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The Task Before the Minister of Health, Professor B. Osotimehin By Dr. Felix S. Odaibo
Providing effective, relevant and an all encompassing health care to the majority of Nigerians in the face of the impaled and prevailing National and Global economic downturn is daunting. This is even more so given the moribund political and dreadful Socio-economic outlook of the majority Nigerian citizwenry. Competing budgetry demands as well as the world perception that Yar Adua's government has shown a lack of political will and determination in fighting corruption, a major factor that has seriously set back development in most developing worlds, Nigeria included, will further serve to reduce available funds that could have been chanelled to improving Health care to the populace. Nigeria's Health Ministry has never commended itself to the Populace. It has been described as a 'Sector in slumber: "The story of Nigeria’s sickly sector in 2008 could be told by the family of late Dr. Enyi Okereke, a younger brother of the Nigerian Stock Exchange Director General, Prof. Ndi Okereke-Onyiuke. Enyi was an associate professor of orthopaedics at the University of Pennsylvania, United States. Last month, the physician was one of the doctors that came to Enugu State to provide free medical services for the poor and teach medical students. The US-based doctor was at the University of Nigeria Teaching Hospital, Enugu when he slumped. According to reports, the hospital did not have the basic equipment to provide alternative support for Enyi’s heart, neither did it have drugs needed to rescue him. Enyi died as staff of the hospital were looking for non-existing equipment. His colleagues and family must be thinking that the man would not have died, if he had not come home." By Niyi Odebode. Punch 31st Dec 2008. The timing and circumstance surrounding Professor Osotimehin's assumption of the job of Minister of Health demands that he prove his mettle even more than it has ever been for any other Health Minister of recent memory. The immediate News that greeted his appointment was one of surprise and disappointment amongst Nigerians. The general impression is that there is a better candidate for this job. Dr Adebisi Adewole, in an article in Nigeriaworld titled “PROF. DORA AKUNYILI: A ROUND PEG IN A SQUARE HOLE” said “Nigeria needs Dora Akunyili's expertise and experience in the most relevant ministry that will impact on the lives of ordinary Nigerians. By assigning her to Information and Communication Ministry, the government of Yar'Adua has failed to discharge its responsibility to the Nigerian people, instead, it has chosen to use a pure and stainless personality to act as a propaganda tool for covering up its excesses and limitations.” To my mind, what this and other articles are expressing in simple language, is that the best candidate for this job is not you! Others were even less charitable to the point of pointedly asserting that you are in this job on the basis of the active support you had of the First Lady, Turai Yar Adua! I will not get involved in all the political maneuvers, undercurrent manipulations, posturings, campaigns and gambits that determine who gets elected into what posts in Nigeria. I shall simply focus on your task ahead and what needs to be done to attain the various Health Policy goals. The incontrovertible fact is that you are now in a position to show the world how competent, knowledgeable, responsible and transformative you are in implementing the various plans designed to improve the health and welfare of the majority of Nigerians. The well known determinants of Health includes Genetic, Physiologic, behavioural, environmenmtal, socioeconomic, social and Institutional factors. Nigeria, a developing country with the attendant problems that the epithet connotes, also has the added problem of our 'set ways of doing things'. This unfortunately further complicates the picture. I know the broad Health care delivery plank lies squarely on the shoulders of Federal, State and Local Government with each carving a niche for itself. The Federal Government being broadly concerned with Tertiary care, the States for the General Hospitals and the local Government for the dispensaries and Primary care. The disadvantage and underbelly of this approach to health care is that everything operates on a boxed and airtight basis. If you ask any Public Health scholar what are the Health care delivery challenges in Nigeria, they would rattle away the fact that: a) Nigeria has a weak Health care delivery system- 'Our diagnostic system is in a shambles. It is because of this that some of us were wrongly diagnosed. I was wrongly diagnosed in Nigeria for years. People now resort to herbalists rather than modern medicine in a country that is so rich.' By Gani Fawehinmi - Punch 12 2008 b) There are significant difficulties in accessing drugs for mass circulation which is further complicated by predominance of fake and now dangerous (my Pickin) drugs being sold without effective regulation. What beats me is how could a caring government look the other way whilst her citizens are being systematically killed by 'Businessmen' for the sake of money. NAFDAC should take on the task of drug control even more seriously. c) It goes without saying that inadequate Funding is a well recognised factor world wide, but this is somehow further exacerbated by the Nigerian FACTOR of endemic corruption. In terms of individual diseases, these challenges can be addressed: Cholera continues to rampage the lives of the people with 1660 cases recorded last year. Measles still topped the epidemic list even though of all the epidemic diseases for which there is a Vaccine, it had the highest rate for immunization coverage. There are a few silver linings in this dark cloud picture: Nigeria is almost eliminating Leprosy, effective strategic plans with regards to ending TB has up to 2010 to complete and there is evidence of substantial progress being made in this area. Nigeria's Present Health Policy is impeccable on the basis of its objectives and I cannot fault it as it goes beyond just provision of just Health care:- The goal of the National Health Policy is to bring about a comprehensive health care system, based on primary health care that is
to every citizen of the country within the available resources so that individuals and communities are assured of productivity, social well- being and enjoyment of living." The health services, based on primary health care, shall include among other things:
"Enjoyment
of Living". What does this mean? I dare say that this is
where one of your real challenges lie. I imagine that this consists of
the basic tenets of fighting poverty, eating good nutritious food,
availability of adequate health care as well as having access to
decent Maternal/Child care. On the basis of the controversial Maslow's
hierachy needs, many in Nigeria are still a long way from the top of the
pyramid. For those not familiar with this term, Maslow's hierarchy of
needs is often depicted as a pyramid consisting of five levels: the four
lower levels are grouped together as being associated with physiological
needs: food, water, health, security of body, resources etc, whilst the
top level is termed growth needs associated with psychological needs.
Deficiency needs must be met first. The higher needs in the
hierarchy only come into focus when the lower needs in the pyramid are
said to be satisfied. It is believed that once an individual has moved
upwards to the next level, needs in the lower level will no longer be
prioritized. So Prof, there is work to do here. I am sure you are aware that 50% of all diseases are waterborne in developing countries. So we need safe water supply and a decent environment. Until there is a national approach to this issue, with active involvement and cooperation amongst all the relevant stake holders, (we need to ensure that all Local Governments guarantee 100% support for immunization as well as safe water supply), not much progress can be made. We also need adequate power supply, a basic ingredient for industrialization and social well being. Never mind that in December 2005, Goldman Sachs investment Bank said that by 2027, Nigeria was going to be a developed Nation, being in the so called Group of "Next Eleven", based on using the factors of macroeconomic stability, Political maturity(this may be contingent on a sound electoral reform), openness in trade and investment climate as well as quality education. Given our present haphazard approach to development, this opportunity may once again elude us. I am glad about your comment "...vow to tackle state governors and local government chairmen on ensuring that allocations meant for the development of primary healthcare at the state and community levels are judiciously used." Vanguard report of December 2008. This will be the key to your success in the Health Ministry. For example, in my Local Government, Ogori/Magongo, over #300 million Naira change from the excess oil fund was going to be squandered by the councillors in providing "loan" for the villagers, meantime 300 of their kith and kin had previously sacked and had not been paid for a year. Patriotic and enlightened individuals there went to court to stop this carnage. When semi literate/illetrate individuals head such vital positions of Chairmanship with no knowledge or idea about how a modern Local council should run or what is important and a priority for their council, then the chances of any National Policy being implemented is next to Zilch. Policies that are likely to have significant impact on the lives of the ordinary people will never get off the ground. You will somehow need to strike a good and sound working relationship with the Minister of Environment, Agriculture, Power and Water resources (power supply in Nigeria is barely 2,200 megawatts, whilst Alberta a province of just over 3 million people generates over 9,000 megawatts), as well as the Local governments Chairmen, even if it means having at least twice a year meeting with all of them to espouse your vision and strategise on how to achieve the MDG'S, Vision 2020 and other health goals. Until the Local Governments are fully on board and understand the essence of establishing sound primary Health care delivery system, any impact on health by any other means is likely to be superficial and ephemeral. As for provision of well equiped Tertiary centers, my former Medical Professor at ABU Zaria, Dr. H. Parry said years ago that you do not need huge Concrete and Chrome structures to have a good University Teaching Hospital center. What you need is a group of dedicared and high calibre doctors working in an efficiently run and well funded unit. There is still a role in bringing Specialist Nigerians home to contribuite their quota, and I suggest you should actively encourage it. The age where Government does it all is long past. Private health Sector need close supervision and have to be encouraged. This is where a Supervisory body with teeth and not just bark, under the ministry of Health, is needed to oversee this aspect. The Medical and Dental Council of Nigeria should strictly concern itself with setting standards and regulating the Medical Profession and protecting the Public. Bringing all these disparate groups together successfully and agree to work together would be a key factor in accomplishing your task. If you ask me in what 3 areas should you focus on, I would say on the three M's, Maternal and Child Health, Malaria and iMmunization. Those are the areas you are most likely to have a long lasting and deep rooted impact on the health of the populace. Of course you will still have your other pet interests of HIV/AIDS. Psychiatric services is probably now non existent. Dr. Taiwo Oladapo said there are only 100 Psychiatrists in Nigeria. Nigerians are generally happy people anyway! They still need sound minds. Before I forget, there is also a need to reform blood transfusion services nationally, re-establish a national emergency/ambulatory care as well as oversee an effective Health insurance that works. Environmental degradation is a major we have not yet started addressing and it is an issue that will not go away. Halima Taiwo stated that Nigeria recorded 1260 oil spills in 2 and 1/2 years! Even one single oil spill is unacceptable. The health hazard it poses goes beyond adversely impacting on the people's livelihood, but it also has a deleterious effect on the environmental food chain. Urhobo Historical Society has a good site for you to browse and liase with your counterpart in Environment Ministry so that you can stategise on how to ameliorate in the meantime, this disgraceful conduct and complete lack of care and respect for the people of Delta, by the oil companies operating in Nigeria. The task is mightily huge! Finally at the 51st National Council on Health Meeting held in Lagos in Nov 2007, your predecessor, Prof. Grange noted that while the Nigerian health sector has witnessed various forms of reform since 1999, all targeted towards improving health service delivery and quality of care, leading to the development of several policy and strategic framework documents for various projects and programmes, these programmes have fallen short of making a significant impact towards improving health service delivery, due to a relatively poor emphasis on implementation, monitoring and evaluation. She promised that the present administration would “move the health sector reform forward, building on the policies and frameworks that have been developed, focusing on the implementation, integration, monitoring and evaluation”. Take Heed. Evaluate constantly whilst being cognisant of the fact that a sound Health foundation is all you need to establish now. Some interventions in health sector would only show results years after your time, but you would always be aknowledged for your role in the good outcome. In ending, I urge you to take heart. Noting that 'In everything you do, put GOD first and he will direct you and crown your efforts with SUCCESS' - Proverbs 3, 6.
References: 1. Punch, 31st Dec 2008.and Jan. 1 2009. 2. This Day, 08/06. 3. Nigeria world. 4. World Bank Country Fact Sheets. http://www.worldbank.org/ 5. Vanguard, December 2008 6. Guardian, July 28, 2008 7. Daily Sun 8. Gamji. http://www.gamji.com/article5000/NEWS5145.htm 9. Wikepidia http://en.wikipedia.org/wiki/Next_Eleven. 10. Urhobo Historical Society http://www.waado.org/Environment/PetrolPolution/OilSpills/OilSpillPage.html
Dr Felix Odaibo is a Consultant Physician in Alberta Canada. He was a former elected member of the Council of the College of Physicians and Surgeons of Alberta and former Councillor of the College of Physicians and Surgeons of Manitoba. He previously held the post of Asst. Professor of Paediatrics, University of Manitoba, Winnipeg. |