal surgery, nursing and diabetic services, rehabilitation services and corporate wellness programme.
The 67-bed centre sits on 2,317 square metres or 24,792 square feet of land. The design provides access to all floors by two bed lifts and a wide ramp which allows two trolleys to pass simultaneously. Fire/service stairways are provided at the side of the elevator and at the back of the building.
Contract for the construction of the edifice was awarded to Deux Project Limited at an initial cost of N1.043 billion on 22 September, 2008 while the project commenced in March 2009 with a one-year completion duration. The cost of the project was later reviewed with the addition of N796.059 million in 2011 bringing the total cost of construction to N1.839 billion.
The contract for the equipment of the facility was also awarded to Deux Project Limited at a cost of N3.389 billion, bring the overall total cost of the project plus equipment to N5.228 billion.
To manage the project, the Lagos State Government last week signed a Memorandum of Understanding with Renescor Health Limited Liability Partnership to run and manage the facility under a 5-year Operation and Management (O&M) concession renewable for another five years term, subject to satisfactory performance and mutual agreement of the parties wherein the proponent will provide all of the healthcare services and total facilities management required for the value-engineering Renal and Cardiac Centre.
The agreement takes in mind the establishment of a state government sponsored foreign capacity building for a minimum of four medical personnel; remuneration, via an annual concession fee of 2.5 per cent of net revenue and a 60 per cent share of net profit to the state government. N2.8 billion, which is 28 per cent of the revenue per annum, is projected for staff salary for the duration of the 5-year concession. The maintenance reserve provision of the facility is provided to the tune of N1.26 billion, which shall be jointly managed by the state government and proponent.
At the signing of the agreement last week for the take-off of the centre, Commissioner for Health, Dr. Jide Idris noted that the government considered it appropriate and timely to have a befitting cardiac and renal centre due to the increasing number of patients with end stage renal failure, decrying that cardiac and renal disease constituted a growing health burden globally, explaining that “there is what is called a triple jeopardy in the health sector, especially in Lagos and Nigeria which require efforts of stakeholders in state health system to address.”
“We have what we call double jeopardy but now it is triple jeopardy in the sense that we do not only have problems with communicable diseases, we are now having problems with non-communicable diseases, and the third one has to do with mental health. But this project is trying to address the major aspect of the non-communicable disease burden.
“Not only that, we also do know that these two disease burden jointly cause serious complications in people who have these problems; and once you have these problems, you have them for life if they are not properly treated,” Idris explained.
The Commissioner stated that government had over the years always earmarked as part of its free health policy quite a huge chunk of its budget to sponsor people abroad for various medical problems that could not be treated in the country where the needed expertise and facilities were not available, adding that these factors prompted the government to build the cardiac and renal centre.
“A copulation of these factors prompted the need for us to build facilities locally, find a way of staffing them locally to provide the needed services to treat people of these ailments, reduce the number of money we are spending to sponsor people abroad, and more importantly to build local capacity,” he added.
Idris also opined that setting up of the facility would help bring back home Nigerian medical specialist as a way of ‘brain gain’ to defeat the ‘brain drain’ phenomenon, lamenting that over the years, quite a number of indigenous medical personnel had left the country for greener pastures outside of the country due to lack of infrastructure and facilities with which they could exhibit their skills.
According to him, “we have over 2,000 specialists in the United States and a similar number in Europe and Canada. And this is one way of brain gain instead of brain drain, because if you establish a facility with the right equipment and infrastructure, we can use that to attract the specialists abroad back home where they can exhibit their expertise and at the same time build local capacity here. That was the basic underlining reason why we decided to embark on this project.”
He noted that the need to get a suitably qualified competent consortium that had the needed requirement to run the facility prompted the state to opt for a Public-Private Partnership, PPP, agreement through the office of Public-Private Partnership, adding that this aim resulted in the appointment of Renescor Health Limited Liability Partnership to run and manage the facility.
Commissioner for Finance, Ayo Gbeleyi said that the reason for opting for qualified competent consortium of medical professionals to manage the facility through a PPP initiative was due to dearth of appropriate competent staff in this environment and the highly specialized nature of the equipment and services to be rendered within the facility.
He said that the PPP office was quite convinced about the capabilities of the private managers, as they are expected to provide quality services in line with international best practices, promote medical tourism, provide training field to develop the capacity of the state’s own health personnel and facilitate a gradual paradigm shift on dependence on foreigners with the skill empowerment of local professionals.
The Managing Director of Renescor Health Limited Liability Partnership, Dr. Ladi Awosika commended the government for building the state-of-the-art facilities which he described as first of its kind in Sub-Saharan Africa apart from South Africa and Angola.
He stated that the Cardiac and Renal Centre has been built to very good specification that specialists that had signed up with the company attest to, adding that the centre has facility for tele-medicine which would make every procedure going on in this facility to be reviewed by colleagues anywhere in the world, thereby ensuring that training and cutting edge facility therapy would be available at the facility.
Awosika explained that Messr Renescour is made up mainly of Nigerian specialists who had been in the Diaspora and could not get a place to work in Nigeria, noting that when they saw what was on ground, they pledged to contribute their quota through the facility.
“As at today, we have about 200 Nigerian specialists who have signed on to be a part of this. Some of them have decided that it will not even be for money, rather they will take one or two weeks vacation to be at this centre to impart their knowledge and skills to the people of Lagos in particular and Nigeria in general,” he said.
Awosika noted that more facilities of the magnitude of the cardiac and renal centre is required in the state to be able to satisfy the demands of more than 21 million residents of the States and promote medical tourism in Lagos, pledging that his company would not let Lagos down.