CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 1, January – April 2024 AFRICA 5 Discussion We found that there were 12 functional PCI facilities in Nigeria with one PCI facility per 16 761 272 people. In a study on 10 countries in sub-Saharan Africa, Kakou-Guikahue et al. found that there were only five PCI facilities.1 In Egypt, there was reported to be one PCI facility per 950 000 people after initiation of the Stent for Life programme.9 In South Africa, there were 62 PCI-capable facilities with one PCI facility per 887 096 people.2 Langabeer et al. reported that there were 1 571 PCI-capable facilities in the United States of America, which amounts to about one PCI facility per 199 097 people, based on the 2011 population estimate.10,11 The geographical distribution of the PCI facilities in Nigeria is concerning as they are all in the big cities. An investment from the government in incentivising equitable development of PCI facilities will go a long way. Of the 12 functional PCI facilities in Nigeria, 11 of them are in the private health sector, creating disproportionate access to them in Nigeria’s stark reality of a fee-for-service model.3,12 This needs to be addressed as part of the broader issue of healthcare access and equity. It will be prudent for the government to invest in the infrastructure and provide more publicly accessible PCI facilities with services that are affordable. There remains a significant brain drain in Nigeria, not limited to cardiovascular specialists.13 The economic conditions for physicians in Nigeria and the prospect of an improved quality of life abroad is attractive to local physicians but does come at a cost as it limits the provision of specialised care in Nigeria. There is also a dearth of sub-specialised cardiovascular training programmes in Nigeria, compounding the problem.12 There needs to be an investment from the government and the stakeholders in Nigeria in the training of cardiovascular sub-specialists. A success story that can be mirrored is the advent of an interventional cardiology training programme in Babcock University Teaching Hospital, which is the first of its kind. There is some good news, with two PCI-capable facilities that opened early in 2022 in Lagos. There are also three cardiac catheterisation laboratories that are not currently functional in Akwa Ibom, Bayelsa and Oyo State, which could be refurbished to help provide more access to patients with ischaemic heart disease. Table 2. List of PCI-capable facilities • Afe Babalola University Multi-System Hospital, Ado-Ekiti, Ekiti State • University of Nigeria Teaching Hospital, Enugu • Reddington Hospital, Victoria Island, Lagos • Euracare Multi-Specialist Hospital, Victoria Island, Lagos • First Cardiology Consultants, Ikoyi, Lagos • Evercare Hospital, Lekki Phase 1, Lagos • Babcock University Teaching Hospital, Ilishan-Remo, Ogun State • SaveALife Mission Hospital, Port Harcourt, Rivers • Cardiocare Multispecialty Hospital, Garki, Abuja • Foxglove Multispecialty Hospital, Gwarinpa, Abuja • Nizamiye Hospital, Life Camp, Abuja • Cedarcrest Hospital, Gudu District, Apo, Abuja Table 1. Number of PCI-capable facilities and 2019 population estimate State/territory Number of PCI facilities 2019 population estimate Abia – 3 841 943 Adamawa – 4 536 948 Akwa Ibom – 4 780 581 Anambra – 5 599 910 Bauchi – 7 540 663 Bayelsa – 2 394 725 Benue – 5 787 706 Borno – 5 751 590 Cross River – 4 175 020 Delta – 5 307 543 Ebonyi – 3 007 155 Edo – 4 461 137 Ekiti 1 3 350 401 Enugu 1 4 396 098 Gombe – 3 623 462 Imo – 5 167 722 Jigawa – 6 779 080 Kaduna – 8 324 285 Kano – 14 253 549 Katsina – 9 300 382 Kebbi – 5 001 610 Kogi – 4 153 734 Kwara – 3 259 613 Lagos 4 12 772 884 Nasarawa – 2 632 239 Niger – 6 220 617 Ogun 1 5 945 275 Ondo – 4 969 707 Osun – 4 237 396 Oyo – 7 512 855 Plateau – 4 400 974 Rivers 1 7 034 973 Sokoto – 5 863 187 Taraba – 3 331 885 Yobe – 3 398 177 Zamfara – 5 317 793 FCT (Abuja) 4 2 702 443 Nigeria (Total) 12 201 135 262 PCI facility per 1 000 000 people None 0.1–0.3 0.3–0.5 1.3–1.5 Fig. 1. Concentration of PCI facilities in Nigeria. Map created using mapchart.net
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