Hehehe......In this exclusive interview with PREMIUM TIMES’ Oluwatoyosi Olawande
and Aminu Adamu, Nigeria’s Minister of Health, Issac Adewole, speaks
extensively on various issues and developments in the health sector,
including the performance of the 2016 budget in the sector and what to
expect going forward.
PT: What is the ministry doing to forestall the strike threat by resident doctors?
ADEWOLE: We have met, and we are addressing the issues and a letter
is going from the Permanent Secretary to the President of the National
Association of Resident Doctors about what we have done on all the
issues. Practically all the things have been looked into, some are key
issues that are under our purview, some are key issues that will have no
control over.
PT: What about the issue of their unpaid salaries?
ADEWOLE: I spoke to the Minister of Finance and Mr. President took a
virement request to the National Assembly. It has been approved. The
issue of November, December salary will be taken care of in the next few
days, so that is the key element of their request.
PT: They spoke of worsening health indices
ADEWOLE: That is not true, that is very unscientific. I would have
expected them to tell me the indices that have worsened since we came on
board; none. You don’t even do indices every year, you do indices every
3 years, every 5 years. The next demographic and health survey in
Nigeria is due in 2018. The last one was 2013, so how did anybody come
with worsening health indices?
PT: They complained about dilapidated infrastructures in health institutions in the country.
ADEWOLE: That is also not true, we are working hard. If you look at
the 2017 budget, there is a lump sum of money that we put there, about
N12 billion, N11.7 billion of that is for upgrade of tertiary centres.
And what we are doing is to partner with the sovereign investment
authority to get some private sector money together so that we can grow
the money and make sure we work on our health facilities.
PT: You heard about the recent unfortunate death of a corps member at an NYSC camp?
ADEWOLE: NYSC is not under us but immediately the death occurred, I
called the Director-General and I said DG, I am writing to all the
federal health institutions to look after your corps members. In
addition, Mr. President has directed that we should bring a memo to the
Federal Executive Council enrolling Youth Corpers in National Health
Insurance.
PT: Still on resident doctors, they said their colleagues have not been paid salaries for 3 months in Akwa Ibom State.
ADEWOLE: The thing is that there is a problem across the country. The
last time we spoke with Mr. President, I think about 24 states or so
have not been able to pay salaries regularly. It’s a general problem.
PT: There is also the point about improper placement of doctors on entry point and non adjustment of their salary structure.
ADEWOLE: That is not true. Doctors are on CONMESS; CONMESS 1 to 7.
Doctors who come back from NYSC actually start on CONMESS 2. They woke
up and said that the entry point should be on CONHESS 9 and you are not
on CONHESS.
That is what the Chairman of the Salaries and Wages Commission said,
that if you don’t want your salary, say so and move to another one. You
cannot stay in a salary scale and say they should give you entry point
of another one.
Sometimes when your constituency fights, you ask them, do they really
know what they are talking about? What you should ask for is that, maybe
the entry point of your own, if you think it should be higher, we can
work on that, ask us to look at it, but don’t say they must give you the
beginning of another salary point because that is not what you need.
PT: What about pension deduction?
ADEWOLE: We have directed that they should deduct their money for pension, we don’t see why that should be a problem.
PT: When will there be white paper on training programme?
ADEWOLE: We are working on that.
PT: On non-payment of salary in some states…
ADEWOLE: We have no control. As I have said, I cannot force Akwa Ibom
to pay you salary, it is not under our control. I cannot force Osun, I
cannot force Oyo or any of these states that have financial hardship to
pay you, we can only appeal to those states.
PT: What about the implementation of No Work No Pay Rule?
ADEWOLE: It is the policy of the land, it’s the law of the land. No
Work No Pay is not my creation, it’s the law. You are free to go on
strike but the law has to take its course, if you are on strike, then
you don’t get paid. There is nowhere in the world where you go on strike
and say they must pay you.
We don’t want strike, we will work hard to prevent strike and our job
is to prevent strike. But we cannot but implement No work No pay rule.
PT: What is your roadmap and timelines for achieving your objectives in the health sector as a Minister?
ADEWOLE: We have a 4-year plan because this administration has a
4-year agenda and within the context of that agenda, we want to
reposition the policy. We are working on that, it has been approved at
National Council on Health, it is awaiting editorial input before we
submit it to FEC for approval. Because, anything we do must be done
within the framework of the policy, because the policy states what you
want to do. This country has had a policy (reviewed)
three times, in 1988, in 2004, this one is third one in the history of
this country. Because we must have a roadmap, we can hold the policy and
say look, this is what you promised to do.
Within the context of the policy, we want to do 4 quick things:
improve on the policy environment; we want to improve on quality; we
want to make sure that we care for the poor and the vulnerable – the
president is so passionate about poor people, rural and vulnerable – and
we want to prioritise health; and we want to begin the implementation
of universal health coverage.
And when we talk about universal health coverage, it is a journey but
it takes about 3 things. When you look at All Progressives Congress
manifesto, it says that we will make health care accessible, affordable
and qualitative. Those 3 means universal health coverage: that means you
access health close to you, it must be of good quality and you must not
look for money when you need it.
And that’s why we then say how do we deliver it? We must revitalise
Primary Healthcare Centres. When Nigerians are sick today, because they
don’t trust the Primary which has more or less collapsed, they walk into
a Teaching Hospital or a Federal Medical Centre and say I have
headache, I have skin rashes, I am having nausea and vomiting. And we
say that it’s not what a Teaching Hospital or Medical Centre is meant
for.
We want to reposition it properly so that it can sit at the base. We
want a base which is the PHC, Secondary and Tertiary. Seventy per cent
of Nigerians will access health at the Primary: those who want to
deliver, those who have malaria, those who have diarrhoea and vomiting,
those who have skin rashes, those who want to immunise their children,
they don’t have to go to a specialist hospital. Twenty per cent will
access healthcare, those who cannot deliver and need caesarean section
will go to Secondary; accidents, bad cases will go there. Then the super
complex cases like the girl with cystic hygroma, the liver cancer,
cervical cancer, renal failure, stroke, will go to a tertiary centre. So
within the lifespan of this administration, we want to reposition this
pyramid.
PT: How well did the ministry perform with the 2016 budget?
ADEWOLE: For the first time in the history of this country, we gave 50
per cent of our capital allocation to the Primary Health Care
Development Agency. It has never happened before. If you look at it, Mr.
President submitted a proposal of N35 billion, National Assembly
reduced it to N28billion and that drastically affected us. But even with
that, we decided to prioritize, we said we must give priority still to
primary healthcare. The total allocation for primary healthcare was
N17.745 billion, so 60 per cent of our budget went to PHC, Primary
Healthcare Development Agency.
That was why when they picked out that polio, all I did was to meet
Mr. President and say Mr. President, we need money. He said what do you
need? I said sir, we make provision for it in our budget, all you need
to do is direct that it should be released. He said it should be
released and the Minister of Finance released the entire N9.8 billion,
100% release. It has never happened in the history of this country.
The international community even said this has never happened before,
that Health will release the entire allocation and that is why we have
been able to do six rounds of immunisation of polio and WHO came and
commended Nigeria. There are other things, if you look at the budget,
apart from Polio, we had N1 billion for other vaccines.
PT: There was a reversal in Polio eradication in Nigeria.
ADEWOLE: It is wrong to say Nigeria is free of Polio when part of
Nigeria was not accessible. And when they say there is resurgence of
polio in Nigeria, I say where? Inaccessible area. The day you pick Polio
in Kano, in Sokoto, Ibadan then I will say there is resurgence. So when
you say under my beat, Polio resurged, No, it’s wrong. We’ve had 4
cases of Polio in Borno, all the four came from areas that were under
control of Boko Haram.
When they say Nigeria was free of Polio, they should have said the
free area or accessible area is free of Polio and it is still free of
polio. We have not detected polio in Sokoto, Kano, Ibadan,
Port-Harcourt, Abuja. We only picked 4 cases of Polio in Borno State,
areas under Moguno IDP Camp, Murna Camp, and Gwoza. So that to me,
scientifically, it is not resurgence. Resurgence is you have controlled
it, it flared up.
We had no access to this place before. It is the security operations
that enabled us to access them and that is why Mr. President said ‘Go
and look for more, you might still find children who are not vaccinated
before’. And if children were not vaccinated, they could develop polio
and that is what happened. We did (immunization in) Borno State, we did
five states and we did 18 states four times and we used soldiers to even
vaccinate.
We worked with the Army, something that has never been done before and
then we introduced IPV. The IPV is injection, you know oral polio will
give about 4, 5 times because it is not as powerful as the IPV, but the
IPV is in short supply all over the world, it is what we are introducing
for routine immunisation. I directed that any IPV in Nigeria should be
taken to Borno and any child that comes out, you are seeing, just give
IPV because we may not see them again. Even if you give IPV once, you
are sure you have given something.
PT: What are your immediate plans to ensure a transparent procurement process for 2017 budget implementation?
ADEWOLE: Well, the first thing is to say that we will continue to
comply with the provision of the public procurement act, we would. Two,
we would be transparent with our figures. I met the funders, even for
2016, this is what we have, we won’t hide it. When they brought the
proposals for 2017, I did photocopy and gave to all the directors. I
also insisted that the director of procurement must not advertise
without getting the quotation from the director or head of unit. Because
it’s the head of unit who is the technical person who knows about what
you want to procure, they must contact them and our budget will be on
the website
PT:
In the 2017 budget proposal, 303.9 billion was allocated to health
which represents below 6 per cent of the budget. Is the Nigerian
government not committed to the Abuja Declaration of 2000 (15 per cent
of annual budget to improve the health sector)?
ADEWOLE: Number 1, I am a doctor so I want more money in Health. But
when you look at Health, what we need to do is to quantify money going
into Health. How much are the states putting there, how much are we
getting from donors, from outside funding?
In 2016, we have a World Bank loan of $500 million, that is about N140
billion that is going into Health. It is a loan from the World Bank,
Nigeria will repay but we give it free to the states as grant to improve
primary healthcare: improve immunisation, improve maternal health,
improve child health, improve nutrition, improve immunisation, improve
family planning, and take care of HIV. When you start taking it, we go
and check your levels and we give you more money next year.
The Global Fund will spend about $1 billion over 4 years in Nigeria;
that has not been captured. PEPFAR is working in some states, 32 local
government areas on HIV, it has not been captured. DFID is supporting
950 PHCs in the North, to revitalise them, it’s not been captured. EU
will rehabilitate 774 PHCs in 3 states in 2017. So when you look at
health, health is not an orphan. I want more money in Health, I am not
going to deceive you, but it is not that we are completely helpless. My
strategy is that whatever we have, let’s use it well and ask for more.
For 2017, health recorded the single largest increase in allocation
for capital. We have 79 per cent increase from 28 to 51 and we are
assured that it will keep on increasing. When I discussed with the
Minister of Budget, I tried to liken it to UBEC. UBEC is out of
Education because UBEC is like NPHCDA, so maybe the solution is to take
NPHCDA out of health so that people know that it is separate.
In fact, Bauchi is spending 16 per cent of their budget on health. So
there are oasis of success and hope across the country. We will get
there, I think part of the challenge in this administration, before now,
we spent over 90 per cent of our budget on salaries. 2016 represents
the first time Government is saying even if we are to borrow, let’s put
money on infrastructure.
When you pay salary, even when you increase my salary, nothing changes
outside other than my buying imported goods. But when you put money on
railway, on roads, you know what will happen? I told my STA, I said once
you put money in roads, it’s a capital project. You find drivers, they
will employ more people, food sellers will come and sell food, by
evening ogogoro people will sell ogogoro, by evening you find some small
shelters, prostitutes will come there, you develop a new life, some
people will open a small clinic to look after those who have accidents.
So when you invest in capital, it’s like you are investing in the life
of the country. And so 30 per cent is going to capital and it will
change the dynamics of things. When the American economy was down, all
Obama did was to fund infrastructure and turn the economy around in
spite of being a black person.
PT:
How well has the ministry been able to harness and redistribute the
resources contributed by the international community, donor agencies and
international NGOs in respect to health for the benefit of Nigerians?
ADEWOLE: Excellently well. You know the interesting thing about this
country, the problem of health in Nigeria is the problem of equity. The
maternal mortality rate of the educated Nigerian is just like that of
Europe and America. Ninety-one per cent of educated Nigerians with at
least secondary school will attend antenatal care. Twenty per cent of
the poor ones will go to antenatal care, so that is why we just must
target rural people, the uneducated people.
The Save One Million is to the poor. We are also using the RRI, the
Rapid Result Initiative, it is for poor people. We are doing free
surgery for poor people, some of them were given transport money, some
were given money to go and start some business. The one I saw in
National Hospital, they repaired the palate cleft, I looked at the
child, the hair was fluffy, showing malnutrition and I said please ask
her what work she was doing. She said she doesn’t do any work. I said
will you like to sell a few petty-petty things? She said yes. I asked
them to give her N50,000 to go and start selling something.
PT: How long will the Rapid Results Initiative last and what is the scorecard of the Initiative?
ADEWOLE: It will last the life of the Save One Million Lives, 4 years.
We have the resources for the 4 years. So we are hoping every year, we
will do 10,000 free surgeries. The whole concept of the RRI is to drive
you. You set impossible targets. We did two series of workshops, invited
the leadership of the ministry, media groups, some other people from
outside, and said we want to do impossible things, touch the lives of
Nigerians. What are the problems, set targets, they are impossible, when
people hear it, they will say wow! That is the whole essence of RRI.
It’s not simple and we do not expect to achieve 100 but we must start,
drive people. Because if you don’t drive them, you won’t achieve.
Usually we set 100 days, we said we will rehabilitate 109 PHCs, test
about 50,000 women. We said we will do 10,000 surgeries, between June
and now, we have done under 5,000. It’s because many of the CMDs didn’t
even believe, until they saw money in their account. The aim is not to
score ourselves but to keep moving and we will roll it on.
PT:
Between 2001 and 2014, Nigerian Government spent about N32 billion on
the construction and rehabilitation of primary health centres,
comprising 687 health centres across the nation. However, our
investigations as published on our PTCIJ web page show that a higher
percentage are either abandoned or not in use. What are your plans to
resuscitate them?
ADEWOLE: There are about 30,000 PHCs across the country, our own data.
For this 30,000, only about 20 per cent are working or functional.
There are 9,244 political wards in this country, for ease of
functionality, let’s call it 10,000. If we can make the PHC work in each
of these wards, that will enable us to deliver health to at least 100
million Nigerians. That will be a major achievement and that is why we
are making that a cardinal issue in the life of this administration.
We are also looking at sustainable models. I went to visit one in
Ibadan, at Ward 3 of Ibadan North local government. A private man, Kola
Daisi, donated a building for PHC and every quarter, he was giving
200,000 naira, that is N800,000 per year. In 5 years, this PHC
registered 18,000 people and has 21 million naira surplus in their
account. It is being managed by his foundation, community medicine
department of UCH and the community, they have a ward development
committee. I sent the NPHCDA to go and look at this one. This model can
work in any of our urban centres, that will reduce our burden of what to
support in the rural areas.
I went there to personally supervise the PHC at Kunchigoro, Abuja. I
invited the University of Abuja Teaching Hospital, their Community
Medicine Department, I said NPHCDA go there. I am talking to General
Electric to give us simple equipment, the phototherapy machine, the
ultrasound came from General Electric. And I called Sterling Bank,
Sterling Bank give me 5 million to this account and then I told the
Minister of FCT I am renovating your health centre, because that is the
one they picked in FCT, they picked them across the country, 3 per
state and FCT, 109. We will do some shops behind there to make some
money, the ward people will open an account, they will manage it, there
will be joint signatory and we are hoping that if we can replicate this,
using FM model because the issue is let them survive, because it is not
every year that we will be putting money there. And so this is a model,
working with Sterling and we are also working with rich Nigerians, you
can take a PHC. I am appealing to National Assembly, a building does not
constitute a health facility, don’t go and use your constituency money
to put up a building and say it’s a facility. And that is what has
happened. People have been building, putting building up, but that does
not make it the health facility.
PT: What steps are being taken to accelerate tuberculosis case finding and treatment in rural areas in 2017?
ADEWOLE: I spoke to Eric Goosby, Eric Goosby and l, we’ve been working
together. Eric Goosby is the special ambassador on TB in U.S.. And I
told Eric, I said Eric you must support me, we have known each other for
years. And Eric is going to support us. Apart from Eric, we have put
money for at least 100 GeneXpert machines in 2017 budget, we are
declaring 2017 as the year of accelerated case finding for TB.
The problem in Nigeria is that we can only diagnose about 20 per cent
of the TB cases, the rest are out infecting other people. We have one of
the lowest case detection rates in the world. So we are going to
invest, we have about 300 machines, my vision is to find one GeneXpert
in every local government, 774 that is where I am going, minimum. It is
the new machine that has the better accuracy. But there is 100. In Abuja
now we have about 300, so we will continue to improve, and make sure
that we train more people.
PT: What caused the recent death of the health worker in Ogun State to Lassa fever? Measures to curtail an outbreak?
ADEWOLE: I got angry when I saw the report. It is unacceptable. The
woman was there for almost 2 weeks on admission. I could not believe it
could happen in a Federal Medical Centre. Because it is a nurse, they
did not think of Lassa fever. It’s madness, they treated for malaria for
3 days, started giving her antibiotics, they thought it was infection,
Ciprofloxacin. I read the report, I have constituted a high powered team
to investigate and we will sanction them.
That is the unfortunate side of the success story against Lassa.
Because of the jingle and everything, you say it’s gone down. Now we
have been having sporadic cases, we lost a doctor in Asaba who died I
think in Anambra. When it affects the health care provider, its more
serious, every patient that that doctor or nurse treats is at risk. That
is why we are worried when it affects the healthcare provider. It also
tells us that even the hospital is unsafe. How can a Federal Medical
Centre, you have malaria that is not responding, the fellow was
vomiting, has diarrhoea and you cannot think of Lassa fever until
Saturday? They then decided to do a test and of course the woman died
the second day. I got angry, I was livid with the commissioner and I
have asked the NCDC to investigate and certainly we will sanction them.
What we will also do is to step up, to continue the surveillance, keep
on making noise that once you have malaria that is not responding, you
have diarrhoea and vomiting, you should think of Lassa fever or any
other viral infection.
PT: Mental Health in Nigeria
ADEWOLE: What we have decided to do is to look at the mental health
situation in the North East, deliberately as a policy and we are working
in that area.
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