Former Commissioner for Health in Lagos State Dr. Jide Idris spoke with EMMANUEL OLADESU, HALIMAT BALOGUN and TAMILORE MACAULEY on the giant strides of All Progressives Congress (APC) presidential candidate Asiwaju Bola Tinubu when he was governor of Lagos State and how he will replicate the feats at the centre, if elected in next year’s poll.
What are the challenges confronting the health sector in Nigeria?
The challenges are very many, but from my own assessment, when we talk of the challenges, we talk about the workforce, the human resources, the health issues, the staff.
Number two, because social progress is slowed down by the high level of poverty, illiteracy. Health insurance is still new. Funding is a major issue whatever you do, you need to fund. It is a major issue. If you look at the past, everybody looked at health from a purely curative point of view where people treated disease and where you are supposed to make people healthy. So, people come before you, you treat them, they go back. We need help to build more hospitals. Hospitals are just 20 per cent of the health sector. The example is when ebola came. Talking about our hospitals, how many of our hospitals are functioning? Everybody ran away because those hospitals were not properly designed to handle it. That’s one. Two, the staffs were not properly trained to handle it. Three, we have not developed our health care industry to take care of emergencies like this. They are called emergencies because you don’t know when they will come, but they will definitely come. So, you have to be prepared. Four, we talked that the basic backbone of the health sector, primary health system, have issues. So, you can continue to say that there are many challenges, but to address these challenges, you have leadership and governance. Leadership, we don’t have any focus. So, those are the challenges and they are still present today. It is getting worse.
How should these challenges be tackled in this dispensation?
I look at the people that are expected to help, fighting with other people, competing to take over. Look at the three candidates or maybe four. We need somebody, you know our country is very complex, different cultures and all. We need somebody that can resolve the challenges. Look, it is not only about going to school. Somebody who has the capability, who is courageous, who also understands the issue of nation building and who can handle this country, who can show leadership, that competency of leadership. See, a leader is somebody, he doesn’t necessarily need to have all the competencies, but who can Assembly talents, who can provide all things they require. He is somebody who can get things either by tapping on people’s expertise, getting people, motivating people.
I think Asiwaju Bola Tinubu is the only one who is competent enough. But like I said, the country is complex. People are talking about those issues. We need someone who knows the history of our country. Some of them don’t even know the complexity of the country. They don’t even know the challenges in the various sectors. Maybe, in their various little sectors, they can have basic education, but, they don’t have experience and understanding of people like that.
To address the current situation now requires somebody who fully understands this country, who has requite knowledge on how to bring the people together. We are diverse people. We need someone who can motivate people.
The economy is down, someone who understands the economy and can do something to reactivate the economy. Having done that, you have to address other sectors. Many of the sectors are there; agricultural sector, education sector, health sector, we talk of infrastructure.
We are building infrastructure, but are we able to maintain that infrastructure. No.We can build this one, but in another couple of years, they are down; there is nobody to maintain them. So, we need capabilities in specific areas where people can come and advice. It is a complex country, very complex, very tough. We just need some time to plan. You can get the right people together by addressing the issue with tenacity. These are the things I see because he demonstrated these when he came to Lagos in 1999.
Could you reflect on how he tackled the challenges of health sector when he was governor?
It is an interesting thing when I look back. I think I will count myself lucky because I didn’t plan to be here then. I came from United States.tBut, like I will always tell people here, you need to be within an environment to understand the process and history of the environment. You need to be in government to understand the madness in it. If not, you will just come and criticize, assuming thinas. I underestimated him. But, I had to change my mind later because I experienced certain things. Later, I understood what he set out to do.
I came from the U.S. They had set up this technical working people to address the different sectors. So, by the time we came in, there was a technical working group established for the health sector and who headed it? The late Prof. Ransom Kuti. I wasn’t there. It was only the report I saw and I saw the contribution of those people who looked at the health sector. Based on the recommendations, he hit the ground running. He did the same thing for different areas like education, defense.
In the health sector, it is that document that he gave to us. Without that document, we would have spent the first two years trying to even understand what is happening in the sector. So, that’s the first thing we decided to do and they made recommendations based on the experience then and we were following those recommendations to the letter. In another situation or occasion, we amended them. So, some of those things they recommended were things like health insurance. He said plan for health insurance, deal with primary health care, preventive medicine. These were things Ransome-Kuti was saying, immunization, childhood illnesses, about 18 recommendations. Ater a few years, we have analyzed, we felt that things were not moving as expected. So, they did a review of the system. So through the internal review, that’s what led to the health sector reform we did in Lagos State. It was that reform that made Lagos State to move faster than other states.
We have challenges. We need to address those challenges. What are the causes of those challenges? When we sat down, we felt this sector needed to be restructured. We can not live the same old style today. So, to restructure the health sector, there are different aspects of the sector you address. We didn’t address all because we can’t address everything. We addressed the key ones.
One of them had to be leadership and governance. In any thing you do, governance is a major problem, especially in this country, especially in Lagos State. So, how do we restructure? We said that the Ministry of Health should have right to do what it is supposed to do. Ministry is about policy, monitoring laws and just overseeing the system, not to be doing everything that every other person will do. Let the doctors or the curative people deal with their functions in the hospital. So, what we did again was to decentralise hospital governance. There used to be a hospital management board in Lagos. You don’t centralize. We gave some partial authority to the general hospitals. They have their own problems because they needed to build capacity. We faced the issue of primary health care because it was a major issue.
Then, the health insurance, financing the health sector. We can not do all these without financing. So, in his own time again, he talked of free health. He made implemented free health because of his experience. There is high level of poverty. Many people could not afford this, but for the ree health. We agreed and when we started, we realized that we cannot fund this totally for many reasons. One, we don’t have the financing because they say health is a right, but somebody has to fund it.
Free health was targeted at children between five and 10 years, and below, adults and then, pregnant women because those are the major causes of diseases. He said let’s look at it and we started planning for insurance. So, in the selected hospitals too, we created the regulatory bodies called Facility Monitoring and Control Agency to monitor hospitals, both public and private, in terms of quality. It is just to ensure orderliness. That is why I say governance is important.
We addressed the issue of cheaper resources because when things are good, everybody comes into Lagos. So, the gain we make in Lagos is not visible because this is diluted. People come from other states to benefit.
Governance is key. Tinubu created a culture of continuity, from one government to the other. So, when you appoint a new government, the conclusion is that it is all a mix, people who had high memory, people that are coming with brand new ideas, the people that are already there. So, that’s why we made out the plans for everything in Lagos State. Planning is tough, implementing is much easier.
We also looked at the relationship between poverty and health challenges. You will see children on the road with polio defects. These are things the board came to discuss. These are diseases of poverty. It is people who are poor, who had no access to immunization that get polio. Polio is crippling. So, a lot of programmes were designed. We mounted education and enlightenment programmes. We came up with programmes like blindness prevention, JigiBola school health programme. All these things people seem to have forgotten. We created the ambulance service, the first state to do it. Blood transfusion service we created. We attended to cleft wound in children with congenital malfunctioning. And then, to build the infrastructure, I told you primary health care was a major focus because any country that doesn’t do it is joking. There is problem of revitalization. You need to revitalize the primary health care system and in revitalizing, you have to address what the infrastructure, staff. We have a policy in the plan, one PHC facility per ward, one general hospital per local government. The teaching hospitals are under the contr of the Federal Government. He didn’t stop. That’s how how LASUTH became one of the leading teaching hospitals today and I know what we went through. We increased primary health carefacilities from 160 to 210. So, we added about 60 or 50 extra and PHC in different wards. We could not cover the whole wards. We implemented our policy of one general hospital per local government.
When he came in, there were abandoned projects, general hospital projects, bungalows that were just abandoned and Asiwaju said, rather than starting again, except those local governments that doesn’t even have at all, let us just complete those ones. Five new general hospital were added to what we met. The plan was that we gradually build more to cover the whole stage. Wecincreased the number of staff. The tertiary were equipped and staffed. Lagos State has the highest number of health workforce, but we still have severe shortage because everybody comes in from other states.
The governor had to increase budgetary allocation to the health sector. Also, although he inherited N600m monthly IGR, he jerked it to N11 billion. BRF took over and added.
We expanded the health programmes under Asiwaju to infrastructure financing, primary health care, community based disease prevention, blindness prevention, hypertension and diabetics screening and prevention, cancer screening, malaria control. Lagos has the best malaria control programme in the whole of the country because we did more than what we were requested to do. He knew he cannot build a solid government when your people have not been taken care of health wise. He understood the link between health and education, climate change, refuse disposal, environmental sanitation, provision of water.
Asiwaju understands these linkages. He understands the sociology of Nigeria, culture. What is happening in the Southdouth is different from what is happening in the Southwest. It is also different from what is happening in the North. Nigeria needs someone who has that overall knowledge.
What is the assurance that he will be able to replicate all these past feats, if elected?
He has leadership qualities. He has the competence. He is a courageous person.
He knows how to build a team. He knows how to feature people who can do things for him. He knows how to mobilizse and motivate people.
So, you must have the competencies. For competencies, you require courage, you require somebody who has the vision for the country, you require somebody who can face challenges without being partial or anything, somebody who understands the environment in which he operates and of course again, we need somebody who has the financial background, economic background because those are key issues and again lastly, if you have those things, you are not the only one to do this, you need to get people who can do it for you. He has that ability to bring people who he feels are competent to handle situations that he himself cannot handle, he will discuss and say oh, when it comes to health, you are the ones that will do that as long as you do a good job and once you get his commitment, he gives you full backing so I have no problem with that. He knows what to do by virtue of his background, his characteristics, his competencies.
What is the motivation for creating a coalition of healthcare personnel?
Like I said, I sat down again and what he did in Lagos State is very interesting because during his time, Lagos State health sector was number one and is still number one in the country. He reflected, he understood the passion and the need for the health sector and he gave his full support and commitment. He knew health was also related to poverty, by virtue of his background, he knew what he had to do, people affected, children of the poor, pregnant women, the vulnerable need to be included. I saw that in Lagos state and other people came too. We actually came that we must do something in support of this man and that is when we say, okay, look, as our own contribution, let us come together, that is why the coalition is Health Care Professionals, not only doctors. It includes nurses, pharmacists, laboratory technicians and we started, now, other people in the health sector, admin people, information tech people, they want to be part of it and when we saw all that, look, just three objectives; in support of his presidential candidacy and in supporting that, what do we do? let us now motivate our various colleagues in the sector and through that again we can get to other people outside the sector and convince them and how do we convince them? We show what he did in Lagos State. We saw the competencies, from what he did in Lagos State. We can come back now and tell people that with this kind of thing, he is capable to run the country. Apart from that, over the years, we in the health sector have always been reactive. People come to government to form policy without our involvement and we now start reacting that this is wrong, this but this time around, we should use this opportunity again to participate in health policy making and the only way we can do that is that we need to sit down as a group, look at the challenges in health sector and give advice and ideas, these are the problems and these are how you can address them. One thing I know in this country is that people are very good at complaining, criticising but when it comes to how do we address it, I can assure you many will not talk, this is what we… Like I keep telling my colleagues, let us not assume that these people in government know what to do. Now, if you don’t participate in this process, you will blame yourselves because other people will come, write policies that may not be good for you and you will start complaining, that’s the essence of the group. We like him, we want to support his candidacy because we believe in his capabilities and let me tell you, it’s not easy in this country right now, there’s no doubt about it so let’s not deceive ourselves, you can call somebody with tie but when it comes to doing, there are other things that come in; you need to be rugged, you need to be courageous, you need to fight where you have to fight, you need to be ready to make friends and that’s what that coalition is all about. Now, there are many rules. We are not saying we are collapsing, it is a coalition but once we have a common agenda. We know this is where to go to. For instance, ask the doctors, what in your opinions are the challenges in the health sector, they will give you answers but most times, they will give you from the perspective of the doctor. If you look at the nurse, she will give you from the perspective of the nurse so if you put everything together. You can now see that okay, for the nation, how do we address it? And mind you again, you say health is in the concurrent list, it is not only at the federal level, it is at the state. Local Government level so again no matter what you do again, each state will have its own peculiar system but again at that level, you have to put somebody in charge. This is where leadership and government comes in. You need to direct, show a pathway where you want to go to and convince the people with you that this is the way to go. The health sector is a very complex sector. Many people don’t know.
Does the likelihood now exist that your group will make an input into Asiwaju’s manifestos in health?
This is where there is a bit of a problem. The answer is yes and no. Yes in the sense that from ideas we are getting, because of the way things are going, we are passing out so many ideas to people who are writing the manifesto but it is not the manifesto that matters now, the only thing in the manifesto, you will just say we are going to do this and this. The problem is the doing. That comes in after he has won. There will still be people working underground to deal with all these things but the main place that expose the challenges in the sector, proffer some solutions. They, in their own understanding, looking at the whole thing globally, in the global thing. They know how much money they can raise, they are the people who can raise money, they know how to look for the money. They know how to do it silently. Then they can now decide and prioritize which ones are the quick, which one can be done medium term, which one can be done in a long term because at that level, it is not only health sector, it is a total thing. Mind you again, if you don’t make them understand that even for health, there are also agencies of government who have greater influence on health even than the health sector so they need to understand that, so channeling policies in all those areas again, if they are positive policies, they will positively affect the health system and I gave an example, education is one, if you don’t educate your child, if you don’t educate the women or the girl child, they can’t take care of the children, they can not even listen to a doctor in terms of what to do and what not to do. Environment is another one, in this Lagos, air pollution is key, air pollution affects health, it causes cancer, it causes all sort of things. Sewage is one, water is one, all these are not under the health sector but they are key ingredients that make people healthy so if we have an all inclusive policy so you cannot effectively build primary health care without water and sanitisation. On the health again, you can only advise people to change their behaviour if water is available.
Did anybody plan for Ebola?No, see how it ravaged the whole world. We were just lucky in this environment, but it will still happen. Now, going back to the past, throughout the responses, it is Lagos came top. Why? Because Lagos state has the ability of tracking, building capabilities and preparing. How do we start preparing for emergencies? If we recollect again, these are building collapse many times all over the place, flood, fires, how many air crashes, two plane crashes, people died during Asiwaju’s time, pipeline explosions that many people died in the explosions. These were things that any sensible government quickly champion their energy. The population of Lagos has gone beyond 10 million, they call it mega city. For a mega city, as a government, what are the things you are vulnerable to? For Lagos now, we are vulnerable to flood, huge population, disaster can come up so a right thinking person or government will sit down and plan against these things happening, don’t ever assume it won’t happen. Remember Ikeja bomb blast, you know the number of people that died. Did anybody ever plan for that?
So, that’s why they say again that in the counter of Covid that you need to build your level of preparedness for disasters. We still need to do better. Ambulance service was created, why? not because.. but it is the same ambulance service we used when Ebola came. If we recollect when Asiwaju came in, the whole Lagos was just mountain of trash, how long it took them to clear this thing, he took everybody in the council to go out so all these happening again, any right thinking government will document this and build on the experiences in building local capabilities. That is why agencies like LASEMA( Lagos state emergency management agency), that is how it came up.
I remember LASEMA had one conference, building preparedness for Lagos state in which they gave a paper on medical emergencies, we never knew Ebola will come, Ebola came six months after but again when Ebola came, just like Covid came, we didn’t know what Ebola but then we had to go back to basics, what they had in each level like that. It is all those things we used together and made change orientation, taught people how to react to it and this is how you build capabilities. The same experience we did for Ebola that we did for Covid. That Yaba bio-security lab, it was because of Ebola that we got that support from the Canadian government to build that security lab and that came up and it was one of the areas we used for Covid so we need to build capacity, we have institution ready and plan towards the future. Now, Ebola, Covid have exposed the whole world that we are not prepared. We have monkey pox in Nigeria, we did not make this amount of noise. Monkey pox in US now is slightly different from what it is here so it’s not a.. They have agencies of government, we caught Covid, Lassa fever, Ebola, monkey pox even yellow fever, they are all diseases of animals that human beings came to contact with so when you are developing your preparedness, you can’t do it at the health alone, you have to look at the whole cost and do it together with all those agencies of government. This is where we require leadership.
