Prof. Darlington Obaseki: Transforming UBTH into Leading Quality Care Provider

As Nigeria’s ailing healthcare system continues to attract public outcry, facilities like the University of Benin Teaching Hospital has stood out thanks to the man behind the wheel; its Chief Medical Director, Prof. Darlington Obaseki. In an interview with REBECCA EJIFOMA after a two-day extensive tour of the facility, he highlighted the profound impact of his four-year strategic plan to metamorphose the hospital into a leading provider of quality care solutions in West Africa

Prof. Darlington Obaseki is a Nigerian Professor of Histopathology, and is currently the sixth Chief Medical Director (CMD) of the University of Benin Teaching Hospital (UBTH) following his appointment on August 17, 2017, after acting in the same capacity for about a month.

Having emerged the CMD, Obaseki rolled up his sleeves, rubbed minds with his team and together they strategised on lasting solutions to revamp the facility in a bid to meet international best practice, and make the facility the best in West Africa. While fired up to map out yet another future plans, Obaseki and his team are said they are ready to work their fingers to bones for UBTH. Excerpt:

I read your strategic plans from all 2018 to 2021 on things you would do as the CMD. Are you happy with what you have achieved so far?

I think the word is not “happy” but “proud.” We are very proud of our work here. We think we are one of the top performing agencies, not just in health in this country. We are very confident about that. People have come; regulatory bodies send people here and they keep asking ‘What do you give your staff?, ‘Why are they working so hard?’, ‘You people don’t operate like a government agency.’

If you come here by 7.30am or 8am, everywhere is buzzing; staff are at work. So we are very proud of that. Some of these jobs are not about buildings. Some say they judge themselves by how many buildings they have put up, whether the buildings are functional. We judge ourselves by the functionality of the processes of our system and the joy of our workers.

When we came on board, we deliberated and said, in healthcare system, the focus is on the patient, they bring us to work. We have told ourselves that looking after that patient for a health care worker is very demanding. So the people looking after them must first of all be happy.

For instance, if Chioma, who is a nurse, has not eaten since morning, and she comes to work, she could transfer that aggression to patients. So we are very proud of what we are doing here. For example we have been on board almost four years now, there has never been a single strike. That is huge in Nigeria of today; we don’t underestimate that.

Before we came on board, I was a member of the previous administration that is how I know. For two and a half years it was war everyday. Almost every two months, one union or the other was on strike, not just UBTH, almost all over the country. Till now, it is still happening. But the fact that we have not had that is a testimony to the kind of relationship, unity and purpose that we have built in the staff and this comes from the fact that we have focused on looking after them, their welfare.

We focused on crafting a vision where we have common goals. What brings us together? We want to make UBTH the leading provider of quality care solutions in west Africa. We took time going round, when you talk to anybody they’ll tell you quality health solutions. So we’re very proud of what we’ve done and that in itself makes me high and keeps me going

At a time many institutions are crying for funds to develop their facilities, you seem to be thriving. How do you manage this?

It is not only you asking about funding. “CMD where are you seeing the money for these projects?” I don’t think I know myself but we have a plan. When we came on board, we sat down for three months and came up with a plan. We decided to focus on six areas – patients satisfaction, manpower training and development, staff satisfaction, research and technological innovation, inward medical tourism and lastly funding.

If you go to the plan, we wrote how we intend to make money to fund all these beautiful things but beside that, what I want to say is it is all about efficiency of utilisation of resources. I will give you an example. We have a very vibrant work department with very young, brilliant engineers. Majority of the works we do in this hospital – the structural works, unlike before when they were all on contracts – are done by our engineers.

One of them was in A & E, Engineer Wasa and Jerry, two fantastic young engineers. All these things were done by them. That ward you saw upstairs was not a contract. And they are coming down at 30 per cent cheaper price. So we are utilising the little we have more. Then of course, we are also getting more because there is more patronage; there is more money coming in. The bottom line is more efficient utilisation of resources and we are focused more on in-house utilisation of our manpower that is why we are able to do so many things.

For most hospitals, constant power supply is a challenge. It is even more crucial in a place like UBTH with your ongoing massive computerisation programme. How do you cope? How much do you spend on electricity monthly?

It is a big problem but we run a functional system. Since I came on board I don’t think we have ever had a day without power in UBTH, even one hour. It is a lot of work and money; you can’t run a hospital without power. If light goes off for one hour in your hospital, somebody dies. It is as stark as that. If you look at it from that point of view, any hospital without power is dangerous.

When we came on board, we focused on the basic things: power, water, and consumables – things the doctors and nurses need to work with. If you can’t provide those things you are not doing well. Any hospital that cannot provide those should not be thinking of any other big thing. So, we had to invest heavily on generators. We have so many generators – over 30 industrial ones – across the length and breadth of this hospital. We spend about N12m to N18m on diesel every month.

Benin Electricity Distribution Company (BEDC) bill used to be N15million every month but since November, they have increased their tariff and it is an average of N25 million. So, for power alone, between diesel minus cost of maintaining generators and running it, between diesel and electricity bill we spend an average of N40 million a month just to keep power on. So it is challenging.

Computerisation is not just the records. We have computerised our clinical services, complete end to end from when the patient comes in to when they leave. In that whole setting of a very busy clinic, if light goes off for five minutes and the computer shuts down, you can imagine the delay it will cost, like an hour or two hours delay.

What we have done is to provide three layers of back up. The public power supply will store series of inverters that can keep those things on for an hour or more. So, there are three layers of backup, but to be fair to BEDC, they have really prioritised UBTH now. We get an average of 20 hours of light a day unless they have a local problem, which they also respond to us fast. Since almost six months they gave us a dedicated line, so we have a very good relationship.

Obviously, the financial burden is quite high. How do you cope?

Since I came on board, we have not added the cost to the patients in our prices. All we have done is to increase the efficiency of our connections, draw loopholes what people are supposed to pay, and we make sure they pay. For example, we were not charging for our oxygen before but we looked at it, we know how much they are charging a cylinder of oxygen in Lagos so we just had to add money. But we are mindful of the impact on the patients.

Like I said earlier, it is not just about my people it is also about the economy. I’m very much part of my society, I can’t be disconnected. These are the things that push me to take some of the decisions. But it is tough, especially the COVID year that everything has gone up. Before COVID, face masks we were sharing to everyone in UBTH was N500 for a pack of 50 pieces. At the peak of July last year it got to about N17,000 yet we never stopped giving it to our staff one day, because here, every decision we take is a life and death decision.

You have about 500 in-patients and many doctors are leaving the country. We were told about a 1000 doctors have gone in the past few months and government hospitals like yours are currently having problems with recruitment. How do you ensure that these patients get the best of services with fewer number of doctors.

The country doesn’t know what we are facing. Right now, the health system in Nigeria is facing a collapse if we don’t tackle this issue of doctors emigration frontally. We are training doctors for other health care systems elsewhere in the world. I just told you now, the government of Nigeria spends lots of money training me to where I am today and I went abroad for training. I never felt inferior to my colleagues, in fact they kept asking me if I trained in Europe I would say ‘No, I trained in Nigeria.’ They didn’t believe because of the quality of training and education the federal government gave me almost free of charge, then I’ll just wake up one day carry my bag and vamoose so I don’t know how, but I think there needs to be a major discussion on doctors leaving Nigeria. There are some factors involved – there’s the push and pull factor, there are things pushing them away so many of our doctors will tell you insecurity, many have been kidnapped, and they want to go to a country where they don’t have to worry about light or water

Yes that one is there, but you can’t overestimate the depth of crisis facing this country. Here, there’s a cardiothoracic surgeon and the one that’s supposed to do heart transplant. There are only two of them. If we lose them, that program will crash. It’s beyond me, it’s beyond UBTH it’s a national crisis that should be attacked at the national level. That’s the much I can say about that. I don’t have the figures of doctors that have left, the worst part of it all is they’ll say they are coming back. Because we can’t easily replace them, we give them benefit of the doubt. Why will anybody want to go to the dessert, Saudi Arabi, a kind of society where there’s no freedom the way we have it here? To tell you, it’s desperation not just about money

However, so many of us had the opportunity of travelling out. I’ve been out of the country, I was away, but I didn’t run away. I was on training for three months in Switzerland and I know how the western world operates. The environment is better, the working tools are there but there is always something missing, we’re just like an insignificant cog. With or without you the system runs. But here, God has blessed some of us. Nigeria has been good to some of us but many people don’t see it that way I trained here in UNIBEN as a doctor. I finished 1991, and we stayed practically free of charge. The country did that for me. You can’t go and stay in America and you won’t pay debts for the next couple of years. Some of us are very much aware of that but we don’t talk about it. Any Doctor that says Nigeria isn’t doing well is not grateful to God and to this country because medical education anywhere in the world is expensive but here we practically get it free or subsidized, so I’m blessed and I feel we need to give back.

What has been your relationship with your doctors, especially the Association of Resident Doctors (ARD), that we don’t hear of strikes in UBTH these days. What is the secret?

Resident doctors and unions see themselves automatically as oppositions to managements across the country. That is the way they are constituted so if you don’t oppose management, you are not doing your work as a union. But that has not been our story. These unionists, including resident doctors, are very reasonable people from my experience and personally my resident doctors are like my junior brothers. I brought up many of them. What has helped me is that I play football that is why you see me skinny and every Saturday I meet them. We’re also very proactive, We know what’s bothering them before hand. Most times, they come to complain about one thing or another but before they finish, I have already sorted it out. One came last week to talk about A and E. But I’ve gone there before and nobody told me. That’s the advantage of my style of leadership which is to be in the frontline every day. I walk round this hospital, they know me, I don’t sit down in one place. I don’t wait for people to come and tell me things. I’m always in the frontline I know what’s happening more than them, some don’t even walk around the way I do, some don’t even know what’s affecting their own members. So when we came on board our plan was to focus on staff satisfaction, motivation, welfare and working conditions, so, it’s difficult for union leaders to say they want to do anything in UBTH because their own members will say no these people are trying so I think that’s it

At the cancer unit, we were told that the Linear Accelerator machine, one of the major equipment for cancer management, has been down since 2017. Why haven’t you been able to bring it back to life as you have done with several other equipment in the hospital?

We set up a dedicated cancer ward just for cancer patients – about 40 beds only for cancer patients where we have dedicated, trained specialised cancer nurses, oncologists, pharmacists with a pharmacy inside the ward. Two different centres have requested that we show them what we are doing. Cancer chemo drugs are very expensive. Most times, when you buy one vial you won’t use all of it but you are not allowed to keep it so you have to throw it away and buy another one next time. So what we did is, we set up a machine there, micro dosing. It allows us if we buy one vial we can share it among five patients. So that has crashed the cost of getting these drugs to cancer patients. We are the first centre in Nigeria doing this and we cannot allow this go down. It requires a special chamber. The linear accelerator, the cancer machine, has been down since I came on board. It is something that worries me. I have done a lot to try to bring it on. That machine was the only one taking care of the whole of the South-South of Nigeria; people come from all places to take treatment here. It broke down about seven years ago. However, last year when I went to Dubai I met the manufacturers. I even got a letter from Sweden.

They agreed to give us two new machines and also promised to remove the faulty one and give us the latest model. That was January last year. They also agreed to spread the cost of payments over five years. Somebody just paid one fifth of the amount. But COVID-19 happened and now we are back again looking for somebody to fund that. We are trying to get to the Federal Government but we have not been able to succeed. We are working on it. Like the one in LUTH, it is a self-sustaining model; the volumes are there. We have done the business outlay, that N1billion we will make it back in one year. But to just get somebody to take the risk, I have met more than five different groups of investors; I have a business case. I’m a pathologist; my area is cancer. It is something I’m passionate about; we are working on it.

This transformation in UBTH is laudable and worthy of emulation. Will you say it has increased the number of patients and what has been the impact on the hospital’s revenue?

The question you asked is very pertinent, ‘How has all these translated to increase confidence in our system by variety of increased patronage?’ We are overworked. The greatest problem I have with my staff now is not whether I care about them or whether I provide things for them. It is “Oga, slow down; the work is too much”. In terms of IGR, our IGR was 100 million in 2017. Now, it is about 300 million per month. We are the busiest teaching hospital in Nigeria; we are very confident about that. The only hospital I probably will suspect that is close or better than us is probably Kano with a population of 20 million but most other hospitals don’t even come close. So, we are very busy. If you come to our A&E at times it is like a market. It is very challenging carrying this burden. It is burden, but we have to do it.

So how much has it cost you to acquire the new equipment, refurbish old ones, develop infrastructure and indeed the total reform in the last four years?

I can’t really put a figure to it. I might as well give you my annual budget. Let’s be honest here; this is a federal owned hospital. About 80 per cent of our bills are paid by the federal government which is in terms of salaries. The major cost of running health systems is in salaries. So if they privatise this hospital today up to 70 per cent of the staff will have to go. So the federal government is almost funding the hospital, but on overhead or day to day running it is from the work we do that we run revolving funds.

Now that your tenure is almost over, what next?

I will tell you what next – sustainability. What we have been saying is all these efforts; it has been a lot of work. It will be a waste if once I step out of this office everything comes crashing down in a month or two. So, succession planning, sustainability, bringing up clones’ leaders are what we are doing. So what next is internalisation of what we are doing, mentoring more persons, selling the vision. There is a phrase I use here: “Coalition of the willing or fellowship of the willing”. We look out for people of like minds. I don’t force anybody. We look out for them; bring them close; open up the space for them. They see everything I do and study me. There is transparency in the system, they see what I’m doing. My dream is to have at least a minimum of 10 persons who, when I leave the office, anyone can take up. But before then hopefully we will get a second tenure, because we are entitled to two tenures ordinarily. We have to do a re-evaluation of everything we said we would do: monitor them, see how well we have done, and draw up a fresh plan.

We must always have a plan of action, because there is a saying that those who fail to plan, plan to fail. So we are midway into it, and we think that we have not reached where we want to be.

UBTH had a vision before we changed it. The vision was in 1973 and it was very cloggy so we now said our new vision is to be the leading provider of quality health care solutions in West Africa. We are not there yet; we are far from it still. We have done a lot. What I tell my colleagues here is that we know that we are probably the very best and highest functioning public hospital in Nigeria now, we know. But for us, it is not good enough. What we say is that health care is universal. It is not good enough to say we are the best by Nigerian standard. One’s life doesn’t know Nigerian standards. Being the best in Nigeria yet way behind global best practices that costs lives and that is why we are still very much driven, fired up and motivated.

We are not playing with Nigeria health; we don’t want to use Nigerian standards to judge ourselves. We want to set the pace. So many hospitals are already coming here to see what we are doing on different aspects (I won’t mention names). One hospital not too far from here sent its management team to come study what we are doing. I’m sure they told you about our pharmacy, the no- prescription policy. There is no government hospital that dare try it; it is a lot of work, but you get professional satisfaction. This also answers your question about the unions. Give people something to do. We have a lot of work so we don’t have time for unionism so much anymore.