COVID-19 and state of public hospital buildings

By Olumide Afolarin Adenuga

The outbreak of the coronavirus disease (Covid-19) has raised global health concerns and in the process exposed the state of public hospital buildings and their services in Nigeria. Health experts have equally raised alarm over the impact of the coronavirus outbreak, warning that the country’s healthcare system could quickly become overwhelmed.

One of the major factors that could be responsible is the neglect of maintenance of our public hospital buildings, which are in deplorable structural and decorative state.

As technology changes with regard to hospitals, so do maintenance requirements.  Technology is time dependent.  As time progresses, so does technology change.  With many developments coming to light every day, health care facilities must be prepared to accommodate whatever the future holds.

Nigeria is one of the Less Developed Countries (LDCs) of the world where poverty is endemic. Consequently, the main problem facing majority of her people is how to survive economic hardship in the midst of abundant natural resources.

Healthcare facilities are designed and managed not only to support and facilitate state-of- the-art medicine and technology, patient safety, and quality patient care, but to also embrace the patient, family, and caregivers in a psycho-socially supportive therapeutic environment.  The qualities of the physical environment in which patients receive care affect patient recovery rate, staff satisfaction, and organisation productivity.

Such effects can be positive or negative.

Basically, government-operated public hospitals are to provide cost effective and specialist services that are safe and of high quality, respond to individual needs, accessible, and equitably and efficiently delivered regardless of geographic location.  Healthcare buildings should meet physical requirements of safety and security. They should also contribute to the environment by ensuring good functionality, meeting expectations in terms of privacy and dignity, providing good access for all, reducing infection and minimising accidents.

Government–owned hospitals are confronted with unique challenges that threaten their existence.  Through an examination of the history, characteristics, and structure of public hospitals, it is found that such institutions by their nature lack the capacity to compete in a market – driven economy. This deficiency is further found to originate from the institution’s inherent government structure, which promotes inefficiencies and inflexibility through the imposition of bureaucratic impediments to operational effectiveness.

Patients in a healthcare facility are often fearful and uncertain about their health, their safety, and their isolation from normal social relationships. The large, complex environment of a typical hospital further contributes to the stressful situation. 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 wellbeing of patients are protected.

In Nigeria, installed health facilities are as old as the hospitals themselves. Some of the medical equipment are unserviceable and need outright replacement. The colonial architecture in some of the older hospitals, which were hitherto famous for their sturdiness and functionality, has now become less attractive because of the general neglect of the buildings maintenance. Overcrowding has also led to deterioration of these facilities. The state of maintenance and the physical surroundings in public hospital buildings are present health problems in public health care delivery. Patients in a healthcare facility are often fearful, uncertain about their health and safety. The qualitative aspect of the building is the issue of maintenance. The need for maintenance arises because buildings inevitably deteriorate with time due to effect of various causes. In Nigeria, maintenance is given very little priority.

Good management, like good health, is the result of daily conditioning. Regular inspection is fundamental to good maintenance, together with knowledge of the causes of decay and a sound understanding of the construction and development of the building. There is a need for regular inspections of public hospital buildings to ensure their safety. Comfort is a dominant concern for the indoor environment. The healing indoor environment needed in healthcare must consider infection control, safety for patients and staff as an added factor for a safe environment of care. Ventilation plays a role in infectious disease management. Clusters of infection have been reported in facilities due to an imbalance of ventilation systems from construction practice or lack of mechanical control. The maintenance manager should understand the ventilation limits for specially ventilated areas within the hospital. The performance of hospital buildings and their components depends to a large extent on continuous and planned periodical maintenance.

Management of any process also involves assessment of performance and in order for any maintenance manager to measure performance and set priorities, the function and performance of buildings and their appropriate standards will be dependent on the users’ perception and their primary needs.

Healthcare systems are costly and impatient 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?

The poor state of building services is a very critical issue to be tackled by hospital management with utmost urgency. They are the determinant of users’ perception and the life of the buildings, more so in an environment that handles the dynamics of life and death. Government should provide necessary resources to ensure the functionality of the services so as to improve users’ satisfaction. Maintenance staff must be well motivated in order to deliver their best during the maintenance work execution. Management should ensure that the head of maintenance department possesses the required skills for the maintenance management of the hospital facilities. Progress report of work done is to be submitted to the management through the head of maintenance department.

Policies and strategies provide the modus operandi for organisational performance. For optimum results, maintenance departments need to adopt sound policies with respect to building elements/services replacement. This will provide appropriate basis for preparing budgets that meet the actual maintenance needs of the hospital buildings and services included. Maintenance managers are to do their best to prepare realistic need-based budgets while the government should make efforts to increase the funding for hospital maintenance.

Government should encourage individuals or other stakeholders to contribute towards healthcare delivery services since government subvention alone can no longer be sufficient to meet the needs, particularly due to the high demand of contemporary developments in healthcare technology.

Inefficiencies and inflexibility through the imposition of bureaucratic impediments to operational effectiveness should be avoided in hospital environment due to the sensitivity of the services being rendered.

Maintenance staff and users of hospital buildings should be given opportunities for further training on their jobs, also on effective use of hospital facilities. This is necessary to reduce the occurrence of defects which will consequently bring about better physical and functional hospital building elements and services.

Maintenance planning based on more realistic assessment of needs and prioritized forward maintenance programme, on a rolling basis should be developed.

• Prof. Adenuga is Head, Department of Building, Faculty of Environmental Sciences, University of Lagos.