CHANGE IN MANAGEMENT AT ABUJA'S NATIONAL HOSPITAL:

C O N F I D E N T I A L SECTION 01 OF 02 ABUJA 001164 SIPDIS E.O. 12958: DECL: 06/30/2014 TAGS: ECON EINV PINR TBIO SOCI NI SUBJECT: CHANGE IN MANAGEMENT AT ABUJA'S NATIONAL HOSPITAL: BACK TO (FUNNY) BUSINESS AS USUAL? REF: LAGOS 1291 Classified By: A/DCM CLAUDIA ANYASO. REASONS 1.5 (B & D). ¶1. (C) CONFIDENTIAL -- ENTIRE TEXT. ¶2. Summary: The GON's decision to terminate International Hospital Group's (IHG) management contract at the National Hospital appears to stem not from irregularities on the part of the British management group, but rather on its intolerance for irregularities that enriched powerful people, some of them apparently close to the President. The saga of National Hospital suggests that the GON's stated policies of streamlining, transparency and anti-corruption do not necessarily apply at the highest levels of government. End comment. ¶3. Econoff met with a key member of the former management of International Hospital Group team (protect source) for a post-mortem of IHG's management contract at the National Hospital in Abuja. His story was very much at odds with the portrayal to date by the Nigerian press and by GON officials. ¶4. According to the IHG official, the contract IHG signed with the Board of Directors of the National Hospital was, in parallel, a management contract aimed at helping the hospital to improve its operations in addition to a consulting contract to lay the groundwork for improved operations in the future. IHG had received a business plan from the Board at the beginning of the contractual period but soon found it useless. No accounts had been kept at the hospital since 1999, and most internal data on patient visits was suspect. Unable to determine how many patients had been treated and how much money the hospital had collected or spent, IHG had no ready benchmarks to assess the hospital's performance. Its first task, therefore, was to put the accounts in order and set up a functioning IT system. After six months, IHG produced audited accounts of the hospital's operations since inception. ¶5. The National Hospital's Board of Directors consisted of prominent people from HEALTH care, the various geopolitical zones of Nigeria, representatives of key cabinet ministers, etc. According to the official, relations with the Board remained excellent throughout IHG's tenure. IHG's contract was with the Board and contained appropriate mechanisms for Board review of IHG's performance and procedures for terminating the contract for cause with prior notice. However, since the hospital is also a parastatal, the GON, represented by the Secretary to the Government of the Federation (SGF),had an exogenous but important role in monitoring the National Hospital's operations. ¶6. IHG's contract, which was for UKP 2.8 million per annum (approximately USD 5.12 million, not the USD 6.55 million cited in press reports),gave IHG authority over personnel matters such as the hiring and firing of staff, including medical doctors. On its own, the GON committed itself to placing anyone who was laid off from the hospital into new positions in government entities. In the contract, the GON also committed itself to providing working capital for the hospital, which in fact never materialized. ¶7. The IHG source believes the company ran afoul of some "important people" by terminating several senior staff members and tightening up the contract tender process. When IHG took over, the National Hospital had, for instance, a very expensive maintenance contract with Julius Berger, the German construction giant that had originally built the hospital (and most of Abuja, for that matter). Not only were the fees much higher than customary, but anomalies such as monthly maintenance fees on pieces of furniture the hospital owned were included. IHG put the maintenance contract out to bid, and Berger was reportedly furious that it did not win the contract. The reason it lost was simple: Julius Berger did not even bother to bid on the contract, apparently assuming their "relationship" would win them the contract. ¶8. In the end, IHG's tenure at National Hospital was terminated by the SGF on ONE week's notice over the head and over the objections of the Board of Directors. The publicly-stated reason was that IHG was in breach of contract because the hospital had not become self-sustaining after its first year of operations under IHG. No mention was made of the fact that the GON was also in breach for not providing the promised and much-needed working capital. According to the source, the report made by the SGF contained a number of outright falsehoods, many half-truths and several arguments full of sophistry intended to discredit IHG. ¶9. The IHG official noted that the interim management team is headed by a medical doctor with close ties to the president who had previously expressed interest in running the hospital himself and who complained that National Hospital was the only major hospital in Nigeria not headed by a medical doctor. The IHG official further speculated that the Nigerian government may intend to privatize the hospital, because the privatization agency Bureau of Public Enterprises (BPE) is represented on the interim management team. ¶10. The official also speculated that the reasons for IHG's rapid ejection was that its oversight of outside contracts had cut off some people's sources of illicit income. Evidence cited for this was the rapid reinstatement of at least three employees who had been terminated for cause, including some who are still under investigation by the Independent Corrupt Practices Commission (ICPC). In addition, Julius Berger was rapidly brought back as management contractor. ¶11. Other actions of the interim management committee indicated that they were paying more attention to personalities and ethnic sensibilities than to operational effectiveness. ONE member of the hospital management, hired by IHG just prior to the termination of its contract, was quickly fired not on performance grounds but for being from the wrong region and tribe. Another example is the IT director of the interim management team, who has no computer on his desk, declines offers to supply him with one, and insists that any document presented to him be printed out on paper. ¶12. Although the IHG official claimed no first-hand knowledge of high-level political interference, the team received numerous indications from sympathetic staff members that IHG's tenure at the National Hospital was a casualty of rivalry between President Obasanjo and Vice President Atiku. The official said he now gives credence to this theory due to the manner in which the termination was carried out: it occurred over Easter weekend, when most of the Board was unavailable and the Vice President was out of town. The official suspects that while the Vice President, whose influence is on the wane, was otherwise engaged, officials close to the Presidency who had designs on National Hospital or vested interests in its formerly corrupt practices gained the President's support for the takeover. This group acted so quickly that no ONE was in place to take over from IHG: after the one-week notice period expired, IHG stayed on for an additional two days, calling SGF regularly to find out when someone would come to the hospital and assume charge. ¶13. Comment: Econoff has met most of the members of the IHG team socially at various times, and all appear to be level-headed, competent professionals. IHG's experience with National Hospital suggests that the hospital is still running as a parastatal, with political goals more important than economic goals. Reinstatement of discredited employees and questionable service contracts runs counter to the GON's rhetoric on transparency and fighting corruption, as does the sudden termination of the contract without formal Board proceedings. If the suspicions of the IHG official are correct, it would appear the GON's commitment to economic reform might not extend to the highest levels of government. End comment. CAMPBELL