IN SEARCH OF EXCELLENCE: DEVELOPMENT MILESTONES AT THE NATIONAL HOSPITAL, ABUJA

CMD, Dr JAF Momoh

Initially christened National Hospital for Women and Children, the hospital was conceived from the Family Support Programme (FSP) of former First Lady,
Hajiya Maryam Sani Abacha and designed to cater for the health needs of women and children in the country and the sub-region.
Its scope of operation was later expanded to accommodate male patients, and it commenced operations on September 1, 1999. It started as a 200-bed hospital with 400 staff and 30 specialist consultants. Today, it has 450 beds, with over 2,000 staff and over 120 specialist consultants in various fields. Like every institution, the hospital over the last twenty two years has recorded unprecedented milestones as well as challenges.

And this where the nature and type of leadership comes in.

Leadership and manpower define institutions and indeed, nations. With good and focused leadership, institutions thrive, evolve and become centres of excellence. They outgrow the initial concept and dreams of their founders to become brands that people the world over look at and marvel. Leadership make and destroy nations and institutions. They are the engine rooms of revolutions. Their ability to work on the psyche of their followers, workers, carry them along, motivate them, rejoice and empathize with them play a key role in what the organization and or nation becomes.

The last eight years can easily be described as a period of major transformation in the life of the National Hospital. True, the organization has had leaders before Dr Jaf Momoh came in as the Chief Medical Director. In the course of this write up, we spoke with three key figures, professionals in their own right who started out with the hospital from its inception and have grown with the institution. The general consensus is that the last eight years have been different. They have been defining moments, despite dwindling resources.
With a management team that seems divinely chosen, even a new member of the team, revealed that what he found interesting is the way the team work seamlessly without rancour. Leading over 2,000 men and women without labour unrest, strife, strikes and scandals in Nigeria is not an easy task. From being a dream, the project of the National Hospital being an international centre of excellence has gradually evolved. Today, the health institution is affiliated with the University of Abuja, now serve as the examination centre postgraduate courses for highly specialized courses for Nigerians and non- Nigerians alike.

Simply put, in the last eight years, the hospital has undoubtedly outgrown the Nigerian centre of excellence cliché to become a West African Health showcase. With the VIP section that attends to the needs of the high and might in the society, the Trauma Centre that brings to Abuja attributes that we normally assumed one could only see in developed countries, round the clock maintenance and staff that are ever willing to think out of the box, the institution has lived up to its billing and indeed surpassed what the initial concept looked like.
One of the key factors necessary for the success of any revolution is the revolutionary command of persons who are the key leaders of the revolution, who believe in the set goal and who are willing to burn extra energy to ensure that the revolution is a success. Dr Jaf Momoh’s team of Directors and Heads of Departments’ keying into his dream and implementing policies set out by the Board has been a major key in the transformation of the National Hospital into an International Centre of Excellence in healthcare. With Dr Aisha Umar as Director of Clinical Services, mobilizing the medical troops, and ensuring that they put in their best, Dr Peter Egwakhide as the Director of Administration, ensuring that clinical and non-clinical staff get everything they need to put in their optimum and have a sense of belonging, and drumming it on them that the focus continues to be excellence in all spheres of the management of the hospital; while Engineer Ola Samuels Agboola labours round the clock to ensure that the whole system does not suffer any form of breakdown, and the ambience around the hospital is breathtaking enough to appeal to even the sick, it is not unexpected that the team and their foot-soldiers have taken the hospital to an enviable level.

TWELVE KEY MILESTONES ABOUT THE NATIONAL  HOSPITAL IN THE LAST EIGHT YEARS
1. Evolution of visionary management team made up essentially of some first set of workers in 1999 who worked in the Hospital, who knew what the dream was all about and who have consistently laboured guided the dream despite the additional management staff joining them.
2. Running a maintenance system that works round the clock without hitches, including supplying electricity to the hospital at about 40million Naira a month despite the fact that government allocation is barely enough to fuel generators for a week.
3. The Radiotherapy Centre as well as Trauma Centre have become major international health masterpieces that West African College of Surgeons acknowledge that they rank among the best in the world hence the use of their facilities as examination centres.
4. With an Electronic Medical Record system in place, and computerization of the IGR system, documentation of patients, keeping accounts of the incoming revenue for the hospital is easier. This has ensured that the National hospital has the highest IGR among its peers in the country.
5. The conditions of Service approved for the staff is sui generis, it has given the workers another reason to know that their tomorrow shall be okay, motivated them to work hard and ended labour unrest.
6. Stagnancy has become a thing of the past unlike in the years before 2014. It has been promotions galore as management has continued to plead with Federal Government authorities through office of the Head of Service of the federation to declare more vacancies.
7. Strategic life-saving surgical operations we used to hear of in other lands now possible and become a common occurrence in Abuja. Open heart surgery, spinal cord surgery, separation of Siamese twins are examples of these
8. Increasing the bed capacity of the hospital from 200 to 450
9. Remodeling and evolution of a state of the art VIP wing that many have described as a 5-Star hospital
10. From near total collapse, the Cooperative society of the hospital staff has become the envy of even banks, paying as much as 700,000 Naira as annual dividend on 12 million Naira when even the best banks pay 120,000
11. Maintaining twenty something year old structures that have stood the test of time, despite the age of some of these structures and building new ones and maintaining the aesthetics outlook of the Hospital
12. Turnaround of the Infectious diseases unit into a bigger, expanded unit after the coronavirus experience.

GIANTS STRIDES IN CANCER TREATMENT

One of the areas the hospital has recorded unprecedented improvement in the last couple of years is cancer care.  This was made possible with the commissioning of its radiotherapy centre. With over seventy percent of cancer patients needing radiotherapy, there is no doubt that the nation faces an uphill task in ensuring quality treatment for its cancer patients. However with the help of the government and painstaking pleas from the leadership of the hospital, Abuja National Hospital now boasts of two LINAC radiotherapy machines, which have enabled it to ensure consistent treatment for cancer patients. This is a sharp contrast to several years ago when patients suffered untold hardships accessing treatment at the hospital because of the poor state of the only radiotherapy machine, which repeatedly broke down and affected patients’ treatments. Curiously only three of such machines exist in the whole country, with the Lagos University Teaching Hospital having the second one. The journey to this feat was not easy.
It was gathered that in late 2016, the then Minister of Health, Prof. Isaac Adewole, paid a working visit to the hospital to assess the state of infrastructure, during which he discovered that a brand new radiotherapy machine was actually purchased and supplied in 2013, but it was left uninstalled. The problem, which was one of the issues the CMD, Dr Jaf Momoh inherited from the former hospital leadership was the hospital’s inability to construct a bunker where the machine would be
installed. The hospital working with the ministry fast-tracked the construction of two bunkers instead of a single unit that was intended, as these would accommodate more than one  radiotherapy machines as time goes on.
Non-functional components  of  the equipment were also upgraded, increment in
bandwidth capacity and eventual installation of the radiotherapy machine, the training of medical staff in South Africa, were also undertaken. This was how the first radiotherapy machine came to be. The second one was to come in 2018 through the help and support of the Ministry of Health, and was indeed commissioned by the wife of the Vice President, Dolapo Osinbajo. With the new installation, officials declared that about 100 cancer patients could now expect to be treated daily at the National Hospital thus giving hope to cancer patients, as they will be helped with the facility.
Ultimately, this has minimised the burden of cancer and associated death rates, what with the positive effects the machine have had on other vital organs of the body when precise diagnosis is carried out. Moreover, with the installation of the machines there is no doubt that the urge and zeal for medical tourism has been on the decline, as the machine are some of the most advanced and sophisticated technologies in the world, with high standard ratings when compared with what obtains in Europe, India and South Africa. Today, the Radiotherapy Centre is still the best in West Africa.

SEPARATION OF CONJOINED TWINS

One of the landmark feats accomplished by the National Hospital in the period under review was the separation of conjoined twins performed at the hospital in 2019. The conjoined twins were referred from the Federal Medical Centre, Keffi, Nasarawa to the hospital on August 13, 2018.

The feat, according to reports lasted 12 and a half hours on November 14, 2019, after which they were admitted and nurtured to 15 months. It was an elated Health Minister, Osagie Ehanire who addressed the media to break the news of the surgery since it was the first of its type done in the hospital and indeed an achievement that has made the realm of advance surgery in the country.
Speaking at the occasion, the Minister stated “I am happy that we have good news coming from a Nigerian hospital and in this case, we do not need to rush them abroad for surgery; it is a case of homegrown surgery.
He also commended the team led by Prof. Emmanuel Ameh, Chief Consultant Pediatric Surgeon and other specialists that separated the twins. “The children had to be nurtured from birth to stable size by the medical team before the surgery was carried out. “I am delighted and proud to be with you and with the leadership of the National Hospital for this achievement,” he said. According to him, the surgery followed a detailed plan, dedication of the team, excellent work and support of the hospital management. Also speaking, the Minister of State of Health, Dr Olorunnimbe Mamora, attributed the success of the surgery to God and the team spirit demonstrated by the surgical team. Mamora said medical professionals and healthcare experts needed to be encouraged to do more, urging them to do more to address other surgical problems.
In her remarks, Dr Mariya Mukhar-yola, Chief Consultant Pediatrician, Head of Neonatology said the babies (girls) Goodness and Mercy were received and they found to be conjoined at the thorax and abdomen. Mukhar-yola said the combined weight of the babies was five kg when they were received. “Major activities prior to surgery included infection control, feeding, fluid therapy, immunisation, monitoring growth and development and controlling crowd,” she said.

GIVING BACK TO THE SOCIETY

The National Hospital despite its laudable activities in taking care of and providing for abandoned patients and or patients who, as a result of trauma cannot easily recall their next of kin, has also been involved in forms of activities we can classify under Corporate Social Responsibility. Under the leadership of Dr Jaf Momoh, the National Hospital Abuja (NHA), built a clinic at the National Youth Service Corps (NYSC) Permanent Orientation Camp, Kubwa to improve the healthcare needs of corps members in 2019.
The NHA Chief Medical Director (CMD), at the commissioning assured that the amenities and healthcare services would be extended to cater for the health needs of the community around the camp. He said that the clinic was built within one year with the support of clients and friends of the
hospital as part of the hospitals Cooperate Social Responsibility (CSR) to the society. Dr Jaf Momoh said that although the hospital was being formally handed over to the scheme, the hospital’s presence would fully remain in the daily running and maintenance of the facility.

The CMD said that the project was carried out with the directive of the President Muhammadu Buhari and the Minister of Health, Prof. Isaac Adewole with the support of an ex-corps member, Dr Ijeoma Nwaejike. The facilities available at the orientation camp was not adequate to cater for the health needs of corps members in the camp and so the President and the then Minister of Health gave the directive that the facilities should be improved. “Someone introduced us to a corps member who was looking for support to build a camp clinic and since our purpose was in alignment, we decided to work together so it was just a coincidence that she came at that time. “We took over the project and built it from foundation to finish and also equipped it with all the equipment and furnishings it required. “At every orientation programme, we always send doctors to assist the
corps doctors working at the clinic and we will continue to do so. “We recommend the ex-corps member who facilitated the project for the presidential award so that others will be encouraged. “Because of her hard work, persistence and effectiveness, we have given her a job at the hospital so she is currently on the payroll of the national hospital, Dr Momoh revealed.

He further stated that, “as we formally handover this clinic to the Director-General of the NYSC for use by corps members; we pledge to continue to support the camp clinic in the area of manpower and medical equipment during every orientation camp. “The completed facility can admit seven male and six female patients at a time with built-in call duty rooms for male and female doctors. “We have a pharmacy in the facility and about four consulting rooms with a waiting room that is why the NYSC director general said that the facility is more than a clinic and can, therefore, be extended as a primary health care facility.

The National Hospital management also agreed that it was possible to run the facility as a primary healthcare centre to cater for the health needs of the local community around the camp, Momoh said that to achieve inclusiveness of the local community, the hospital would carry out awareness and mobilisation at the community level to inform community members of the availability of the
facility. He said that civil servants living around the facility who were enrolled in the National Health Insurance Scheme (NHIS) would also be encouraged to use the facility as their point of accessing health care. “I want to urge the National Hospital to convert the facility to a Primary Healthcare facility so that the local community can benefit from it as well.
Apart from this, the hospital also embarked on major outreach for some Abuja residents in 2019 as it marked its 20th  year anniversary. Over 3,0000 Kuchingworo residents received free  medical Check-up during a medical outreach programme to mark the 20th birthday of the hospital. The Chief Medical Director of National Hospital Abuja, Dr. Jaf Momoh, who spoke to newsmen at a press briefing to mark the hospital’s 20th anniversary said the National Hospital management would not relent on its oars in ensuring every patient gets the best service delivery from the hospital. According to Dr Momoh, “As a pioneer staff, I have had the rare honour to have witnessed the various developmental stages of the hospital with successive boards and respected senior colleagues who had steered the ship of the top management of this great institution. “I acknowledge your various contributions towards the development of this citadel of excellence and the noble feats the hospital has attained. To the esteemed and invaluable staff of this hospital, I commend your immense efforts, toil and sweat to bring this hospital to a lofty height.

COLLABORATION WITH DONOR AGENCIES

Because of the conducive environment, many donor agencies have been willing to partner with the National Hospital either by citing projects related to their fields in the hospital or offering one form of support or the other. The reasons for this are not farfetched. No donor agency will like to partner with a government owned institution that will not be able to maintain the equipment or facilities that have been donated to it. The National Hospital boasts of having electricity twenty four hours a day, seven days a week, all through the year. No other hospital in Nigeria at its level can boast of this. The maintenance level is high and with little room for decay and shortfall.
As a result of this, when donor agencies and or other organisations are looking for public health institution to partner with, they easily pick the National Hospital. The array of specialists in various fields also speak for itself.
One of such organisations that in recent times picked the hospital for special collaboration was KidsOR. Kids Operating Room or KidsOR ‘work directly with Ministries of Health, local surgeons and their teams to transform operating rooms, pre-op and post-op rooms in their hospitals into dedicated spaces for children’s surgery. According to their website, they have installed 50 Operating Rooms in 20 countries in Africa and Latin-America, creating a capacity for more than 30,000 operations a year. Given the type of leadership and friendly environment that exists at the National Hospital under the leadership of Dr Jaf Momoh, it was only natural that the hospital be chosen as one of the beneficiaries for the KidOR projects.
According to the group, ‘Children are at the heart of what we do. The distinct graphic animals you’ll see on the walls of our Operating Rooms have become a huge part of who we are.

While they look amazing, they actually serve a special purpose: they are designed to offer reassurance and a colourful distraction for children about to undergo surgery. An operation is scary, even for adults. Unlike in high income countries, many of the children in these hospitals aren’t under anaesthesia when they enter the Operating Room. They hear the scary sounds from the machines and see surgeons they don’t know in scrubs. These designs ensure that children don’t feel as scared or anxious. They therefore set out to install ‘Child-friendly Operating Rooms’ designed for children to feel safe.

MULTI MILLION DOLLAR NOMA PROJECT

In an effort to bring succour to Noma patients and assist Nigeria in mitigating the burden of Noma, the Winkler Family of Germany, through the Nigeria Aids Noma Initiative (NANI), is supporting the federal government to build a National Noma Treatment Centre at the National Hospital, Abuja. This is the second NOMA Centre that the German family will be building in Nigeria.
The Foundation for the big project was laid early last month by the Nigerian Health Minister, Dr Osagie Ehanire.
Noma or cancrum oris is an infectious and noncontagious disease which rapidly eats away soft tissue and bones around the face, resulting in an awful disfigurement that does not fail to draw attention. Noma has a mortality rate of up to 90 per cent and almost invariably affects children from the age of two to six years with poor health status defined by abject poverty and malnutrition. Those who survive it suffer life-long disfigurement from defects of the face that makes eating, speaking and social relationships difficult. Social exclusion and stigma are the result.
In 1999, a 70-bed Noma children’s hospital was established in Sokoto State to treat patients in that region. It is the only facility in Nigeria till date, catering to the specific needs of Noma patients and survivors. It was gathered that treatment of survivors there has been with highly specialized reconstructive plastic surgery and it has been free of charge.

Speaking during the foundation laying ceremony, the Minister of Health, Dr Osagie Ehanire, said the Winkler’s family was so touched by the plight of Noma patients, that the mother made a promise to bring succor to the victims by financially supporting their treatment. He said, “That act of kindness grew and led to a pledge to build this hospital. As age caught up with the dear mother, the son Mathis decided he will take up the challenge and fulfill his mother’s wish. They mounted a private family effort to raise funds in their country for this building. The building will be completed in the next one year.
“This is not a government, but a family driven initiative. I leave you to imagine what it must have taken to raise funds, commission a hospital design and travel here for the foundation laying and to
establish this Centre.” Ehanire noted that the National Hospital Abuja is central for ease of access to Nigerian Noma patients referred from any part of the country. “It will hopefully give more visibility of a disease that many do not know,” he added. According to him, the National Hospital was chosen because of this central location as well as the ambience it has with specialists needed for the various stages of NOMA treatment available there., which were conditions the sponsors gave before an agreement was reached.
The Chief Medical Director of National Hospital Abuja, Dr Jaf Momoh, who expressed joy that the National Hospital was picked for the project said the centre would have capacity for 100 children at the same time. He said Noma disfigures the face, the muscle, even the bone of the mouth is destroyed by the disease, adding that the treatment will require plastic surgeons and other dentists to fix the teeth and rearrange them, including speech therapists, all of whom are present at the National Hospital. A representative of Hilfaskion Noma, Ute Winkler Stunpf, the family that is financing the NOMA centre, in her remarks, appreciated the support received from the officials of the National Hospital and Federal Ministry of Health that resulted in the successful take off of the project.

She confirmed that her organization has taken the responsibilities of building and equipping of the treatment facilities as well as offering the treatment and support services to Noma patients. According to the Hilfaskion Noma team, the National Hospital project is the largest to be embarked upon by the team even from its initial conception.

VIP WING LIKE A 5-STAR HOTEL

One of the major challenges Nigeria has is the amount of money the citizens spend on health tourism. The National Hospital rose to the challenge by repackaging its section meant for the well- to do and high- profile patients who are used to the ambience of elitist foreign hospitals. This led to the VIP Wing of the Hospital being remodeled in 2018.
The Chairman Governing Board of Abuja National Hospital Rt Hon. Olubunmi Patricia Etteh inaugurated the renovated VIP Wing of the hospital. Etteh, at the event revealed that the wing was in addition to the already existing six standard wings aimed at curtailing medical tourism and brain drain. She said the wing could be compared with what was obtainable in Europe and America, among other countries, due to the standard of the facility. According to her, there is no medical check-up or care that anybody will want to do outside the country that is not available in the hospital, especially in terms of staff and equipment. She said that “the board and hospital management discovered that for us to achieve this, we have to put our VIP section in place.
“It has been rehabilitated in such a way that there is no point for anybody to start thinking of going abroad. “The amount we are charging here is very low, compared with the airfare not to talk about the exorbitant charges for each consultation for medical care abroad.

The hospital board chairperson compared the wing with a 5-Star Hotel in terms of equipment. She said “we believe that if we have such facilities in the country, Nigerians will not bother travelling abroad for medical check-up anymore. Dr Jaf Momoh in his own words said that the facility was specifically meant to attract and discourage people from travelling abroad for medical care to explore services available within the country. Dr Momoh described the wing as a centre of excellence, emphasised that it
makes provision for those who wanted the best in healthcare.

According to him, the upgraded wing can cater for six patients at a time on admission and it is majorly to provide healthcare for people who complain that government hospitals are dirty or filthy. He added that “this upgraded executive wing is in addition to the already existing six standard VIP wing.
“What we are doing is to make sure we match the place with excellent clinical services and attitudinal change on the part of the staff for improved care and services. “This is because we believe that our attitude and clinical skills and training will ensure patients’ satisfaction.”

STAFF TRAINING, RETRAINING AND WELFARE

One area which however has been topmost in the attention of the management and board of the National Hospital Abuja has been the prioritization of welfare of the staff of the Hospital. To the credit of the management team, issues of labour unrest, have become a thing of the past in the
hospital. Some of the achievements in this regard include implementation of skipping, payment of promotion arrears, payment of rent arrears en-bloc, acquisition of land for NHA Staff housing scheme, management support for acquisition of Housing units for staff in various estates, subsidizing of medical bills to staff on treatment of critical medical cases.
To the credit of the hospital management, even when the hospital cannot health challenges involving their staff they pick the hospital bills of such staff. One case that falls under this category include that of a staff that had to go for an eye operation at the National Eye Centre. Another example was the case of a staff who had to go for a surgery in a private hospital and
the cost was borne by the National Hospital. This is despite the fact that all the staff enjoy waiver if they come for treatment at the Hospital, while not discountenancing the fact that they are also registered for the National Health Insurance Scheme by the National Hospital. Our investigations also reveal that the Hospital management agreed to new service guidelines for the staff. It was gathered that the issue of conditions of service had been on for some time but the grey area had been the exit package for workers, that is disengagement allowance for those who are retiring. Staff of the hospital demanded for exit package like it exists in special organisations like NNPC, FIRS, CBN etc. even when management told them that such exit packages were part of the laws of such organisations, staff insisted and eventually had their way as the Board of the hospital approved some amount which can be generated internally. This, we gathered is not going to be backdated as the cost of such a move could be highly detrimental to the finances of the
Hospital.
If there is any area staff could of the National Hospital can claim to have enjoyed working under the management of Dr Jaf Momoh -Led management it is in the area of staff training and retraining. The hospital is believed to have trained over 200 resident doctors to consultant level, and over 2,000 interns in various fields. The hospital has become a postgraduate training ground for doctors.

Before now, University of Ibadan was the only Examination Centre in West Africa, but the National Hospital has since joined and to cap it all, over eighty per cent of the of the candidates are now examined by the Hospital now.
The hospital witnessed expansion in its facilities, such as the building of the country’s first ever Trauma Centre. The Centre, which was built during the administration of President Goodluck Ebele
Jonathan, has continued to treat serious emergency and accident cases.
It is to the credit of the administration of Dr JAF Momoh as CMD, Dr Peter Egwakhide as the Director of Administration and Patricia Etteh as the Chairman of the Board that staff promotion has been fast-tracked in the Hospital. For instance, for the first time, the number of nurses now on Assistant directors level is now more than 40 from less than 5 it was before, with at least 2 making the Deputy Director no level. Indeed, over 150 staff are promoted annually at a pass rate of 80% of eligible staff. All in all, nearly 92% promotion of staff has been achieved since 2015.

This includes conversion and proper placement or upgrading of staff once they have additional or qualifications. There is no doubt that all these have bode well with the staff who are also appreciative.

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