The Infrastructure Concession Regulatory Commission believes that  Nigeria has about 195,000 km of road network. About 32,000 km out of these are federal roads, and 31,000 km are state roads. In total, we have  about 60,000 km paved and the remaining 135,000 km are untarred. Most of which are in a state of disrepair.

When two cities in two different states of the country are linked up by a road, that road is considered to be a Federal Road. This is a very broad definition that could get things complicated along the line.

When I see a long  expressway where vehicles run for hours, leading to another state,  it’s easy for anyone to say that the road is a federal road ; what makes it complicated then is when this road twists and bends into streets in a particular state. Under that situation, should the twists and bends within a state, used mostly by people in the state be also a part of what belongs to the Federal Government?

A typical example is the Portharcourt road Aba in Abia State,  which joins the Enugu/Portharcourt Expressway. Most of the commuters using the road are in Aba, the streets are in Aba, the small shops and businesses there are in Aba, in fact almost everything about the road is in Abia State for instance,  and yet the road is considered a Federal Road . This dilemma has left most roads in shambles for years leaving them in deep mess as these roads are not visible enough for the Federal Government since they are hidden in the streets within a particular state.

Another example is the Lekki/Epe Expressway. Located in Lagos, leads to different places in Lagos, and used mostly by Lagosians travelling to other parts of Lagos State. Yet, the apparent reason for it’s neglected state is the fact that it is considered the property of the Federal Government.

The States think the roads should be built by the ‘owners’ ,the Federal Government thinks they are close enough to the states to be one of their own. In this state of confusion, the roads suffer neglect and the citizens get the pain. 

In many developed countries around the world,  road projects are executed using monies and revenue generated from tax. If a particularly road was built using taxpayers money,  the road users are expected to use for free. Otherwise, toll gates are introduced. I know what heavy vehicles do to roads, and anyone who thinks that vehicles should not contribute to repairing the wear and tear they contributed on the road based on how heavy they are should kindly reconsider.

I have seen a newly constructed road get ripped apart by a low bed truck carrying an excavator, I have also  seen a newly constructed drain get wrecked by a fully loaded tipper truck parking just next to it. Though this may have more to do with the quality of execution than prolonged wear and tear still; it reminds us that vehicles deteriorate roads.

Hence, the reintroduction of toll gates on roads should be seen as a need to restore efficiency and the culture of sustainable development. In some countries private companies build roads and then introduce toll gates which helps in keeping the roads maintained.  Also roads built with loans collected from banks are also serviced by the revenue generated from toll gates.

What We Can Do

So then, as the nation contemplates on the big picture restructuring, whether or not the ownership of resources within a state should belong to the Federal Government or the State Government, they have to restructure the ownership of roads. State Governments should own, maintain and generate revenue from all roads within their topological boundaries with assistance from the Federal Government in critical cases. Also,  the members of the National Assembly should as a matter of urgency to try to do the needful. Then, there should be a total, I repeat! total expulsion of touts who neither build nor maintain roads from all government owned roads.

No government would be taken seriously by anyone if there are as many touts as there are potholes and gullies in their major roads.

I went to ESUTH University Teaching Hospital, Park-Lane, Enugu (popularly known as Park-Lane) recently. I got to the hospital shortly before 10 am and went straight to their NHIS records office so I can get my folders and go to the General Out-Patient (GOP) Unit to seek a doctor. When I got there (the Park-Lane NHIS records office), the crowd I saw that were waiting to be attended to was much. I felt discouraged. I was given a sheet of paper to write my name and wait for my turn, which will be according to my serial number on the ‘attendance sheet’. No problem; I wrote my name against number 69 (in attendance sheet C since A and B have been taken into the office) and sat down knowing that I’ll spend the whole day there.

When I looked around me, I realised I shouldn’t even complain because there were people that really needed immediate medical attention waiting on the line with me. Funny to say that what we were even waiting for was folders that we will take and then start the rigorous processes involved in seeing a doctor. We were not even sure we will succeed in seeing any doctor that day – as if I know already.

People were called in based on their serial numbers in the ‘attendance sheet’. Each set of people that go in to ‘prepare’ and pick their folders spend nothing less than 20 minutes before coming out and then giving chance for another set to go in. My turn came a few minutes to 12 noon and I walked out with my folder when it was some minutes to 1 in the afternoon. I got to the GOP Unit and there found another story to tell.

The nurses there refused to collect my folder and allow me to see a doctor because it was already late. It is not like the doctors have gone home (after all it was just 1pm), but the crowd there was so much that the nurses knew that all of them may not be able to see the doctors till it’s very late in the evening. Well, I didn’t argue; I didn’t even want to argue because what I saw there spoke for itself. Honestly, I was a bit relieved when the nurses asked me to come back the following day because I don’t think I would have wanted to sit down there wondering when a doctor will see me. But my small mind didn’t remind me that I may still come ‘late’ the following day.

I had this experience at Park-Lane, Enugu, but I know it is the same thing with most government-owned hospitals. To be honest with you, our health sector needs total overhauling. A lot of work needs to be done.

The essence of writing this article is to call the attention of those concerned to some of my observations, which may need to be addressed soon.

MY OBSERVATIONS
1. Wrong handling of confidential materials: This is not seen as something wrong in government owned hospitals, but I believe it is wrong for non-staff members to handle patients’ folders and files. When I said something about it at the hospital, a fellow patient told me that it is not the same thing with all sections. According to this person, this act is more prevalent in NHIS office, where the NHIS beneficiaries are expected to move their folders to and from the consultation areas (because they don’t pay much). But I believe it doesn’t happen only in NHIS records office because I saw other people moving around with theirs. I think hospitals need to look into this.

2. Delays and Waste of Time: I spent over two hours just to get my folder. The staff members in the office are actually doing their best, but then their best wasn’t enough. It is quite unfortunate that someone that is not healthy will be made to spend so much time waiting to be attended to. This is quite unfair.

3. Inability to See Doctors Easily: In as much as I was relieved that I didn’t have to stay any longer in the hospital (even if it means seeing a doctor), I still think the system made it hard for people to see doctors there. What then is the essence of someone going to a hospital if not to see a doctor (and to see him as soon as possible)?

I brought up this issue in the hospital and one of the patients there told me that if I don’t want to waste time seeing a doctor (that is if I will succeed in seeing one that day), I should go to the Emergency Unit and someone will definitely attend to me. But that I should be ready to pay heavily for the services. Anyway, I didn’t confirm that; but I hope it’s not true.

4. Large Number of Patients: Government owned hospitals have good doctors, and they are cheaper than private ones. For that, a lot of patients troop to their hospitals. But these hospitals find it difficult to manage this large number of patients. The waiting areas are always rowdy and filled to the brim, with some people standing, or sitting on make-shift seats. Sometimes I couldn’t help wondering if doctors actually have enough time to attend to all these patients very well.

Kindly note that I’m not against many people going to government owned hospitals (I use them too, you know); my own is that these hospitals should make provisions for the comfort of these patients, and ensure that they are well attended to.

5. Shortage of Staff: I think Nigerian health sector is understaffed. The workers I met in Park-Lane are really good, but they were over-stretched. One of the nurses at the GOP Unit was already antsy when I went there. She was yelling at patients, especially those that didn’t do as she instructed. I know that her approach was unethical but I didn’t blame her: she had more than she could chew and she didn’t know how to manage them.

THE WAY OUT
It is not enough to just observe the problems at our hospitals without finding out their causes and possible solutions. Well here are a few suggestions I can make based on what I’ve been seeing in most hospitals, especially government-owned:

1. Embracing ICT: I wasn’t impressed with the way patients folders were packed at shelves and on the floor at the NHIS record office. The worst is that when you want to collect your folder, they have to search through the shelves to bring it out, and then perform other ‘rituals’ involved in setting up a folder before a doctor is consulted. If someone’s folder mistakenly gets misplaced, or a paper falls out of it, a lot of records and information will get misplaced too. Besides, searching for folders the way they do wastes time.

But if these hospitals decide to store patients’ records and histories in their digital database, to be pulled up whenever they (the patients) visit, a lot of troubles will be saved. Someone needs to tell these Medical Directors about that.

2. Recruiting More Workers: There is no debating this: government hospitals should recruit more staff. These staff should be placed on shift-duties. I mean, I can’t come to the hospital for an urgent attention in the evening only to be told that NHIS office has closed for the day. And it is wrong to be told that the GOP Unit will no longer ‘accept’ patients because many are waiting to see doctors. Let the hospital management team do something about staffing in the hospital.