Lagos State N5.6bn Cardiac and Renal Centre, Gbagada, with 24 dialysis machines remains in ruins since it was commissioned in March 2015 by a former governor of the state, Babatunde Fashola, to provide comprehensive treatment to patients with kidney disease. As the multi-billion naira centre remains grounded, PUNCH Healthwise investigations revealed that only three out of 28 general hospitals in the state operate with dialysis machines. JANET OGUNDEPO reports
At 6am on Tuesday, the feet of 28-year-old Justin Ikechukwu (name changed to protect his identity) and his elderly father, were the first few feet that trod the Dialysis Centre at the General Hospital, Gbagada, Lagos State.
But the previous night, sleep evaded his eyes as worry lines took over his brow.
Bringing his father, who was recently diagnosed with end-stage kidney disease also known as kidney failure to GH, Gbagada for dialysis from the Ikorodu area of the state was a task he braced himself for twice a week.
“My dad was transferred from General Hospital, Ikorodu to this place because they (GH, Ikorodu) don’t have the dialysis machine,” a tired Ikechukwu said.
Despite the early arrival, Ikechukuwu’s father was called in for his dialysis around noon.
The long wait time was due to many patients also being at the centre for their dialysis appointments.
Aside from the extended waiting time, Ikechuckwu spends over N20,000 to fuel his car every time he brings his father to the facility.
While at the hospital, he pays N43,000 for a dialysis session and could sometimes spend about N14,000 extra to buy required injections and hospital consumables.
Perhaps, if GH, Ikorodu, touted as “the busiest secondary facility in Lagos State” and the “most improved General Hospital in Lagos,” had a renal centre and dialysis machine, Ikechukwu would not have to spend over N70,000 each time his father needs undergo a dialysis session.
After spending over four hours at the centre, PUNCH Healthwise gathered that some patients came as far as Abule-Egba, under the Alimosho Local Government Area of the state.
Most populated city with 18 dialysis machines
Lagos State, Nigeria’s commercial capital and megacity, has the highest influx of persons with non-communicable diseases accessing public secondary health facilities.
Meanwhile, the World Population Review estimates Lagos’ 2024 population to be 16.5 million.
Furthermore, the Lagos State Ministry of Health’s website states that there are 28 state-owned secondary health facilities, “comprising General Hospitals, two standalone Maternal and Childcare Centres and the Accident and Emergency Centre.”
Two reliable sources disclosed to PUNCH Healthwise that apart from the Lagos State Teaching Hospital, only three general hospitals in the state have dialysis units and machines.
This implies that 22 secondary health facilities, aside from the five specialist hospitals (A&E centre and four Maternal and Child Care centres), do not have dialysis machines or a renal centre.
The three facilities with dialysis units are General Hospital, Lagos; Gbagada General Hospital, Gbagada; and Alimosho General Hospital, Igando.
Investigations by PUNCH Healthwise revealed that these three health facilities have about 11 working dialysis machines.
In all, the state can only boast of 18 working dialysis in its facilities.
PUNCH Healthwise reports that secondary facilities paraded as big general hospitals by the state including Randle General Hospital, Isolo General Hospital and General Hospital, Ikorodu have no dialysis machines and renal centres.
Consequently, hundreds of patients with acute and end-stage renal diseases flock to the three general hospitals offering life-saving dialysis.
But the renal centre rots away
Yet, the Cardiac and Renal Centre at Gbagada General Hospital, Gbadaga, Lagos built by the Lagos State Government and commissioned by former governor, Mr Babatunde Fashola, SAN, on March 18, 2015, is surrounded by weeds and overgrown trees.
At the commissioning of the CRC, PUNCH Healthwise gathered that the then Commissioner for Health, Dr Jide Idris, said cardiac and renal diseases had increased globally to a worrisome state, especially in Lagos and Nigeria which required efforts of all stakeholders to address.
The former governor, Mr Babatunde Fashola, stated that the CRC was a 67-bed facility spread over three floors and has a state-of-the-art cardiac care and renal centre with eight specialised out-patients clinics.
Fashola listed a Cathlab, CT Scan, four-bed intensive care unit, a molecular theatre unit, two theatre suites with laminar flow air–control, a central sterilisation and supply unit, a four-bed recovery room, echo lab, a stress test lab and 24 dialysis machines, as some major facilities at the centre.
He added that apart from offering specialist care to patients locally, the facility would help in reversing human capacity flight from Nigeria thereby turning a brain drain into a brain gain.
Fashola also said the centre would provide a comprehensive healthcare solution and services to patients suffering from cardiac and renal diseases at an affordable cost and reduce the rate at which Nigerians travel abroad for medical care.
Nine years after Fashola’s promises, the facility is yet to fulfil its purpose.
A visit to the facility showed a big red Building Sign at the entrance with the words, “Isolation Centre” written in white letters.
Plastic signs with the inscription, “CAUTION. ISOLATION AREA” and “NOTICE. ISOLATION AREA PLEASE PRACTICE UNIVERSAL PRECAUTIONS” were placed on the welded mesh and chain link fencing.
Opposite the CRC is a low-fenced shed housing lambs and rams.
Further down the lonely path of the CRC, is the hospital’s blood bank centre. Checks showed that part of the CRC was now converted to the blood bank.
Newcomers to the hospital would have a hard time believing that the abandoned building, fenced, gated and locked, was the CRC commissioned nine years ago.
At LASUTH
Further findings at LASUTH showed that there were three separate dialysis centres in the tertiary facility.
Investigations by PUNCH Healthwise revealed that there were five working dialysis machines at the Special Services Centre, and two at the Dialysis Centre.
However, the cost of dialysis is slightly different from that of GH, Gbagada.
PUNCH Healthwise learnt that while GH, Gbagada’s dialysis session costs N43,000, that of LASUTH costs N40,000.
However, it was gathered that the price was N36,000 before October 14 when the new price was introduced.
Further findings revealed that patients came in all the way from Ogun State and farther parts of the state to access care in the facility.
At Alimosho
At the Alimosho General Hospital, Igando, sources told PUNCH Healthwise that there were three working machines.
The fee for a dialysis session was N45,000, aside from the purchase of other hospital consumables and injections.
Findings also revealed that the hospital, due to the situation with electricity, could only run a batch of dialysis per day as the generator is turned off at 4pm.
Like Gbagada, Alimosho also attends to patients on an appointment basis.
Who needs dialysis?
A former corporate driver, Ismail Fatai, came out wearily from his over three-hour session of dialysis.
His relative and caregiver, identified as Iya Ibeji, went to his side as he sat on the bench of the waiting.
She lamented that because her relative missed his previous dialysis appointments, his stomach and feet had become swollen.
The N43,000 fee, coupled with other fees, was becoming burdensome to pay.
“He has started dialysis since July this year and we have spent a lot. We were told to come three times a week for the dialysis but where do I get the money from? We only come when the money is available.
“He can no longer continue with his job so we have to depend on funds we can get from loved ones,” Iya Ibeji said.
The struggle to get the fees is a herculean task for Fatai and his relatives.
But he is not alone.
PUNCH Healthwise learnt that many patients’ relatives also struggle to adhere to the required frequency of dialysis.
Some, it was gathered, have sold their lands, cars and other sellable properties to fund their relatives’ dialysis sessions.
A Consultant Nephrologist at the Jos University Teaching Hospital, Dr Zumnan Gimba, said dialysis was required for patients whose kidneys have failed.
He further explained that in some groups of patients, dialysis and treatment would help to revive the kidneys to normal function while persons with chronic kidney failure depended on dialysis to survive.
The nephrologist said, “A patient with acute kidney failure could have dialysis for a short time and then the kidneys could pick up. But for them, if the kidneys fail, you will need to do dialysis.
“The second group would be those whose kidneys have failed and have failed permanently. So we call them people who have chronic renal failure, end-stage kidney failure or end-stage kidney disease. These are people who will need dialysis to survive. Indeed, even for those who have chronic or acute, if the kidneys have failed, dialysis becomes perhaps the only means to survive. Otherwise, whatever it is that is accumulating in the body will just end up killing the person.”
To ensure persons in need of dialysis can access them when needed, Gimba stressed the importance of having dialysis centres in many places.
What happens if not dialysed?
Speaking on the implications of patients’ inability to regularly access dialysis, the President of the Nigerian Association of Nephrology, Professor Jacob Awobusuyi, said, “A standard prescription is three times a week for local maintenance dialysis. But the majority of the patients only go twice a week, many go once a week. So, they are being under dialysis and this is responsible for the reduction in the lifespan of those who are on dialysis.
“Many of them, almost 60-70 per cent of them, die within the first year of dialysis. Many of them get admitted to the hospital for various kinds of complications that are preventable if they have been on dialysis regularly. So, those are the major implications of being under dialysis.”
NHIS covers six sessions
Gimba emphasised the need for adequate insurance to cover the cost of dialysis as against paying out of pocket.
He noted that the National Health Insurance Scheme covered six sessions of dialysis, stating that persons with CKD were not covered.
“They also are clear that they don’t cover dialysis for somebody who has chronic kidney disease or somebody who has end-stage kidney failure. So the coverage is for somebody whose kidneys have failed temporarily, you know, those people that have acute kidney injury. So the NHIS offers dialysis only for a maximum of six sessions.
“For an individual who needs dialysis over and over again, once the six sessions are exhausted, then they will have to keep paying out-of-pocket,” the nephrologist said.
He noted that since almost all consumables needed for dialysis were imported, the naira devaluation and inflation were responsible for the price increase in the materials and sessions.
The nephrologist added that the cost of setting up and maintenance of the machines could be responsible for the fewer dialysis centres in the country.
Longer wait, distance
Since there were inadequate dialysis centres and machines, Gimba stated that this meant longer waiting times, travelling longer distances and high costs.
He further said that the fewer numbers of nephrologists, nurses and technicians as well as funding, contributed to the inadequate machines.
He said that the situation has led to slower recovery and low treatment outcomes.
“Most of our patients don’t do very well because they don’t have the money to do the dialysis adequately. It is like saying you prescribed a medication and the person is taking an underdose of it. Of course, the person won’t get well,” the doctor said.
125 dialysis machines in Nigeria
According to the Directory of Dialysis Centres in Nigeria, there are 125 dialysis centres and about 565 dialysis machines across the federation.
But Awobusuyi, who is also the president of the Transplant Association of Nigeria, said these numbers were inadequate compared to the rising cases of kidney diseases in the country.
He further noted that the centres were mostly located in the cities, making accessibility difficult for patients and their relatives.
“Obviously, they are not adequate. If you look at the distribution of the centres, you will see that they’re concentrated mainly in the urban or cities, Lagos, Kano, the big cities. We have an uneven distribution of the machines, and even at those places, a lot of people cannot access the centres,” the don said.
Six govt, 20 private hospitals
The nephrologist further noted that while there were only six government-owned hospitals with dialysis machines, there were over 20 privately run dialysis centres in Lagos State.
Of the six government centres, two are Federal Government owned.
“In Lagos, I think there are a lot of private hospitals with dialysis machines. The government hospitals with these machines, if you take Lagos University Teaching Hospital, Lagos State University Teaching Hospital, GH, Lagos, Alimosho, Gbagada, and the Federal Medical Centre, Ebute Metta, are the government hospitals with dialysis units. But at least 20, if not 30, private hospitals have dialysis units,” Awobusuyi said.
The NAN president further noted that because the machines were affordable, the machines in most centres were not enough for the patient load, leading to overburdened machines and longer waiting times for patients.
Abandoned Renal Centre
Speaking on the CRC, Awobusuyi confirmed that there were 24 dialysis machines when the Lagos State Cardiac and Renal Centre, Gbagada, was commissioned.
Considering the number of years the facility has been abandoned, the TAN president expressed uncertainty over the functionality of the machines in the centre.
“There are more than 20 machines in that centre. If I remember correctly, I think there were 24 or so. The truth is I’ll be surprised if any of them are still working because once you start using the machines and you stop for any reason, because the concentrate that the machines use is salt, what happens is that salt deposits in the tubings of the machine and then blocks several valves within the machine.
“If the machine is not preserved, and has been used previously, by the time you take it up for use, maybe after a year or so, most of the time, the machine will not function, because of precipitation of salts in quite a number of the valves in the machines, and that’s a very difficult task to trace,” the nephrologist said.
He further stated that the cost of replacing the blocked valves was high.
The NAN president noted that a price reduction in the cost of dialysis in government hospitals was dependent on the government.
From N15,000 to N45,000
Awobusuyi, who was instrumental in the setting up of the dialysis centre at Alimosho GH and 12 other centres by MTN Foundation, stated that before now, the cost of dialysis at the centre was N15,000.
The don said, “That was maintained for many years because MTN supplied consumables to those centres that would last them for two years. The plan of MTN for that centre and others established across the country was that whatever revenue that will be generated in those two years, will be used to purchase more consumables and sustain the centre.
“The cost was determined by the MTN Foundation and not really market forces. So, it depends on the government, if they want to bring the cost of dialysis down, it is something that could be done, it needs investing in and would need either talking to the importers of the consumables or opening up a fair channel for the importation of those consumables. We have very few importers and they capitalise on the fact that they have the monopoly of the products.”
He urged the government to remove the monopoly of the importers as one of the ways to ensure a reduction in prices of consumables and dialysis.
Some tertiary hospital without…
Gimba further revealed that not every tertiary hospital has dialysis centres, due to the dearth of nephrologists.
He also said that since many health professionals have left the country, the burden of treatment has increased on the remaining workers.
Speaking on the way out, the nephrologist said, “The government could offer a waiver for consumables and dialysis machines imported. The government can also encourage philanthropic organisations and big corporations to look into supporting patients with diseases.
“For instance, a big corporation could buy container loads of consumables and supply them to hospitals. This can drive down the cost or the government itself can offer to take care of people who may not be able to take care of themselves.”
Gimba advocated indigenous manufacturing of some hospital consumables to ensure reduced cost.
CMD silent on numbers
When contacted, the Chief Medical Director of LASUTH, Professor Tokunbo Fabamwo, was silent on the number of dialysis machines in the hospital.
He emphasised that the hospital provided dialysis to patients in need of it.
The don further clarified, “We have three categories of dialysis. Number one, we have infectious diseases dialysis, which we use for patients with either hepatitis or HIV/AIDS. Then we have critical care dialysis, which is for patients who are very sick, but also need dialysis. The third one, which is in our Special Services Centre, is just a straightforward routine dialysis. So we have three dialysis units in LASUTH.”
In his contribution as a medical expert, Fabamwo noted that while there was an increase in the number of patients in need of dialysis, the units were not enough.
“There are not enough dialysis units for the rising numbers that need to be sustained on dialysis. Number two, the cost of dialysis in Nigeria is still very high unlike in some other countries where dialysis is subsidised for their nationals. Only foreigners pay economic fees for dialysis. But their nationals pay almost next to nothing for dialysis. An example is India, where dialysis for their patients is almost free,” LASUTH CMD said.
Dialysis shouldn’t be above N5,000
The don called for measures to ensure persons with end-stage renal failure, who need dialysis to sustain themselves have access to it at affordable prices.
“Right now, a round of dialysis in most centres, either private or public, is not less than N45,000. In my own opinion, dialysis should not cost more than N5,000. But I know that the actual cost is more than that. So what I’m saying is that either health insurance should be expanded to cover the cost of dialysis. That’s my suggestion.
“As we speak now, there is a particular scheme with the Lagos State Health Insurance that covers a number of sessions per annum or per month or something like that. But I think we should liberalise it such that Lagos citizens or Nigerian citizens who are unfortunately diagnosed with end-stage renal failure and have to be maintained on dialysis can have it done at rates that they won’t have to break the bank to be able to afford,” Fabamwo said.
Gbagada General Hospital has six working dialysis machines – MD
The Medical Director and Chief Executive Officer of the General Hospital, Gbagada, Dr Olusegun Babafemi, told PUNCH Healthwise that six machines were working in the dialysis centre.
He added, “Of recent, we have acquired two machines and we are about to get another three from the Ministry of Health. That would then make it five. We have gotten a place where we have renovated to put in five machines of which two have been acquired and three has been promised through a good Nigerian through the Ministry of Health.”
Babafemi further noted that all patients who were given appointments were attended to, stating that patients who were not attended to were those who came in the night.
He, however, stated that such patients would be dialysed in the first session of the next day.
Speaking on the CRC, the MD said that the centre was supposed to be a tertiary centre for advanced renal support system and cardiac surgery.
He further noted that the government was restrategising to make the facility better.
PS mum
When contacted, the Permanent Secretary of the Lagos State Ministry of Health, Dr Olusegun Ogboye, told our correspondent to send the questions to him on WhatsApp.
Subsequent reminders sent for his response were yet to be acknowledged or responded to as of the time of filing this report.