Maintenance management financing in public hospital built environment: a case study of south-western Nigeria

• Author: Adenuga, Olumide Afolarin

Introduction

The standards of public health services in Nigeria are generally perceived by members of the public as being very poor. Phrases such as “mere consulting clinics” and “mortuaries” are being used to describe many hospitals in Nigeria (Onifade, 2003). According to the author, the providers of health care services, themselves, are generally dissatisfied with the perceived quality of care and have for many years used their professional associations to demand increased government funding of the health sector. Government, on the other hand, has often expressed the view that it is not just increased funding, but the management of such funds that determine the quality of services in the public health sector. The author, in his findings, is able to document that the proper utilization of increased input resources can lead to an increase in the quality of services and, consequently, an increase in service utilization as well as an increase in client/patient satisfaction.

The corporate goal of every health institution is to provide patient care, produce medical and health manpower, and investigate health – related problems. In Nigeria, the University Teaching Hospitals (Reconstitution of Boards etc) Act Cap 463 LEN 1990 now University Teaching Hospital (Reconstitution of Boards etc) Act Cap U15 2004 LEN were established to train medical expertise in providing patient care, production of highly skilled medical and health manpower, provide daily public enlightenment and teaching of patients and relations in all their outpatient clinics and wards. All these can only be achieved in a conducive environment where adequate maintenance management of the existing buildings and their facilities is operating. According to Australian Industry Commission (1996), funding for public hospitals in Australia, comes from a number of sources. They are the Australian, State and Territory government, and workers compensation and compulsory motor vehicle third party insurance. They are to contribute to the expenditure in public health in Nigeria, according to Onifade (2003), the major source of funds for health institutions in Nigeria is the annual federal/state government budgetary allocation. Other sources are fees paid by patients for consultancy services. It is of recent that few organizations are now coming up to support the health programme just as it is being done in other countries. Over the years government budgetary constraints, have adversely affected funding to health institutions. According to Oladapo (2005), the grants to institutions by the government have been falling in value over the years because of the rapid decline of the naira from a peak of less than one naira to a US dollar in the 1970s to the present rate of about 150 naira to a dollar. To the author, in Nigeria, building maintenance budgets are mainly based on a constant percentage of construction cost (current replacement cost) of buildings. Such budgets are grossly inadequate for two reasons:

1. They ignore the effect of inflation and

2. There is always in large variation between estimates, approved estimates and the actual amounts provided, especially in the public sector.

In his conclusion, he suggests a more pragmatic and reliable approach, that is, to base maintenance budgets on a building’s maintenance profile. Accordingly, Shohet (2003) believes that the development of a maintenance budget must be tracked continuously for each specific building, for each specific year, and in relation to building performance (actual needs). This is in sharp contrast with existing literature that recommends allocations of a constant percentage of the replacement cost for annual maintenance. Most often, maintenance works are not carried out according to actual need, but they are dictated by financial priorities. Inadequate funding of maintenance all over the world has made the prioritisation of maintenance demands a critical issue. In Nigeria, healthcare funding has become such a hydra-headed business that government subvention alone can no longer be sufficient to meet the need, particularly due to the high demands of contemporary developments in health technology (National Health Management Information System (NHMIS) (2003). All these also call for the formulation of appropriate maintenance programmes especially in health related buildings. Healthcare systems are costly and inpatient treatment in hospitals is a major part of these costs. The question is how can greater efficiency be achieved without compromising the core business of the hospital, which is to take care of patients? While it is true that good patient care comes from dedicated individuals, it is equally true that the physical structures and hospital environment must be such that the safety and well being of patients is protected. In Nigeria, maintenance is given very little priority. A more progressive attitude should be to conserve the existing building stock through proper maintenance because it is a major national asset (Hutton and Lloyd, 1993). Therefore the principal proposition of this research is to investigate the budgetary allocation set aside for the maintenance management of public hospital buildings in South – Western part of Nigeria. The study also determines the level of funding in relation to maintenance performance for effective health care delivery.

Aim and objectives of the study

The aim of the study is to find out the adequacy of funding and the budgetary allocation set aside for maintenance management of public hospital buildings in South – West, Nigeria. The following are the major objectives of the study:

1. To find out how adequate is the maintenance budget of these public hospital buildings

2. To determine the relationship between the funds allocated for maintenance management and the efficiency of the maintenance department.

3. To find out the economic benefits derived when a hospital built environment are regularly maintained.

The research questions

This study will try to answer the following questions on hospital maintenance management.

1. How adequate is the maintenance budget of these public hospital buildings?

2. What is the relationship between the fund allocated for maintenance management and the efficiency of the maintenance department?

3. What are the economic benefits of maintaining a hospital built environment regularly?

Research hypotheses:

The hypotheses postulated for the study are:

1. The funds provided for maintenance management of public hospital buildings is not adequate for efficient maintenance work.

2. There is no correlation between the level of funding and the performance of maintenance department.

Scope and delimitation of the study

The study covers all federal government university teaching hospitals, orthopaedic, psychiatric hospitals and selected state hospitals randomly sampled in South-west, Nigeria. A total of 46 public hospitals is used for the study out of 114 public hospitals (health-centres exclusive) existing in the South-West, Nigeria. A hospital comprises not only the buildings but also services like water, electricity, lifts and telephones as well as communal facilities like parks, playgrounds, and waste disposal system. This study is limited to the maintenance of only the buildings, their internal services and the physical environment. South-West was chosen because the region has high concentration of some of the specialist hospitals when compared with other regions in Nigeria. The hospitals are located in the same geographical zone with similar social background. This study is limited to buildings structure, the mechanical and electrical systems.

Significance of the study

This study seeks to...