We can’t run Nigeria like this, Health Minister tells commissioners

Nigeria’s Health Minister, Professor Isaac Adewole, speaks on health matters in the country. Excerpts:
Can you share your thoughts on what your sector has done in two years and the challenges you have?
(Cuts in) I have been part of the healthcare system for a long time and I have seen a lot of it over the years. I have been a critic of the health system before now and now I am inside the system. I used to say then that we should have this or that but I have come to see the whole gamut of the system and we are working very hard to make it work better for all. That is what I can say about that.
So given that hindsight what are you doing differently?
What I will do differently is what I call strategic engagement. I will be focused, I will pick a few things and hit them right. I will not deceive myself and the people of Nigeria that I can solve all the problems in the health sector in just one day.
It is not just possible and we must be ready to tell Nigerians nothing but the plain truth so that they can continue to know and understand what is happening. For that reason, I have told myself that I will do policy formulation, I will do strategic rearrangements of issues and programmes involving the health care system in Nigeria and a few others.
Accordingly, and in consideration of the things that stare us in the face, I want to build cancer centres across Nigeria for early detection and treatment. I also want to tackle Malaria and HIV scourge to the barest minimum. We need to take it one after the other.
But having been in the saddle for about two years now as the minister in charge of health matters in Nigeria, what would you point at as your achievements?
I do not like to talk as if I am counting my achievements. No. I would want Nigerians to do the assessment by themselves and come to a position as to what we have done so far. But I would simply say that since I came on board, I have put in place for Nigeria a National Health Policy, I started an innovative health care programme called ‘Save-One-Million-Lives Initiative’, I kick-started another health scheme called ‘Rapid Results Initiative’ that has so far offered free surgery to no fewer than 10, 000 Nigerians.
I also initiated a Joint Venture Agreement on Vaccines, which has led to the production of vaccines by Nigeria, something that had long been stopped before now. I also initiated the Central Posting of Health Officers. I declared 2017 as a year of accelerated Tuberculosis Case Fund and I started 909090 for HIV. These are the modest things I have done and I will continue to take necessary steps that will propel the system to a higher height for the overall interest of the country.
Have you been able to draw a road map for the country within this period?
That’s why we are concentrating on documentation. Apart from Policy development for the country, we are also working on strategic and development plan to give the country a robust health system.
What does that mean?
That is translating the policy into action and costing what the interventions will require. We are in the process of developing that. We have called all the stakeholders for a meeting including all the health commissioners in the country and we have shared the strategic document with them.
I am also working on the situational report on health in Nigeria for submission to the Federal Executive Council. That document will show at a glance the current health situation in the country, what is needed to be done to change the situation, the cost implications, the sources of funding available for such interventions and many other indices.
So, what are you proposing as likely sources of health funding? Are we likely going to push it into a First Line charge given its importance?
Not in that sense. Already, the National Assembly has passed the National Health Act giving 1% of national revenue to the health sector and we are hoping that we can be able to draw that in 2018. But we must keep on engaging with relevant agencies of government to get things right in the health sector because our position is that we need to get it right in the health sector if all other sectors must be right. Health is necessary for agriculture, education, infrastructure and others to thrive. In other words, without healthy citizens, there can be no serious development and growth in the country.
Will that lead to a situation where the National Health Insurance (NHI) will be made a right and not a privilege for few Nigerians?
Of course, that is what we are aiming at. We want to make the National Health Insurance Scheme to be compulsory and useful to all Nigerians. We need enough money to fund the scheme to be able to achieve our target or expectation. That is why we need money from other sources apart from the National health insurance scheme.
In Thailand for example, the national health scheme is funded strictly with tobacco tax while in the UK, it is funded with direct taxation from the citizens. So, we are looking at many options and the committee will come up with innovative approaches. To me, that would be the landmark event for the health sector.
One worrisome issue in the health sector is that Nigeria does not have an early warning mechanism whereby the citizens are alerted before a major outbreak of epidemic strikes. You can see that in the recent outbreaks of Meningitis, Lassa fever, Ebola, Measles and others, Nigerians were taken unawares. Why does this continue to happen in a big country like ours?
I will pick each of them one by one to tell you that that solution lies in every Nigerian. In July 2015, in one particular village in Niger called Fuka, we lost 17 people one after another, and we did not get to know until six months later. The meningitis outbreak started in first week of December but we only got to know about it in February.
It shows you the disconnect in the health system in the country. The States are not communicating their health challenges with us at the federal level and we cannot do magic. What we need is a really functional system whereby the local governments will communicate with states and states will communicate with the federal government for all of us to be on top of every situation that develops or about to develop. If one person develops meningitis in Zamfara and we get to know the second day, we would dispatch our surveillance officers there, we will quickly treat and vaccinate people around there and it will be safe, but a situation where we do not get to know for months then things could become terrible and that is what has been happening.
We have called all health commissioners for a meeting and informed them that we cannot run this country this way. One case is all you need, alert us on time. Call the CEO of Nigeria Center for Diseases Control (NCDC) and me. I have personally sent letters to all the governors and health commissioners in the country on this matter.
Many of the outbreaks are predictable and appropriate preventive measures are possible for each situation. For instance, Lassa Fever will likely occur during dry season, Meningitis will occur around November/ December, Cholera will start April/May, Measles, December/January and so on. Now, given that understanding, we are writing to all the states to say please alert us in case of any trace of any of these outbreaks.
If you also visit any of these places and notices anything that looks like a threat to health, please alert us. If you also visit our website we have “Global Advisory Warning”, which gives warning on these issues. Even on my Twitter handle, I have warning on Meningitis, Measles and Cholera just to show you that we recognize that what we need is communication. There is a local proverb that says when you have a sunken eye, you start crying from far off.
Where we do not have the resources to treat everybody then we must start early to prevent such ailments from occurring. We do not have money to vaccinate everybody. Don’t bother about what people say, oh! They would have done this and that but where is the money?
The meningitis vaccine is about £20 averaging for the five ravaged states we need to vaccinate about 21 million people. 21 million by £20 is £420 million. That is more than my health budget. So if I am asked as a public health person what I should do, I will quickly do a trick, I will tell you to quickly let me know your problem on time and quickly move people there to solve the problem than vaccinate everybody when we do not have the resources.
Is that what has given rise to the Rapid Response Initiative, RRI?
Partly. But let me say that the Rapid Response Initiative, RRI is distinct, peculiar and strictly President Muhammadu Buhari’s health initiative, something I would like to call ‘Buhari Care’.
What is it all about?
Rapid Result Initiative (RRI) is a project aimed at transforming the lives of Nigerians.
It is tailored by the Buhari government to give quick and free surgery to those in need of such vital service, screen Nigerians for diseases, check their blood and sugar levels, de-worm them and render necessary health care to those who are very poor and incapable of paying for such services. This is geared towards transforming their lives.
How do you select the beneficiaries?
The Social Services Department of the Health Ministry developed some guidelines to identify the poor, the jobless in different parts of the country and we used the data to select the beneficiaries. Besides, when we go down for the exercise neighbours help to identify those who are really poor and we help them. The result has been very wonderful so far with lots of testimonies following each medical mission.
How many of such missions have you carried out so far?
We have so far carried out the outreach in 40 teaching hospitals and medical centres with 5000 surgery and 10, 000 people screened nationwide.
The Millennium Development Goals, MDGs have come and gone and we didn’t achieve much. Any lesson learnt from the failure?
(Cuts in) We did a lot but we couldn’t meet many of the targets. I think we should also do something about our achievements. I think there is a difference between “We did not do well and we haven’t achieved all targets”. We did well but we did not achieve the targets, let’s celebrate ourselves.
Where do you see Nigeria in the current Sustainable Development Goals 3 as regards achieving its health target come 2030?
Goal 3 is about Universal Health Coverage and we are committed to it, we are not only doing SDG 3 alone, but we are also partnering to achieve SDG 2. We are part of the Zero Hunger Initiative and we work with Ministry of Agriculture and former President Olusegun Obasanjo to develop the zero hunger document. The committee is meeting presently in Benue and we are part of that meeting to strategise on how to make more quality food available to end hunger and malnutrition in the country.