SPECIAL REPORT: Abuja’s health facilities insufficient to address rising population

Kingsley Ugochukwu was asleep sometime in March 2023 when his phone rang. It was 2 a.m., and the female voice on the other end of the call asked him to come to the University of Abuja Teaching Hospital in Gwagwalada, where his pregnant wife was admitted.

The doctors needed his consent for a major medical procedure. However, Mr Ugochukwu could not make the 44-kilometre journey to the hospital because he had no means of transporting himself there that night. Also, security challenges in the Federal Capital Territory (FCT) make such a journey risky, even if he had a private vehicle.

“That very day, I thought, ‘anything can happen’. Even the doctor called me to come; I told him I could not because it is very far,” Mr Ugochukwu told PREMIUM TIMES in an interview at his shop where he sells phone accessories in Kapuwa, Lugbe, a satellite town along the Umar Yar’Adua Expressway, also called Airport Road, in Abuja.

Mrs Ugochukwu would not have needed to be taken to Gwagwalada if a secondary healthcare facility was close to where the family lives in Lugbe. She started bleeding late in her second trimester. At the nearest primary healthcare facility, the bleeding did not stop. She was advised to seek care at a general hospital 29.1 kilometres away in Kuje Area Council.

“At the AMAC hospital, they could not stop the blood flow,” her husband recalled. “They even asked me to sign a paper to remove the baby under six months — a 50/50 chance, they said, but my mind did not accept the instruction from the doctor. I said no, I am not interested. Then, I took my wife to Kuje General Hospital, but they directed us to Gwagwalada, where she stayed for three weeks. Since then, I use Gwagwalada – myself, my children, and my wife,” Mr Ugochukwu said.

“I did not enjoy the service at the AMAC hospital, even Kuje. Despite the availability of doctors, I did not enjoy the service. The way they treated people, I did not like it. Later, one doctor advised us to go to Gwagwalada.”

To access healthcare services, Mr Ugochukwu and his family travel to Gwagwalada and endure long queues before seeing a doctor. For him, they do not have a better option. When asked what he would do in an emergency at night again, he responded, “I don’t know what I am going to do.”

Many in Abuja, Nigeria’s capital, can relate to Mr Ugochukwu’s story, particularly those living in the satellite towns. They travel long distances to access care due to insufficient secondary healthcare facilities in the territory.

The FCT is expanding faster than the government can provide social amenities. According to data from the National Population Commission, Abuja’s population as of 2007 was 1.48 million. The estimated figure as of 2022 was above three million people, which means the population has more than doubled in the last 17 years.

The population growth rate and rapid urbanisation demand considerable investments in infrastructure like healthcare facilities, roads, schools, and other essential services.

As the cost of land and housing rises in the municipal area, residents are moving to the satellite towns, particularly along the Umar Musa Yar’Adua Expressway, in search of affordable accommodation. The axis has grown exponentially in the last few years, with gated estates dotting the landscape. Places like Lugbe, Aco, Gosa, Sabo Lugbe, Kichingoro, and Karamajiji now have more people living in them.

However, patients living in those areas who cannot pay out-of-pocket for care at privately owned clinics must make the long journey to Wuse, Asokoro, Maitama, Kuje, and other public secondary healthcare facilities.

Administration of the FCT

The federal capital is administered by the Federal Capital Territory Administration (FCTA), headed by a minister appointed by the president. According to section 299 of the constitution, the FCT has the status of a state with its six area councils – Kuje, Gwagwalada, Abaji, Kwali, Bwari, and Abuja Municipal – the equivalent of local government areas.

The FCTA, through the FCT Hospital Management Board, provides public secondary healthcare, while the area councils are in charge of primary healthcare facilities.

The FCT has 15 secondary healthcare centres.

These are Asokoro District Hospital, Maitama District Hospital, Wuse General Hospital, Kubwa General Hospital, Bwari General Hospital, Kuje General Hospital, Abaji General Hospital, Kwali General Hospital, Karshi General Hospital, Gwarinpa General Hospital, Nyanya General Hospital, Robochi General Hospital, Karu Mental Health Rehabilitation Centre, Zuba Cottage Hospital, and Garki General Hospital (managed by a private firm under a Public Private Partnership).

An infography showing the disparity in budget allocation among general hospitals In the Federal Capital Territory (FCT).

Experts say the allocation of these hospitals did not anticipate the current geographical realities of the FCT. While the hospitals are spaced across the FCT, the administrators have yet to respond to the needs of new communities. Lugbe Federal Housing, where thousands of people live, does not have a public primary healthcare facility, let alone a secondary facility.

“I use Wuse General Hospital. To go to the hospital, I ride a bike (from Kapuwa) to the Police Signpost, take a vehicle to Wuse, and finally, a taxi to the general hospital. There is no direct vehicle to the hospital. At the hospital, the crowd is always much,” Chinyere Ogonna, a trader in Lugbe, told PREMIUM TIMES.

Several communities in Abuja, like Kado, Mpape and DeiDei face similar experiences as Lugbe. However, Lugbe’s case is unique because it was not included in the original Abuja Master Plan.

“Lugbe was initially not in the configuration of the city, it was just an extension of the satellite towns but then around 2007 or so the FCT Administration saw the need to include Lugbe as part of the city hence it is now in Phase 5,” Mukhtar Galadima, an official of the FCT Development Control Department wrote in an Op-Ed published on Daily Trust.

No Hope for the People of Lugbe in the 2024 Budget

In the past four years, the budget of the FCT has grown at a fast rate. In 2021, the entire budget of the FCT was N329 billion. It jumped to N607 billion in 2022 but fell to N579 billion in 2023. In the 2024 fiscal year, it again jumped to N1.2 trillion. All those exclude supplementary budgets.

This newspaper’s review of the 2024 budget shows that the government needs to prioritise expanding access to secondary healthcare in the FCT. In the capital component of the budget, the government allocated nothing for the development of the Satellite District and the FCT Semi-Urban District Hospitals.

In the budget, N10.42 billion was allocated to the Health and Human Services (HHS) Secretariat. However, no breakdown exists to show what the funds are meant for. PREMIUM TIMES wrote a Freedom of Information (FOI) request to the FCTA for details of the line items in the 2024 budget, but the ministry has yet to respond several weeks later.

People in Lugbe and its environs may have to continue taking long trips to access medical services. Many people in the community said they go to Asokoro District Hospital, Maitama District Hospital, and Wuse General Hospital, the three main public secondary healthcare centres in the city centre, because they are the closest and have relatively good services.

Wuse General Hospital, Abuja, where Mr Salem’s remains were found on Thursday by the police.

A review of the budget of the FCT shows that this quality is a product of the better funding the three hospitals get compared to their peers located outside the city centre.

This is a pattern in the administration of the FCT, where resources are concentrated at the city centre and other parts of the territory are neglected.

In the 2024 budget, Asokoro District Hospital got N2.7 billion as personnel costs and N215.4 billion for overhead, totalling N3 billion. Maitama District Hospital got N2.2 billion in personnel costs and N215 million in overhead costs, making N2.4 billion, while Wuse District Hospital got a total of N2.6 billion.

In contrast, the ten semi-urban district hospitals and satellite district hospitals combined got N9.7 billion as personnel and overhead costs.

On average, the semi-urban and satellite district hospitals got N970 million each as overhead and personnel costs, about one-third of what was allocated to Asokoro District Hospital.

Isaac Akerele, a medical doctor who spoke with PREMIUM TIMES in a phone interview, said the distortion of the city’s master plan created the crisis. He argued that had the plan been followed, a proper hospital would have been provided along the airport road to expand access and address the population growth in the area.

“We need to be able to get back to the original plan. Because of certain challenges like insurgency in the North-east and North-west, there has been a lot of migration towards the south and the centre (Abuja). This has resulted in a population explosion in the city, which the infrastructure and pace of development cannot cope with.

“When there is a population explosion, essential services will suffer. Abuja has a master plan, and if this master plan had been looked into and reviewed, the administrators would have been able to know what is needed. Along the airport road, the population explosion is so huge, and yet, access to healthcare services is a mirage to the people. They depend on high-cost private healthcare centres, which are not properly equipped,” he said.

He stated that there is no political will to tackle the problem and called for the option of a public-private partnership to fill the gap.

Garki General Hospital and Federal Medical Centre in Abuja run on the PPP option suggested by Mr Akerele. However, many residents consider services at the two hospitals expensive.

Overcrowding at Wuse Hospital

This uneven distribution of resources is also putting pressure on the Asokoro, Maitama, and Wuse District Hospitals. When PREMIUM TIMES visited the district hospital in Wuse, the reporter observed crowds of patients. Those interviewed lamented that they spend long hours before they see doctors.

The influx of patients is not just from the satellite towns; some are from neighbouring states like Niger and Nasarawa. Primary healthcare centres in Mararaba and other communities refer patients to Wuse, Maitama, and others.

Abdullahi Hassan lives in Mararaba in Nasarawa State but receives care at the Wuse Hospital. He said coming to Wuse is more convenient than options available in Nyanya and other places.

PREMIUM TIMES visited the FCT Hospital Management Board in May to get a reaction to this story, however, the management directed us to write an official letter.

On 10 June, this newspaper submitted a Freedom of Information (FOI) request to the board. The request asked for details on all publicly-owned secondary healthcare facilities, including their establishment dates, any plans for establishing additional facilities along with the associated timelines, and data on the usage of these facilities, including waiting times.

However, the board has failed to respond to our enquiries, in violation of the FOI Act.

Fortunately for Mr Ugochukwu, his experience did not end in a tragedy for his family. The baby boy his wife delivered at Gwagwalada Teaching Hospital marked his first birthday a few weeks before the conversation with this reporter.

However, the problem persists. Only when the authorities have a deliberate policy change will taking long trips to access healthcare services stop being a problem for many people in the new communities of the FCT.

The story was supported with funding from the Centre for Journalism Innovation and Development (CJID)