Despite the N13.59bn budgetary provision for the State House Clinic in the last five years under President Muhammadu Buhari, the facility appears 'unfit' to treat his Chief of Staff, Abba Kyari.

The State House Clinic is meant to treat the president, the vice president, their families and other staff of the presidency.

Kyari, who tested positive for the COVID-19 after a trip to Germany, allegedly shunned the State House Clinic and the special coronavirus treatment centres in Abuja and moved to a private hospital in Lagos.

Credible sources told Daily Trust that the chief of staff to the president opted for Lagos to get a better treatment for the COVID-19 and other complications because of the deteriorating nature of the State House Clinic.

"Facilities at the State House Clinic have been deliberately grounded because of some policies and political intrigues while some equipment could not function because their subscriptions at the factories they were manufactured abroad have not been renewed," one of the sources said. "The hospital is not functioning the way it should function because several reagents are also not available," he said.

Another source said, "The status of the hospital has been changed, it is now not bigger than any primary health care centre... Therefore, there are certain surgeries or consultations that we cannot carry out even if we have the manpower and the facilities." Asked to give more details on the status of the hospital, the source said, "It is not higher than a primary health care centre... Of course we have the doctors, the nurses and other specialists, but the facility cannot take charge of some ailments because of what I told you earlier.

"The issue of its status in the eye of the powers that be is that it is just a clinic meant to attend to a select group. May be this is why the chief of staff to the president moved to Lagos," he said.

How villa clinic was reduced to 'primary' health facility

Daily Trust recalled that the change of status of the villa clinic came to the fore during the budget defence of 2019 by officials from the presidency.

The then Permanent Secretary of the State House, Jalal Arabi, at the budget defence before the Senate Committee on Federal Character and Inter-Governmental Affairs, on Monday, April 1, 2019, said President Buhari had directed that the State House Medical Centre (SHMC) revert to a clinic to serve the original purpose for which it was established.

A statement issued by Attah Esa, Deputy Director (Information), State House, quoted the permanent secretary telling the senators that, "without prejudice to what is currently obtainable at SHMC, the intention to revert to a clinic is a presidential directive. This is to make sure that the facility is functional and serves the purpose for which it was established, ab initio."

Arabi also told journalists after the budget defence that the reversion of the centre to a clinic was a case of "cutting one's coat according to one's cloth."

He said, "It was initially meant to serve the first and second families and those working within and around the villa. The overstretching of facilities at the medical centre by patients is some of the challenges the centre have been going through. It wasn't meant for that purpose.

"Nobody was charging anyone for any services and relying on appropriation means we will depend on subvention when it comes to run the Centre. Whatever comes is what you utilise and if the last patient comes in to take the last drugs based on the last budgetary release, that is it and we have to wait till another release is done.

"But this new development means that services will be streamlined to a clinic that will serve those that it was meant to serve when it was conceived," Arabi said.

Little patronage from targeted patients

President Buhari and his family are known for shunning Nigeria's underfunded hospitals, including the State House Clinic, to get medication abroad.

The president was widely criticised for spending more than five months in the United Kingdom in 2017 despite his repeated promise to end medical tourism.

"Despite the restriction on foreign trips, most key government officials who have resources at their disposal still prefer to go to private hospitals here in Abuja and in Lagos instead of the State House Clinic," a source said.

"Some of them are mounting pressure on the National Hospital and some of the government hospitals in Abuja because they don't have the option of going abroad. This is the time for them to reflect and make the system work, there is no place like home. The State House Clinic is a world class facility, it is only suffering because of the interest of some people," he said.

Kyari had said in a statement that he made his "personal care arrangements" to avoid further burdening the public health system which faces many pressures. His decision to go for "special treatment" without two of his aides who had contracted the virus as a result of their contact with him also remained a subject of discourse in many quarters.

Kyari had also been criticised for violating the World Health Organization (WHO) and National Centre for Disease Control (NCDC's) guidelines for his refusal to self- isolate after returning from Germany.

Besides, sources said the fact that he went to a private facility in Lagos instead of any of the government's designated isolation centres violated the norm.

"This could put other people at risk considering the contagious nature of the virus," sources said.

Daily Trust reported how Kyari mingled with the president, cabinet members, governors and officials of the ruling APC and other elite before he was found to be positive for COVID-19, raising fears that he might have exposed several others to the virus.

The chief of staff to the president was reportedly flown to Lagos in an air ambulance, and the location where he is being treated has not yet been made public. The Lagos State Commissioner for Health, Prof. Akin Abayomi said on Tuesday last week that he had "exchanged messages with him (Kyari) via WhatsApp but did not know his whereabouts. When asked about Kyari's refusal to receive treatment at a public facility, a presidency source told our correspondent to only ask him "about the president."

Budgetary allocations for villa clinic

Since the inception of Buhari's administration, a total of N13.59 billion has been budgeted for the State House Clinic, Daily Trust reports. Analysis of federal government's budgets showed that the funds were appropriated from 2015 to 2020.

A breakdown of the total budgetary provisions within the period showed that N3.94 billion, N3.87 billion and N3.20 billion were budgeted in 2015, 2016 and 2017, respectively.

In 2018, 2019 and 2020, the budgetary provisions dropped to N1.03 billion, N823.44 million and N723 million, respectively.

It is not clear what percentage of the money has been released to the hospital and whether it has been fully utilised or mismanaged.

During the 2019 budget defence, Arabi told the Senate committee that the villa hospital had a total budget of N1.03 billion in the 2018 appropriation, with N698 million as capital expenditure and N331.7 million as overhead cost.

He said the total overhead expenditure released for the centre from January-December 2018 is N331.7 million, representing 99.9 per cent while the capital releases on projects is N231.9 million, representing 33.2 per cent. Findings revealed that unavailability of medicines still persists in the hospital.

Buildings at the clinic also require facelift with sources saying the infrastructure did not have an overhaul for some time now due to budgetary constraints. "A general renovation would go a long way in supporting staff to deliver excellent medical support to patients," one of the sources said.

The Chief Medical Director of the clinic, Dr. Hussaini Munir Yakasai did not respond to calls sent to him at press time to comment on how they were coping at the facility.

As at 2017, the clinic reportedly could not boast of basic things. The situation was such that the wife of the president, Hajiya Aisha Buhari, said the hospital could not boast of syringes during her visit to the hospital. The president's daughter, Zahra Buhari also claimed via her social media handle that the hospital could not provide ordinary paracetamol.

CSOs demand probe of spending on clinic

Some campaigners have started calling for a probe, saying the budgets for the State House Clinic over the years must be investigated because they could not be justified since the hospital was not delivering the purpose it was meant for.

The Civil Society Legislative Advocacy Centre (CISLAC), the Transparency International Nigeria (TIN), and the Resource Centre for Human Rights and Civic Education (CHRICED), have expressed dismay over the state of health facilities in the country.

They were reacting to the billions expended on the State House Clinic, which cannot allegedly take care of the health needs of Kyari, leading to his being taken to an unnamed private hospital in Lagos.

CISLAC's executive director, Auwal Musa Rafsanjani, said "Nigeria has only two doctors per 1,000 citizens and 0.5 beds per 1,000 citizens.

According to him: "Health personnel are unable to effectively deliver essential services. In addition, over 90 per cent of the Nigerian population is without health insurance coverage and cannot afford even basic health care.

"CISLAC's long-term experience in the health sector shows the inability to effectively address numerous public health challenges. Corruption, limited institutional capacity and an unstable economy are major factors responsible for the poor development of health services in Nigeria.

"If the N13bn has been actually used for the State House Clinic, the situation would have been different and same applied to the general health sector in the country," he said.

"Those it was meant to serve are still spending taxpayers' money to seek treatment elsewhere," said Human Rights campaigner, Dr. Ibrahim M. Zikirullahi.

Zikirullahi said it was unjustifiable that the State House Clinic would be gulping billions of taxpayers' money and those the facility was meant to serve would still be spending millions to seek treatment in other private facilities within and outside the country. He therefore called for a comprehensive audit of the spending on the facility and of the health sector in the country.

The President of Nigerian Medical Association (NMA), Dr. Francis Adedayo Faduyile, said despite its huge natural resources, Nigeria's health system is very weak and could collapse in the event of a large outbreak.

He recently told Bloomberg that "the health system is not strong enough," saying "Over the years, it has been denied normal funding and things are not where they supposed to be."

According to him, "If the burden of the coronavirus is added, it (health system in Nigeria) may be too heavy, it may actually collapse." (Daily Trust)

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