Nigeria’s healthcare on crutches, By Tajudeen Kareem

 

Since 27th November, 2024, the nation’s premier tertiary health institution, University of Ibadan Teaching Hospital (UCH) has operated without electric power supply.

Rather than address this problem, the Nigerian government finds it more important to distribute N4 billion to the so-called poor citizens. Also, on its top priority is sharing rice palliatives to students in tertiary educational institutions; students who are forbidden to cook in their hostels!

Who is thinking for the Federal Government? How do Ministers relate with the President, and what options do they consider in tackling emergent challenges? What is the essence of governance!

Last Wednesday, 29th january, 2025), students of the College of Medicine at UCH, Ibadan staged a peaceful protest over the persistent blackout at the institution.

The Students Union President, Bolaji Aweda said the protest became necessary following the expiration of a seven-day ultimatum given to the management of both University of Ibadan and UCH.

Aweda, who alleged a powerplay among the stakeholders, added that the lack of electricity had lasted over 82 days. The situation was affecting the living conditions of students and their academics, making them unable to function well.

“Our demand is the immediate restoration of power to UCH and other hospitals currently facing a similar situation.

“We desire the implementation of the 50 per cent electricity tariff discount announced by the Ministry of Power in August 2024 and the reform of the health sector in Nigeria.

“If UCH, the foremost healthcare hospital in Nigeria, is in this bad shape, one can imagine what other health institutions in the country will look like,” Aweda was quoted in reports in the media.

On the heels of the Ibadan protest, the Association of Resident Doctors, ARD, at the seat of power, FCT, commenced a three-day warning strike over unpaid salaries, allowances, and other demands. The strike grounded activities in government hospitals in Abuja.

The President of ARD FCTA, Dr George Ebong, said the strike came after a three-week ultimatum issued last year by the doctors had elapsed even as he decried the neglect of hospitals and doctors’ welfare in the nation’s capital.

Ebong likened doctors in Abuja, albeit in all government-owned hospitals, to abandoned projects, calling on the Minister of FCT, Nyesom Wike to intervene to avoid an indefinite shutdown of hospitals.

“The three-day strike is being implemented across all government hospitals in Abuja—from Wuse to Asokoro, Maitama, Kubwa, Zuba, Kwali, Abaji, Nyanya and all other hospitals in Abuja.

“We gave the government a three-week ultimatum to meet our demands, and after that, we met with them and dialogued on several occasions. They pleaded for two weeks, but after that elapsed, nothing has been done. Not even the minimum thing.

We expected them to pay for the six months of unpaid arrears to doctors,” said Ekong.

Healthcare as Priority

The problem of electricity supply at UCH dates back to 2019; attributed to dwindling government subvention for an hospital that treats minor ailments as malaria and cough, but unable to charge patients commensurate rates. While management struggled to meet up with bills, matters got out of hand when the Minister of Power rolled out discriminatory tariff. Hospitals and educational institutions in urban areas were classified under Band A consumers. Band A electricity tariff across Nigeria is N209.50 per unit and N1000 gives only four units or thereabout.

The Chief Medical Director of UCH, Prof. Jesse Otegbayo said despite efforts to meet its obligations, the Ibadan Electric Power Company, IBEDC, has remained adamant in charging the highest rates and is unfazed by the humanitarian services

rendered by the nation’s premier tertiary hospital.

The DisCo last year disconnected the hospital several times citing unpaid accumulated debts.

“We made efforts to pay since IBEDC forced us on Band A. Our bill for one month jumped to N99 million. We paid N60 million, but they refused to reconnect us. We offered to pay current charges and defray the accumulated over time, but IBEDC rejected the offer,” said Otegbayo.

An analysis of payment schedule offered by the UCH indicates that the power company sent a bill of N723 billion from January 1, 2019, to November 10, 2024 while the hospital paid N676 billion. “The distribution company has, against all entreaties, categorised this hospital as a business concern”, the CMD lamented.

The hospital management, in a memo circulated on November 5, acknowledged the “chaotic and unbearable experience” arising from the disconnection by IBEDC and pleaded with staff, students and patients to exercise patience while alternative power sources are being strengthened.

“Management has initiated the process to ensure that power is restored to the hospital as soon as possible. Nonetheless, provision of alternative power supply to some critical areas in the hospital, with priority to the service areas which are in high demand, has been put in place through generators and solar panels/inverters, as well as pumping of water to all areas of the hospital,” the memo explained.

Before the UCH got permanently cut off on 27th November, it received an average monthly electricity bill of N85m, even with some downtime. “The highest bill we have had is N98m in a month after the hospital was migrated to band A tariff”, said Otegbayo.

On January 13, the CMD wrote IBEDC proposing a payment plan for the current and outstanding electricity bill for UCH. Otegbayo’s letter reads: “Management of the University College Hospital, Ibadan, writes to appreciate you for your understanding and willingness to reconnect and restore power to the Hospital.

“However, having considered the financial capacity of the Hospital, I write to inform you that the Hospital is willing to pay the sum of N25,000,000 (Twenty- Five Million Naira) monthly on the outstanding bill in addition to the current bill on monthly basis.

“In view of the above, we seek your understanding and kind consideration of our Request”.

Two days later, the Managing Director of IBEDC, Eng. Francis Agoha replied in a stone-faced manner:

“I am writing in response to your letter dated January 13, 2025, regarding the proposed payment plan for the outstanding electricity bill of N373.8 million owed by the University College Hospital (UCH) to the Ibadan Electricity Distribution Company.

We appreciate your prompt communication on this matter and the discussions held during the recent meeting.

“After careful consideration, we regret to inform you that the proposed repayment plan of N25 million monthly, in addition to your regular energy bills, is not acceptable. As discussed in our meeting, we require a 50% down payment of the total outstanding amount before reconnection can occur. The remaining balance can then be settled in equal instalments over the following two months, alongside your regular energy charges.”

How UCH is surviving

An exasperated Otegbayo has written dozens of letters to the powers that be in Abuja, pleading that the hospital be 1) removed from Band A billing, 2) government fulfils a pledge to pick half of the monthly bill from IBEDC and 3) that the facility be considered for a more sustainable and realistic power grid.

But while several promises remain in the pipeline, UCH management is scratching its head to cope with the current challenges by embracing solar devices to light up the wards and clinical areas of the hospital. That option has enabled the hospital offer skeletal services to avoid complete shutdown.

The Federal Government has, among many options, promised to provide federal education and health institutions with solar-powered mini grids.

While the Ministers of Power and Health are holding endless meetings and junketing, the managers at UCH are digging deep to salvage the prestige of the institution which has produced no fewer than 6,000 doctors and 4,513 nurses.

“We have different groups indicating interests in assisting the hospital with alternative power supply. Some have donated/supported the installation of solar power systems,” said the UCH Energy Committee Chairman, DR. Micheal Obaro.

The UCH is also considering separating the College of Medicine, which trains doctors and nurses from its power grid. “The College is an arm of the University of Ibadan which has its budget separate from the hospital, we think they should carry their burden”, said Otegbayo.

Headaches Across the Country

The travails of UCH are not unique. Several health and educational institutions owned by the Federal Government are suffering similar fate.

For many days last year, the Lagos University Teaching Hospital, LUTH, was severally left in darkness when power was disconnected by the Eko Electricity Distribution Company.

Similarly, in July 2024, students of the University of Benin, had to cry out after suffering discomfort from the disconnection of electric power to their campus. They took to the streets, hampering vehicular movements to voice out their lamentations.

The students were barely two weeks away from their examinations, yet had no electricity to study after lectures. They demanded a 24-hour electricity supply. The authorities could not meet the demand, so they shut down the university indefinitely.

Apparently, the university was thrown into darkness following its inability to reach an agreement with the Benin Electricity Distribution Company over contentious electricity billing. The institution which regularly pay N80 million monthly was suddenly slammed with a bill of N280 million because of the upward review of electricity tariff.

The Ahmadu Bello University, Zaria, was not left out in this as it lamented the hike in electricity tariff, saying it cannot afford the N3.6 billion annual electricity bill.

The bill averages N300 million monthly, when the facility was classified as Band A customer by the Kaduna Electricity Distribution Company, KEDCO.

In a letter signed by 40 Professors sent to President Bola Tinubu over the looming energy crisis at ABU, the institution called for intervention and suggested that universities should be shielded from the extremities of commercialization.

The professors suggested alternatives; either the government pay the cost of electricity as part of its overhead grant or, use its 49 per cent shareholding in the electricity companies to direct them to supply universities uninterrupted power supply in exchange for tax credits.

A third suggestion is to mandate the electricity companies to introduce a dedicated social tariff band with rates the universities can afford.

Negative impact of electricity disconnections

The effects of incessant power cuts are severe. Lecture halls without lights, computer labs with idle screens, and research projects left incomplete. For students, this translates to disrupted classes and an inability to access essential resources.

For faculty, it means an environment where teaching and research are continually compromised.

Indeed, the Committee of Vice Chancellors of Nigerian Universities recently warned that if nothing drastic is done, about 52 federal universities may collapse in the country soon over the recent hike in electricity tariff which has automatically increased their overhead costs.

The VCs urged the Federal Government to provide a concessionary electricity tariff rate for the universities.

Coping mechanisms

The management of LUTH has stepped up efforts to embrace alternative energy solution. It is investing in renewable energy, especially solar energy to solve the problem of unreliable and inadequate electricity supply to the hospital.

“Before the deployment of solar devices, the hospital bill on the average was about N180m while we were using our Independent Power Project. LUTH was generating electricity herself with 24/7 supply.

“Presently, our bills have reduced to around N110m on the average. Hopefully, when critical areas of the hospital are fully on solar energy, the bill will drop to an average of N60m per month, that is the aspiration and target of the hospital management”, said Professor Wasiu Adeyemo, the CMD.

Mr Femi Numa, managing director of Taranis Novus Limited, energy solution provider to LUTH said the company has provided an all-in-one 20kw/40kwh energy solution based on solar renewable energy which ensures that medical and healthcare facilities would never be saddled with blackouts or power outages.

Presently, all clinical areas are covered either by dedicated generators or solar power. Patients can now attend their clinics, have access to facilities in the laboratories, blood bank and emergency services. The hospital has deployed solar inverters to cover critical sections including Adult Emergency and Children Emergency, Labour Wards and Labour Ward Theatres, Neonatal Unit, the Blood

Bank and intensive care unit, and the Alima Atta Cancer Centre.

The Aminu Kano Teaching Hospital, AKTH, relies heavily on the national grid, solar energy, and diesel-powered generators to sustain its operations, but the rising cost of electricity and diesel has placed immense financial pressure on the institution.

Dr. Dalha Gwarzo, the Deputy Chairman of the Medical Advisory Committee in charge of clinical services at AKTH, said the hospital is 100% dependent on the national grid.

However, the national grid collapsed about 12 times in 2024 alone, further worsening the hospital’s electricity supply headache. These frequent collapses have forced AKTH to rely heavily on generators and solar energy to sustain critical operations.

“When the grid collapses or when we don’t receive adequate power from it, we have no choice but to rely on solar energy and generators to keep things running.

Unfortunately, not all sections of the hospital are powered by solar, so we frequently depend on generators, which come at a significant cost”, said Gwarzo.

He disclosed that the hospital spends between N70 to N80 million monthly on diesel to power generators, a cost that continues to strain its financial capacity. In addition,AKTH struggles with settling its monthly electricity bills from KEDCO. Gwarzo explained that while the hospital’s monthly electricity bill ranges between N90 to N100 million, it can only manage to pay 50% of this amount. This shortfall has led to the current N600 million debts owed to KEDCO.

“KEDCO has now informed us that they will no longer accept part payments and will require full payment of our monthly bills moving forward”, Gwarzo added.

AKTH is classified under Band A, which means the hospital is expected to receive at least 20 hours of electricity daily. However, this target is often unmet, especially during the hot season from March to June, when power supply can drop to as low as 10 to 13 hours per day.

The unreliable electricity supply and financial burden have forced the hospital to adopt load-shedding measures. Gwarzo said a task force was raised to monitor and ensure that devices such as fans and air conditioners are turned off when not in use.

Additionally, critical areas like the laboratory and diagnostic centres are prioritized for uninterrupted power supply, while non-essential areas experience frequent power cuts.

Despite these measures, Gwarzo admitted that power issues still lead to occasional delays in surgeries and medical procedures.

Looking ahead, Gwarzo is enthusiastic on the promise by the Federal Government to provide renewable energy solutions, particularly solar power, to sustain critical areas of the hospital. “We hope this promise will be implemented soon, as renewable energy is the only sustainable solution to our persistent electricity challenges”, he noted.

What the Federal Government is doing

Chapter Two, page 13 of the Nigeria Electricity Regulatory Commission, NERC, consumer protection regulation stipulates that: “A Distribution Company shall not disconnect electricity supply to any premises where it is aware that a life support machine is in use.

“Customers that have life support machines installed at the premises shall enter into an acceptable arrangement with the Distribution Company for the settlement of their bills and the Distribution may seek to recover any debt due from these customers by other legal means.”

Going by the provisions of these regulations, disconnecting a healthcare facility on the basis of non-payment of electricity bill must be regarded as a criminal act in contravention of the regulations of the NERC. But what are government officials saddled with these responsibilities doing to alleviate the sufferings of Nigerians?

The Federal Government recently unveiled plans to introduce an annual electricity subsidy of $600 million for all customers starting in 2025, as part of ongoing efforts to reform the country’s power sector.

Set to last until 2027, the subsidy aims to bridge the gap between cost-reflective tariffs and regulated electricity rates. It is also intended to help address the metering deficit and improve the financial stability of power distribution companies.

Nigeria’s Energy Compact plan states that this initiative is part of the broader initiative which aligns with the country’s electrification and clean energy transition goals.

Nigeria, along with Côte d’Ivoire, Zambia, and nine other African countries, presented their energy compacts at a two-day summit in Tanzania attended by President Bola Tinubu and focused on innovative energy solutions.

The subsidy plan is a temporary measure to ensure affordability as the government gradually moves towards implementing full cost-reflective tariffs.

The document notes that the subsidy could take various forms, such as a flat monthly amount per electricity customer or a subsidy for the first 50 kilowatt-hours used each month.

By 2027, the government plans to introduce a social tariff to protect low-income and vulnerable customers once the broader cost-reflective tariff system is fully implemented.

The government’s roadmap to full cost-reflectivity includes a $600 million per year

subsidy from 2025 to 2027, while the metering gap is closed, after which a full cost-
reflective tariff (except for vulnerable customers) will be implemented.

The electricity sector has faced financial sustainability challenges due to high technical and commercial losses, low tariff recovery rates, and liquidity issues.

Despite efforts under the Power Sector Recovery Programme, tariff shortfalls

reached N650 billion in 2023 and are projected to exceed N2.2 trillion in 2024.

The new subsidy scheme is aimed at providing temporary relief while ensuring that distribution companies meet their financial obligations to power generation companies and the Transmission Company of Nigeria.