What, In the World, Is a ‘World-Class’ Hospital?, By Simbo Olorunfemi

Some of us have this penchant for simply throwing around words, concepts and phrases, which our arguments betray that we have little or no understanding of. There seems to be one for each season. ‘Restructuring’, ‘True Federalism’ are among those recently bandied around by many, even when their understanding of them appears to be less than well-grounded.

With the president’s illness, the talk of a ‘world-class’ hospital in Nigeria has again been propelled to the fore, as if the only consideration that comes into play in deciding where a patient is best suited to receive care is the state of its structure and facilities. Sometimes, variables such as the familiarity with care-givers, privacy and security might even be of greater consideration. But that is not even the point here. Rather it is what appears to be our obsession with so-called ‘world-class’ hospitals?

Even the Federal Ministry of Health, sometimes back, announced its plan for a ‘world-class’ hospital in Nigeria. The ministry said it had signed a tripartite agreement with America and France to build an American Specialist Hospital for women and children, at an estimated cost of $73 million, to “provide American standard of high quality health care and promote medical tourism in Nigeria.”

But then, what is it really with Nigerians and the so-called world-class hospitals? What, in the world, is a ‘world-class’ hospital? The more the phrase has been thrown around, the more I have found myself wondering: What really is this world-class hospital we are often desiring to build or, in some instances, claiming to have built?

What is the etymology of this phrase? I conducted a search online for ‘world-class hospital’ and, not surprising, what popped up was a history of usage of the phrase, which is largely Nigerian. The other related use I found had to do with India. No point guessing that must have to do with Nigerians searching for ‘world-class’ hospitals in that country, which has now become the preferred destination of many of us in search of healthcare. So, I hastened to conclude: the search for a ‘world-class’ hospital is more of a Nigerian thing. Our way of life, soft and hard infrastructure in Nigeria might be nothing close to ‘world-class’, but nothing has ever stood in the way of our desire for conspicuous consumption and construction of so-called world-class structures in our island of the phantom, surrounded by an ocean of poverty.

We throw words and phrases around without consideration of what they really mean. We seek to recreate superstructures we see elsewhere without willingness to accept or erect the substructure upon which they would sit. We fashion solutions without thoughtful contemplation of where we are, where we want to be, and how we want to get there. We simply want a ‘world-class’ facility like the stadium left to rot in Abuja and the under-utilised one in Uyo. It simply has to be ‘world-class’, irrespective of our peculiarities and the challenges that we are faced with.

What, really, is a ‘world-class’ hospital? Who says our problem is the lack of a ‘world-class’ hospital, if there is indeed anything like that in the first place? Where is the place of the so-called world class hospital in the hierarchy of issues plaguing the health sector in Nigeria? What percentage of our problem in health is tertiary in nature that we have to prioritise erecting edifices in the name of ‘world-class’ hospitals? Should our priority be that of catering to the ‘exotic’ challenges of the elite who have the means to access hospitals anywhere in the world, anyway, or that of addressing those basic challenges pulling us back to the bottom?

Of course, there is a place for the specialist centres, especially like the one proposed to have its focus on women and children; but would a more sustainable funding model not bring out the best in our teaching hospitals? Even though the ‘world class’ one proposed for Abuja is a public private partnership, one wonders though what $73 million, put at 11 billion naira, earmarked for the project, can do in kick-starting a bottom-up re-engineering of primary health care founded around community insurance.

But it has to be ‘world-class’ here. Still I wonder: Do we need a ‘world-class’ hospital to take care of the 100 million malaria cases and about 300,000 deaths we witness every year? Do we need a ‘world-class’ hospital to respond to the challenge of having the highest burdens of diarrhea in the world? The statistics out there are such that we should organise a ‘world-class’ day of mourning, but our people will rather have us build a ‘world-class’ hospital.

Here are the numbers: 37 percent of Nigerian children, under five years, have stunted growth; 23 percent of children between 6 to 23 months are underweight; over 90 percent of Nigerians are at the mercy of malaria attack, with over 100 million cases reported every year, and 300,000 deaths annually; 36,000 Nigerian women die in the process of childbirth, with 69 children out of 100,000 dying in the process of birth. UNICEF tells us these every single day.

Nigeria loses about 2,300 under-five year olds and 145 women of childbearing age, which makes the country the second largest contributor to the under–five and maternal mortality rate in the world. We are told that malnutrition is the underlying cause of morbidity and mortality of a large proportion of children under five in Nigeria, as it accounts for more than 50 percent of deaths within this age bracket. It also says that the death of new-born babies in Nigeria represents a quarter of the total number of deaths of under-five children across the world. The majority of these occur within the first week of life, mainly due to complications during pregnancy and delivery, reflecting the intimate link between newborn survival and the quality of maternal care.

Do we need a ‘world-class’ hospital to fix this? What makes a ‘world-class’ hospital? Fanciful structures, new-age equipment and cutting-edge technology? Where is the place of know-how in all of these? What have we done with maintenance of the basic structures we have, the equipment installed and management of the tools and expertise we presently have that we think our craving for ‘world-class’ hospitals will fix?

We have a history of private initiatives in this direction, don’t we? How have they done? How are they doing? Is there a surprise that they appear not to have been able to come off the ground? Governor Akpabio took it many notches high with his ‘world-class’ hospital in Akwa Ibom, but what has become of this? Has the hospital turned into another white-elephant project?

Does that not tell us something? Rather that think more at the primary level and focus on those who cannot afford care and universalise access, some of our people are throwing around words to cater for the exotic taste of the elite? Can such structures set up to cater to the needs of people who can afford Air Ambulance to ferry them out be commercially sustainable, given the preference here for anything foreign?

How is setting up a ‘world-class hospital of concern to the ordinary Nigerian when the question of access to primary health care has not even been resolved? Prof. Olikoye Ransome-Kuti showed us the direction we ought to go, but we have managed to steer our way more in the opposite direction, rather than find a way to consolidate gains made by finding a means to incorporate a sustainable financing model for community health care. But our people are talking about ‘world-class’ hospitals whereas what we mostly need are basic and functional centres powered though health insurance where people can have immediate access, irrespective of the state of their pockets. The cost of one such ‘world-class’ hospital will meet a myriad of yawning needs at the primary level to the benefit of millions at the bottom of the pyramid.

Our urgent need is not a ‘world-class’ hospital but a ‘world-class’ thinking that will generate solutions to bring about an improvement in the five dimensions of management capacity, regulatory processes, health infrastructure and financing, health systems, and policy conditions used by a group of experts for the assessment of Health Governance Capacity of countries, including Nigeria. What, in the world, is a ‘world-class’ hospital that we crave, rather than confronting what should be of paramount interest to us?

Simbo Olorunfemi works for Hoofbeatdotcom, a Nigerian Communications Consultancy and publisher of Africa Enterprise. Twitter: @simboolorunfemi