Interview with the Executive Director of the National Primary Health Development Agency (NPHDA)
Sustainable healthcare system is what every nation desires. You have made your marks in bringing Nigeria out of a health crisis. Sir how do you sustain this knowing that sustenance is critical?
The issue raised is very important and strategic for us in the sector. But I think it is important, we let people know that health is not only health sector’s business, it is everybody’s business. The moment it is everybody’s business we keep on watching and looking to make sure that the right thing is being done. If you go with that mindset of the progress and the achievements we have recorded, it will be sustained because everybody will be interested not only in terms of providing funding for the health sector but monitoring and tracking the utilization of that fund.
In specific terms it is important also for the implementing platform that is the local government and states that have the constitutional responsibility to buy into the programme. So, what we have done is to ensure that states and local governments bought into what we have done. For example, polio eradication, we are not doing it in isolation. We have over the years created demand for services. We have also over the years created ownership for states and local governments and with that ownership and being on the driver’s seat.
What we have done is to create demand, to get them involved, bring them on board, and they are driving the process and we are giving support from behind. That is the way it is supposed to be. It is different from the business as usual approach in which you drive the process and then you expect somebody that is not involved in planning and execution to run the programme.
So as it is now, we have subsidized the local government, we have subsidized the state, we have involved them in planning, we have provided leadership and guidance and gradually we are taking the back seat and they are driving the process. And that has resulted in a number of programmes at the sub-national level.
For example we have the primary healthcare under one roof that will conceive as a platform to sustain the gains we have made not only in polio but maternal mortality reduction, child survival and other primary care intervention programmes, primary healthcare under one roof, looking at micro level and the macro level.
At the micro level, instead of having multiple players at the state level, we have collapse all the players into one. And we have established state primary healthcare development agencies. Before now only two states have primary healthcare development agency but as at now 29 states have primary health development agencies in place. That has collapsed all the players in PHC at the state level. In some states we have Special Advisers on Primary Healthcare, you have Ministries of Health involved in primary healthcare, you have local government in primary healthcare, confusing the system and resulting into insufficiency so that has been collapsed now. Able to deliver primary healthcare is being managed by state management agency. So, we are working with the state primary national development agency and that has proven efficiency.
At the micro level, we have all the primary health care centers being collapse and being managed by the state primary healthcare development agencies unlike before when the local governments will run and we all know the limitation of the local governments in terms of capacity and in terms of funding, so all those things have been address now.
That provides the answer. The answer is the state and the local governments are running it with the federal government providing leadership, guidance and oversight. That is the key to sustain the progress we have made.
Late last year President Jonathan signed National Health Bill into an Act, your agency is at the center of the implementation of the content of the act, what are Nigerians looking out for in this Act and how do you give it proper implementation?
Let me start by appreciating Mr. President for signing the National Health Bill into an Act because that will go a long way in addressing the major challenges of our health system over the years in terms of roles and responsibility, in terms of quality and care, in terms of funding, and in terms of availability of healthcare services all over the country. That is a major game changer for us in the health sector.
Looking at the Act itself, the agency has a very important role to play because besides the issue of polity there is a provision for basic healthcare provision funds which is akin to primary healthcare fund that will be used to provide drugs, equipment and capacity building for human resource for health. And these are critical ingredients of the functionalities of the health system particularly input. Over the years, we have been talking that people will go to the primary healthcare centers and there are no drugs. This would address some of it. And then skilled frontline health workers is another issue that would be addressed by this Act because there is a provision for that, that will support states in terms of building the capacity of the front line workers.
But besides that, the Act also seek to address the issue of lack of demarcation of clear definition of and responsibility in the health sector in terms of what the state supposed to do, what the federal government, supposed to do and what the local government is expected to do. So, the Act clearly defines what everyone is supposed to do without any ambiguity.
Thirdly, and very important the Act will also address the issue of bottleneck, for the very first time in this country, the world health system is being incorporated into the national health system. So, what it means now is that the community is now a critical stakeholder and before now we have been proactive because we have been establishing and revolving ward development committees. I am sure you will be wondering what a ward development committee is. It is a group of people that has religious leaders, community leaders, civil society organizations and all the key leaders within the community that will co-manage primary healthcare services in that ward. They have been incorporated as part of the national health system.
They are being organized and they have a role to play in terms of managing and monitoring health system in that ward. This Act will address most of the issues that have affected the health system in the last few years. So it is going to be a major game changer besides bringing the issue of funding which is a major challenge in the sector. So it will provide funding to face most of the challenges we faced in the sector in the last few years.
Nigeria was part of the comity of nations that signed the MDGs and you will agree with that health takes up to four out of the eight goals. Giving the time bracket we find out that the target is counting down. What is the fate of the Nigeria?
Let me say that as a country we have done well. We may not have reached the desired destination but we have gone very far. For some of the goals we are almost there. For one, we are almost attaining it. The global communities and Nigeria have reviewed the MDGs. Where we were we with the MDGs? Where are we now? And what are the ways forward to sustain it? And the consensus that has been reached is that the health agenda is an unfinished business. Post 2015, the health agenda will continue to be relevant, relevant in the form of sustainable development goal. Post 2015 the nomenclature will change, we will have the health agenda as a major agenda. We will continue with the health agenda in post 2015.
But I want to say that we have made a lot of progress between the time MDG was conceived and now, in terms of reduction of the burden of HIV, in terms of reduction of burden of maternal mortality, in terms of reduction of burden of childhood mortality. We have done well, we are not yet at the destination but we are almost there.
You are involved in the Presidential Committee on Live Saving initiative, what is the progress now?
As you are aware Mr. President is a Co-chair of the UN commission of the Live Saving commodities and the idea behind the live saving commodities is to see how we can use high impact live saving commodities to improve the health outcome of the Nigerian women and children. So far Mr. President has given us marching order to make available these commodities in our health facilities and we have introduced some of these live saving commodities; magnesium sulphase, zinc… tackling the issue of maternal mortality, tackling the issue of child mortality and improving child survival. That has gone a long way in improving child outcome and maternal health outcome in this country.
There is no way an agency making an appreciable progress like this would not be faced with one or two challenges, what are these challenges?
As usual, the responsibility of the provision of primary healthcare services is that of the local government and states; that means there is need for us to continue to advocate and engage all the local governments and states, that itself is a major challenge relating with about 774 local government. Secondly, the local governments that are supposed to implement PHC services, we all know the challenges they have in terms of capacity and even when the capacity is there, there is issue of funding for this programme.
Thirdly, funding itself, there is no amount of money that will be adequate even for the best run programme. For us too we can make do with additional funding. But with what we are receiving, we are being very effective and efficient in the utilization of those resources. Then fourthly, journalists and media people also need to work with us in terms of sending out positive messages. Because it is not only when bad things happen that is when you go to the air. When good things happen you do not say it.
In the last few years, due to our intervention in the health sector due to our intervention with provision of meningitis vaccine no outbreak of meningitis has happen. Before now there were thousands of cases of meningitis during hammattan, it does not happen again, journalists are not saying it.
There were measles outbreak with several cases during the hammattan season, but now no outbreak of measles and journalists won’t come out to commend the government that they are doing well. PHC platform was used to contain Ebola in this country you people are not celebrating the primary health workers. It is important that journalists should continue to partner with us in terms of sending positive messages. I am not saying you are not doing that but like Oliver Twist, we request for more.
