On the 7th of September 2011, there was an extraordinary meeting with the Minister of State for Health in Nigeria; Dr Ali-Pate and his team, were seated in the offices of the Federal Ministry of Health in Abuja Nigeria, with hundreds of Nigerian health care professionals around the world. No, they had not all flown into Abuja, but met via a webinar (web based seminar), that was hosted by the Anadach group. Technology is bringing those Nigerian leaders that choose to use it closer to the people, and hopefully they can begin to reduce the perceived distance between the ‘leaders’ and the ‘led’.
NHW asked Dr Pate the first question of the webinar – “What objectives he had set for the health sector”. Previous Ministers of Health have answered this question in dubious ways, listing the number of primary care centers to be built or CT scanners to be bought. So, we were quite excited when Dr Pate, probably for the first time since we started writing on health issues in Nigeria said explicitly that he will set health oriented outcome measures and process indicators to measure these. He went on to list the 4 strategic objectives that the Ministers of Health had set themselves during this tenure as
Improve basic service delivery at the front-lines focusing on consolidating the work begun in maternal and child health
Focus on the prevention agenda – immunisation, health education, tackling the growing non-communicable disease burden etc
Focus on clinical governance and improve quality of care in the Nigerian health sector from the chemist to the specialist hospital
Unlock potential of market forces to support and drive innovation and improvements in the health sector
To achieve this, the Minister called on the help and support of Nigerian health professionals in the Diaspora, especially in these 3 areas;
To hold the health sector and its leaders accountable with constructive criticism.
To be advocates for the Nigerian health sector
To leverage their expertise, resources, skills, and networks to support the Nigerian health sector
After his presentation, the Minister took questions on a range of issues. On cancer, he acknowledged that this is a growing challenge and a lot of work is going on to improve the capacity of our teaching hospitals to deal with these cases, but also advocated for the role of prevention. He acknowledged that sadly, apart from the register in Ibadan, there was no national cancer registry in Nigeria and that we have no way of knowing how big the problem really is – as you cannot really manage what you cannot measure. He promised to look into this. When asked on the Ministry’s work on supporting Nigerians with disabilities, he admitted that this was an area that had not received a lot of attention in Nigeria due to competing priorities. Questioned on the existence of a single cath lab in the country, he threw the question back at colleagues challenging Nigerians in the Diaspora to invest in these high end diagnostics, while government assures access and equity to the majority of the population.
Dr Pate made what was maybe the most important point of the session that the health Sector as it is presently structured was not not as pro- poor as it should be. He illustrated this using a slide on the inequity in health outcomes across the country, but also stated that within cities, with our meager resources – most public expenditure in health disproportionately favours those that need the least – the wealthy. The little access that the poor have in our rural areas is left in the hands of the weakest link of Government – the Local Government. This might sound good on paper, but it is terrible for the patients in real life!
Dr Pate illustrated the challenges around clinical governance, and quality of care with the example of his recent visit to aTeaching hospital in Nigeria, where a patient lost her life after she “fell” off the operating table during surgery. This team of Ministers will be prioritizing this to ensure that Nigerians that do go to the public sector for health care are assured of a standard and quality of care and know how to insist on this, when they do not receive it. This will come as good news to Nigerian patients who have gotten accustomed to often being treated as inanimate objects rather than humans in their care pathways.
Finally, Dr Pate encouraged Nigerian professionals to develope domestic solutions to local problems, noting that we cannot afford to think in silos that are convenient for professionals, but bad for patients. Referring to innovative approaches he led on while at the NPHCDA, like the deployment of Midwives around the country, he challenged colleagues to imagine what would happen to our health indicators if we could mobilize 200 000 community health workers to support Nigerian mothers and children.
While it is difficult to gauge the reactions of attendees in such webinars, our team that attended from Nigeria health Watch felt that there was indeed a “breath of fresh air’ in our Ministry of Health. We concluded that we have a team of competent colleagues as Ministers, one who had spent most of his life in the Nigerian public hospital scene, and the other who had spent most of his career working his way through the ranks in the tough US health system, and eventually through the ranks of the World Bank, before returning to turn around one of the most ailing parastatals in the country. If this team of Ministers does not get it right, then we will be at a loss as to who will.
Having said that, make no mistakes about it, our health sector is in a deep deep mess. The Minister has said all the right things….now its time to deliver. For those in the Diaspora, it is time to roll up your sleeves and contribute, with no expectations of a red-carpet reception.
It’s a murky world out there, but its home.
Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead
Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (www.epiafric.com), which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.