This is an open letter to Dr Osagie Ehanire the newly inaugurated Honourable Minister of Health
With recent development in Nigeria, its people now know those who will oversee the respective sectors of government for the next four years. One sector that has been deprived of its due attention since 1960 and has gotten worse in recent times is that which manages the people’s physical, physiological, psychological, mental and social well being – the health sector.
In as much as there are some marginal gains here and there, not much has been recorded in achieving a healthy population which is key to economic prosperity. The indices of health coverage, child and maternal health, life expectancy among other variables remain ugly and sometimes depressing. It is therefore no gainsaying that you have got a huge job to do if your impact must be felt by the Nigerian people now and in years to come.
One major task ahead of you is attracting the attention of the people to your ministry through a well organized system of efficient and result-oriented intrasectorial, intersectorial and intergovernmental strategies, policies and programmes. By now, I expect you to have published your plans, policy documents and roadmap for the health sector as like the time of then minister of health under the then military government of General Ibrahim Babagida – Prof. Beko Kuti (late). We are waiting not waiting for to settle in, you have been there before. A road map will tell the Nigerian people your policy direction and plans for them.
Nigeria over the years has put in place a number of structures to address the challenges against the efficient healthcare delivery to all. These include the Basic Health Service Scheme in 1975, National Health Policy in 1988, National Primary Health Care Development Agency in 1992, National Health Insurance Scheme in 2005, National Health Act in 2014 among others. As at now, only about 20 per cent of the 30,000 public PHCs in the country is fully functional according to a recent survey by a non-governmental body, CISLAC. What has been mainly lacking in achieving the goals of these well thought out plans of primary and universal heath care for is the political will to ensure things are done as expected at all levels.
Moving forward, there isn’t time for you (Dr. Osagie Ehanire) to engage in rhetorics in the name of organizing summits, conferences, gallivanting round the globe or what have you. You should rather have a quick evaluation of the above structures, get them refined and see to their implementation.
The primary health centre revitalization programme which was launched in 2017 and has been abandoned, needs to be revisited urgently. Quality human resources, equipment, consumables, etc should be readily available and there should be frequent and sporadic visits to assess the level of functioning of these facilities.
Please be aware that as I write you this letter, we have only 7 radiotherapy machines serving 200 million Nigerians and you know what? Only one is working! The remaining 6 have broken down from overuse or are now archaic and out-of-touch with modern technology. This was authoritatively reported by the investigative online news media, Premium Times. In 2017 (of which you were a junior minister then), the BBC reported that: “a dog with lymphoma in Miami has a better chance of getting treatment than a woman with a brain tumor in Lagos”. They added that: “a dog in the US is more likely to receive radiotherapy than a person in Nigeria”. This speaks volumes for cancer care services in Nigeria.
There is strong need for the domestication of the WHO’s universal health coverage, service delivery, public policy and leadership reforms to close the intolerable gap between the people’s aspirations and the resources available for implementation of primary health care.
The National Health Insurance Scheme currently covers about 5% of the population, who are only civil servants and their families leaving out poorer Nigerians who are forced to pay out-of-pocket or cannot outrightly assess medical care. How do we achieve Universal Health Coverage for all with this? This is 14 years after the scheme was set up and have only five per cent coverage. At this snail-pace, it will take Nigeria up to 280 years to achieve universal coverage! The scheme need to be more encompassing and probably made compulsory if you have in your plans the intention of affordable and quality access to health care for the Nigerian people.
Again, the issues of a transparency and accountability in the heath sector especially in budgetary allocations cannot be over emphasized. Your are serving in government that came into power with the mantra of “fight against corruption” The allegations of corruption in the nation’s health sector are too grave to ignore, considering the critical nature of services it provides and thus should be given serious thoughts and corrupt health officials in met with firm actions. This will encourage greater private sector participation in health insurance, healthy competition, universal best practices and growth of your ministry. The Nigerian people will be better for it.
On medical tourism, about 400 billion naira ($1billion) has been estimated as what the nation loses annually to other economies. 90 percent of the medical tourists are politicians even in this government that promised change from the norm in 2015. With judicious use of available resources, legislation to ensure government officials treat themselves in Nigeria and increased budgetary provision from the currently less than 4% of the total annual budget, improved medical facilities, specialist training, better pay for health workers, right attitude of personnel, quality service delivery with results among other measures, this menace can gradually be reversed. It’s also important to understand economic losses and other impacts of the brain drain in the sector on the nation’s development.
Another important task waiting for you Sir is finding a lasting solution to the unhealthy intrasectorial or interprofessional rivalry. There is need for clear demonstration of neutrality, and each category of health workers must be accorded its dignity be it a Nurse, Pharmacist, Laboratory Scientist or a Doctor. You should not be seen to be taking sides and the term “minister of doctors’ should not be used to describe you. Every member of the Nigerian health sector must feel they belong to the system. For every rivalry that exist between a doctor and other health workers, please know that a patient if not patients die.
Intersectorial collaboration with Ministries of Education, Environment and Transport is vital. Health education must be done massively both formally and informally to all people for increased consciousness of their general well being and that of the public. Human security, food safety and security, availability of potable water to all, pollution control and prevention, prevention of road traffic accidents, hazards control and prevention among other health related events can be achieved through your organized partnership with the respective sectors involved.
In order to democratize any gain in the health sector, the state, local governments and private sector must be seen on the same page with the Federal Government to avoid disjointed or parallel programmes. The organised private sector should be given a greater role in heath delivery. A regular evaluation of these programmes and intersectoral participation will help attain the set goals. Dr. Osagie Ehanire Sir, please carry every tier of government and the private sector along. Health for all is not a federal government responsibility alone. This mentality has been part of the problems all along.
Finally, the only way the country can justify sustained international support is displaying serious commitment to the health of its people and showing results for previous investments in the health sector. Universal health coverage for Nigerians is achievable if you start laying bricks on the foundation!
You are a gentle man, your tenure should be free of the vile language that was the trademark of your former boss.
Let me say a hearty congratulations to you on your appointment as the substantive Health Minister of the Federal Republic of Nigeria.
God bless the Federal Republic of Nigeria
Dr. Olaniyi Kolade