On December 9th 2015, we gathered in Abuja, Nigeria’s capital city, for the first Public Service Lecture of the Nigerian Primary Health Care Development Agency. Despite starting three hours behind schedule, we waited. There were two primary reasons for this patience: firstly Professor Eyitayo Lambo belongs to an extremely small group of leaders in the Nigerian Health Sector that can hold their heads high in the knowledge of having contributed significantly to improving the health of the Nigerian people, and secondly it was probably the first major public outing of the two new Ministers of Health in Nigeria.
After the Minister, Professor Isaac Adewole finally arrived, he apologised profusely for being late, having had multiple engagements on the same morning (his support staff is probably still coming to terms with scheduling his engagements). Professor Adewole gave a few inspiring opening remarks, stating that during this administration, “the health, life and death of every Nigerian will count,” promising to focus on outcomes: babies delivered, children vaccinated, people treated e.t.c. Most significantly he promised to lead a Health Ministry that will accountable and accessible. The first signs were good.
After the pleasantries were over, the high table was occupied by Nigeria’s new Minister for Health, the Minister for State Dr. Osagie Ehanire, the Executive Director of the Nigerian Primary Health Care Development Agency, Dr. Ado Mohammed, the acting Executive Secretary of the National Health Insurance Scheme, Mr. Olufemi Akingbade as well as the Chairman of the Senate Committee on Primary Health Care and Communicable Diseases, Chief Mao Ohuabunwa. In fact, all the leaders responsible for delivering an improved health sector to serve the Nigerian people were present. The first indication of what was to come was when Professor Lambo requested that all of them leave the high table and sit in the front row, so that they could hear and see what he was about to present… something probably only he could do with such unassuming confidence.
Professor Lambo then took the audience through a history lesson in the evolution of primary health care in Nigeria from the pre-Alma Ata days. He described the international intrigues leading up to the Alma Ata declaration and the protests afterwards, highlighting the work of a few other colleagues, including Professor Olikoye Ransome Kuti, who stayed faithful to those ideals, even against strong opposition from within Nigeria’s Ministry of Health. The analogy that he gave that stuck the most described how the three tiers of a national healthcare delivery system can be likened to the 3 major parts of a house:
- The primary healthcare system is the foundation,
- The secondary healthcare system is like the walls,
- The tertiary healthcare system is like the roof of the house.
“An effective shelter can only emerge when these three component parts are ‘welded’ together,” he said, going on to describe an effective primary healthcare system as one that can resolve 80% of the health needs of the people close to where they live and work.
Professor Lambo described, with great nostalgia, the period 1986 to 1992, during Professor Olikoye Ransome-Kuti’s tenure as Health Minister. This era saw the birth of first comprehensive National Health Policy, and the creation of the Primary Health Care Directorate in the Federal Ministry of Health. In 1986, the FMoH selected 52 LGAs to be developed as models for primary health care services and these were paired with a College of Medicine/School of Health Technology to provide technical assistance. Village Health Services and Village Health Committees were set up in these 52 LGAs. The National Primary Health Care development Agency (NPHCDA) was established in 1992. A key achievement during the period was the attainment of 80% immunization coverage for fully immunized U5 children. He however added that this period of relative success was short-lived largely due to the withdrawal of donor support because of the unpopular Abacha regime.
At this point he asked the audience if Nigeria had attained 80% vaccination coverage in the room since then, and some in the audience shouted “Yes – 90%”. But Professor Lambo was prepared, as he showed a slide showing the DPT3 coverage according to the last National Demographic and Health Survey in Nigeria in 2013 to be 38%. Some people in the room must have felt very ashamed.
Lambo ended his narrative of that era quoting his good friend and colleague, Professor Oyewale Tomori, on NPI and the purchase of vaccines during the period:
‘…the NPI was established, ostensibly to ensure every Nigerian child got due vaccines at the right time, but it turned out to be a programme where the undue process became due, and where disease eradication became a system for ‘incentuous’ avenue for amassing ‘ blood’ money. The beneficiaries, ministry workers, civil servants, political party agents and their types went away with illegally acquired money, while parents of children succumbing to vaccine preventable diseases mourned their losses’ ( Tomori, 2013).
Before Professor Lambo began his reflection on his own era as Minister of Health in Nigeria he turned to the new Ministers and prayed that they succeed where their predecessors failed, in leading Nigeria to the ‘promised land’ in terms of health. To do this, Professor Lambo advised the Minister to keep his eyes firmly on two parastatals whose leaders were sitting with him: NPHCDA and NHIS, stating that if there is any chance of a resurrection of primary health care in Nigeria, these two parastatals must serve Nigerians with a single vision and purpose. He reflected on his own era, when he would pay surprise visits to primary health care centres and not find a single person in the facility.
No one knows the history of the new National Health Act better than Professor Lambo and it was no surprise when he asserted that the biggest flaw in the legislative framework with regard to health was not solved by the act, that is, the non-assignment of roles and responsibilities with regard to health to the three tiers of Government. The other major flaw in the Act of 1999, which established the NHIS, was that it made health insurance voluntary, unlike other similar laws such as the Pensions Reform Act. This left openings for the trade unions to oppose its full implementation, a situation which has persisted until today.
Professor Lambo ended by encouraging the revitalisation of the country’s lapsing primary health care services, especially through the schemes such as the National Midwifery Service Scheme (MSS), the SURE-P MCH Programme, the Saving One Million Lives initiative and most recently the PHC Under One Roof programme.
In conclusion, Professor Lambo called on President Buhari to do three things:
- “Fight the good fight against corruption, fraud, abuse of office at all levels of government very doggedly – this is high on the list of ‘changes’ that we expect from your government
- Remember the ‘Abuja target’ of at least 15% of government total expenditure allocated to health (2001) and incrementally move towards achieving this target within the next 8 years
- Explore with relevant organs of government some innovative ways of financing health services, especially primary health care
Professor Lambo ended his talk to a prolonged standing ovation. Watching the “body language” of the Ministers there is no doubt that they were listening attentively. However, this is always the case with Ministers when they are new in office. There is no area of governance more in need of innovative, competent and courageous leadership than the health sector. Just as Prof. said to the Executive Director of NPHCDA, for the next lecture, the focus should be on what you have done, not what you want to do.
Read the full transcript of Prof. Lambo’s presentation at the NPHCDA Public Service Lecture.