- Zero capital budget release for two years
- 90 per cent of fleet depleted
- Low call response rate for critical emergencies
- Health ministry stranglehold on operations
- Staff demoralized, retiring in droves
By Tunde Niyi-Akinmade
When the Bola Tinubu Administration in Lagos State launched the Lagos State Ambulance Services (LASAMBUS) in 2001 as the first public Emergency Medical Services (EMS) system in the country, it was with the hope that it would help in saving lives in the state metropolis. But sadly almost twenty years down the line and with several billions of Naira expended on its operation, the Department is fast turning into a hope dasher for many seeking emergency medical rescue in the state.
Investigations by Independent Observers revealed that more than 90 per cent of its ambulances and ambulance points are grounded and not working while the Department could not respond to more than 80 per cent of distress calls of Lagosians, thereby leaving many souls dying on the streets as results of accidents or attacks.
Checks revealed that while the Tinubu Administration and its successor, the Babatunde Fashola Administration tried to modernise and keep the LASAMBUS‘ operations in top gear, the Akinwunmi Ambode Administration virtually crippled the Department, starving it of funds while officials diverted critically needed resources to other uses.
In the last two years of the Ambode Administration, the Department received zero allocation for its Capital Budget financings as only its Recurrent Expenditures of Personnel cost, consumable, administrative expenses, and minor vehicle maintenance were approved and released.
The lack of funds has led to a situation whereby only 3 out of the 45 ambulances of the Department are working. Even then, two of these are in ‘fit and jerk’ state as they are constantly breaking down, sometimes with emergency patients being ferried to hospitals.
When the Fashola Administration left office in 2015, it was able to leave 13 ambulances out of the 20 ambulances in the fleet of LASAMBUS in good operational conditions. On resumption, the Ambode Administration added 20 new ambulances purchased from a foreign country.
This move, staff alleged was the beginning of fleet management and maintenance problems for LASAMBUS. There were allegations that the new ambulances bought by the Ambode Administration were ‘refurbished ambulances, which are too complicated to maintain in the Nigeria environment as they were not suited for our system.’
A staff of LASAMBUS stated that this purchase, which was supervised by the ex-governor and some top officials of the Lagos State Ministry of Health, was not in good faith.
“The ambulances were not for our system. Some were old and falling apart. They were just repainted to make them look anew. Likewise, their parts are not readily available in the country for maintenance. Someone has a case to answer for such transaction,” the staff told Independent Observers.
Efforts to reach Dr. Jide Idris, a former Permanent Secretary and Commissioner in the Lagos State Ministry of Health and a major player in this transaction failed to yield results.
After the purchase of the ‘irrelevant 40 ambulances, the Ambode Administration gave no Capital Budget release to the Department in 2018 and 2019, even though the State Government’s 2019 Approved Budget had the ‘Expansion of LASAMBUS Activities’ as a major Capital Budget Sub-head.
The Department only got an intangible Capital Budget release this year.
Checks revealed that within a spate of few months of their acquisition, the new expensive ambulances bought by the Ambode Administration started breaking down and the cost of fleet maintenance astronomically increased thereby piling up pressure on funds for LASAMBUS.
Investigations revealed that most of these new ambulances were the expensive mobile intensive care unit (ICU) variants while few were of the transport variants. LASAMBUS officials believe this was a wrong choice of equipment deployment as most of the medical emergencies handled in the state are pre-hospital care and transportation to hospitals.
“15 per cent of our cases are life-threatening requiring the mobile ICU ambulances. Why then did the government spend over 60 per cent of its ambulance spendings on this type of ambulances,” a female staff of LASAMBUS asked.
But when asked a top staff member of the Lagos State Ministry of Health’s Public Affairs Department was quick to debunk the claim that many of LASAMBUS‘ ambulances are presently grounded.
“It is entirely false. About 40 per cent of its ambulances are working perfectly well right now. This administration has started doing the right thing,” he told Independent Observers at his office in Alausa, Ikeja, obviously unaware of what he was commenting on.
But checks by Independent Observers revealed that about 30 LASAMBUS ambulances, including the expensive mobile Intensive Care Unit (ICU) ones, are currently in various states of disrepair and parked inside the premises of the Lagos State University Teaching Hospital (LASUTH) in Ikeja. Some are scattered in private workshops across the state.
Those grounded in LASUTH premises include the ones marked 4A16LA; 4A24LA; 4A31LA; 4A32LA; 4A50LA; 4A75LA; 4A76LA; and 4A81LA.
Others included 4A83LA; 4A85LA; 4A86LA; 4A87LA; 4A87LA; 4A88LA; 4A89LA; 4A91LA; 4A91LA; 4A92LA; 4A93LA; 4A94LA and 4A95LA.
Staff alleged that the situation got more compounded when Dr Olusegun Ogboye, resumed as the new Permanent Secretary of the State Ministry of Health around November 2019. On resumption, he stopped the existing arrangement for the repairs and maintenance of the ambulances.
He initiated a move to get a fleet management company to take over this duty and ‘professionalise the system while saving money.’
But staffs say the company contracted for the job has done more damages to LASAMBUS‘ fleet management rather than introduced any professionalism to the system.
“This company has not been able to professionally repair and service our ambulances. Yet we are paying it about 300 per cent above our usual repair costs. This is a fraudulent move by the big ogas in the ministry,” a staff told Independent Observers.
They alleged that the company has also not been able to fix a single ambulance of LASAMBUS since it was commissioned and paid to start managing LASAMBUS‘ fleet many months ago.
When confronted by this allegation, Ogboye said he was being maligned because he was trying to fix a rotten system. While stating that he didn’t know the company before its bid was brought to his table, he said what he initiated was to get a professional company that would be able to offer what LASAMBUS needs: “tow our vehicles, pick, fix and return them at the shortest possible time.”
He explained that when he resumed as the Permanent Secretary, he was shocked by the frequency and nature of the requests for the repairs and maintenance of the LASAMBUS‘ ambulances.
“Some of these requests were for parts I don’t even known exist in vehicles, even though I have owned cars for decades,” he said.
While not ruling out sabotage on the part of some staff of LASAMBUS, Ogboye said he is being misunderstood because he is trying to change a system that is entrenched with personal interests.
“Some of the repairs requests are as a result of sabotage. The staff members are now trying to resist the repairs going to a third party as they are no longer directly doing such,” he said.
However, he told Independent Observers that the Ministry is reviewing the contract it has with the fleet company as it is obvious it is ‘not responsive as we would like it to be.’
Staff motivation has also taken a backward slide at LASAMBUS. Some staff complained that in the last three years, some top ministry officials have ‘manipulated LASAMBUS staff recruitment while diverting its funds to other uses.’
Along this line are the allegations that medical staffs with no knowledge of Emergency Medical Services were recruited to the Department.
This complicated a lot of things for the Department as most of these new staff had to learn on the job. In some cases, this set of staff had no clue on how to handle the situations, left office to handle emergency calls without the necessary equipment or consumables.
Also, there had been no local or foreign training for the staff between 2016 and last year. However, in 2019, there was a training organised with the University of Texas, through the exploitation of LASAMBUS‘ Director, Dr Olusegun Kola-Korolo’s relationship with some key staff of the American institution.
The recruitment of greenhorns and lack of staff motivation had some attendant disastrous results for patients and the system leading to some loss of lives and integrity for the Department as its top-notch services and reputation nose-dived.
Another area some LASAMBUS staff are complaining about is the payment of Allowances, especially special ones for the medical emergency staff.
“We don’t get any allowances for the special works we are doing. This is even more essential at this time of COVID-19 emergency, in which we are at the forefront. Other medical staff are enjoying the special allowances but we are not,” a staff said.
But Ogboye said the LASAMBUS staff like any other medical staff in the employ of Lagos State Government are being paid the same allowances.
“In the health system, all workers are emergency workers who work shifts and overtime. LASAMBUS staffs are paid the same allowances like other health workers,” Ogboye said.
However, Kola-Korolo explained that LASAMBUS staffs in their complaints are economical with the truths as they enjoy special allowances for their efforts. He said that even the drivers are treated specially with payment of Call Duty Allowances, which no drivers in the Civil Service enjoy.
“Our drivers, who are trained First Aid Responders at the peak of their career enjoy Call Duty Allowances, unlike others in the Service. This also applies to our staff who are in the local governments as Community Health Extension Officers. Every staff enjoys one Special Allowance or the other,” Kola-Korolo said.
The apparent lack of motivation has made some senior and experienced staff leave the services of LASAMBUS to either join other government Departments, private companies or travel abroad for better job satisfaction.
As of March 20, 2020, only 59 operational staff members were available for duties to cover just three operational zones of the Department’s operations across the state. The other zones had no operational services to offer Lagosians. As a result of the virtual redundancy, large numbers of its staff are currently on leave: Medical, Annual and Study leave.
Many Lagosians are now finding it so difficult to get a response from LASAMBUS through the 112 or the 767 distress calls. There are allegations that the ambulances don’t come or come late.
In response to this, Kola-Korolo explained that all distress calls to the toll-free numbers 767 and 112 do not go directly to the LASAMBUS switchboard but to a general switchboard, where operators screen them and dispatch to the appropriate agencies for the required emergency rescue operations.
“Sometimes depending on the timing and location, we can’t respond to distress calls unless the RRS (Police) gets on the scene. We all work as a team. When we found out the RRS hasn’t gotten to the scene in such a situation we can’t move in for security reasons. But most Lagosians don’t understand.” Kola-Korolo said.
Furthermore to the complaints of the LASAMBUS staffs is the allegation that some top management members of the Ministry of Health are deliberately stiffening LASAMBUS‘ operations to pave way for some private operators to make an inroad into the Emergency Medical Services in the state. They point out to the quick emergence of a private ambulance service company as a major provider of ambulance services at LASUTH and its environment.
“This company is owned by a medical doctor, who was a staff of a teaching hospital, and a friend and professional colleague to our ogas. It is making quick business in LASUTH and our Department is going down. That is public service for you,” a LASAMBUS staff said.
But Ogboye said he is concerned about LASAMBUS‘ operations rapidly going down the hills. He explained that upon resumption of duties, he had a strategic meeting with Kola-Korolo and his staff on the way forward and a plan of action is being perfected to put the Department back on track.
Kola-Korolo also seems to have realised that the task ahead is tough and is trying to find a way out of the administrative bottlenecks surrounding LASAMBUS‘ operations to chart a way forward for the medical emergency services Department.
He explained that part of these plans might include trying to set up an in-house repairs workshop to handle minor repairs and maintenance works on the ambulances; increasing the frequency for staff training and regularly having a strategic interface with top Ministry of Health staffs.
He said the Department is also working on deploying the right types of ambulances for its operations, taking into considerations the nature of its emergencies and the fact that the ambulances would have to work 24/7 each day.
“We have lots of plans to turnaround the Department. This will include the selection of the best equipment for the jobs, organising the appropriate training for staff, finding a way around the bureaucracy and providing excellent medical emergency services 24/7 for Lagosians,” he said.
Ogboye is also thinking of strategic plans for LASAMBUS.
“Re-organising LASAMBUS to be effective is a priority on our list. This starts with the provision of ambulances, changing the attitude of staffs, especially the drivers. We are expecting new ambulances this year,” Ogboye said.
But many insiders believe that the real solution to the deteriorating services and state of things at LASAMBUS would be a full autonomy for the Department.
Investigations by Independent Observers revealed that while the Lagos State Government is currently looking in this direction with the transformation of LASAMBUS into the Lagos State Emergency Medical Services (LASEMS), some of its top officials are averse to this proposal.
Ogboye, who stated that he was not aware of the plans to transform LASAMBUS into a full agency, said he is not against such plans if it will be beneficial to all.
“All I am for is for us to have efficient emergency medical services for the people,” he said.
A female player in the private sector of the medical emergency industry, who described LASAMBUS‘ structure as a ‘joke’, said the best option for making LASAMBUS efficient is to grant it full autonomy.
“One wonders why the state government gives more priority to waste disposal than health emergency. The Lagos State Waste Management Agency (LAWMA) has autonomy but LASAMBUS is still tied down in the Civil Services bottlenecks. This is a sick joke. Yet the State Assembly is also there. If the Executive is not smart enough, what of the Legislature? Are there no smart knowledgeable legislators on its Health Committee, who could initiate this much-needed idea?” she asked.
With the COVID-19 currently raging in the country, investigations revealed that LASAMBUS like other health agencies and departments might end up benefiting from the pandemic. There are indications that after the pandemic had been successfully fought and wipe out, some of the ambulances donated by private sector players might be allocated to LASAMBUS.
But the prayer of many is that apart from providing LASAMBUS with new ambulances, the Lagos State Government will find the political will to restructure the Department for effectiveness and efficiency and away from the stranglehold of its Ministry of Health officials.