The Minister of Health, Prof. Isaac Adewole, spoke with select reporters in Ibadan, and talks about how the ministry is pursuing a comprehensive health project to revamp a minimum of one Primary Health Centre in every political ward across the country. Bisi Oladele was there
Healthcare delivery looks poor in this country. What is your ministry doing to revamp, particularly about the Primary Healthcare Centres (PHCs)?
I think we should start by saying upfront that primary health or primary care is not direct responsibility of federal government. But as I have said often and often, our job is to look at the entire healthcare architecture and make sure that we get it right. What we have today is a situation whereby the primary health care is dysfunctional and the secondary is begging for help. The only one that is actually doing good work is the tertiary. People now abandon primary and secondary and work straight to tertiary and this is why we have the problem we have on ground – a situation in which a large majority of our people visit tertiary care is not good. So, what we are trying to do, because we are in charge of policy, is to reverse this unfortunate and unacceptable trend by making sure that we reposition the healthcare system in a way that 85 per cent of our people would go to primary health care rather than going to a teaching hospital and that’s why we have taken the initiative to flag off the programme of revitalization of PHCs and it has become a cardinal programme of this administration.
There was a time primary education was also in total crisis and the federal government came up with an idea that up till today, teachers were rescued. Is it not possible for the Federal Ministry of Health to also come up with that kind of idea that will rescue primary health care because that is the closet hospitals to the people?
That is exactly the same reason that necessitated our focusing on PHCs. It has become the cardinal programme of Mr. President and he personally flagged off the Kuchingoro model PHC on January 10 to really demonstrate his commitment to revitalizing PHCs. PHC is the healthcare facility that is the closest to the people. And if you look at the All Progressives Congress’ (APC) manifesto, it identifies healthcare system that is affordable, accessible and of good quality and within 3-5 kilometres to the people and that is why we are focusing on PHCs. And we looked at what we have on ground. We have about 30, 000 PHCs for now but only about 20 per cent of them are working. So we said if we can make one in every political ward function, we would reach about 100 million people. Each political ward has about 10,000 people. So, if we have about 10,000 PHCs we would reach about 100 million people. The National Health Act passed in 2014 has given the Ministry of Health the authority to define what basic healthcare is all about. And for me, the basic healthcare package includes ante-natal care, delivery, treating malaria, checking blood pressure, giving vaccines to young ones and treating other basic problems, testing them for HIV and TB.
You mentioned affordable healthcare as being part of the APC manifesto. But today, if we go to tertiary health institutions, because of shortage of funds, they look inward to generate additional revenue to plug short fall in their expenses and the implication is that they pass on a lot of expenses to poor patients. Don’t you think that this is contrary to the promise to offer affordable health?
Well, let me assure you that good care and affordable care do not necessarily imply free care. There is nowhere in the manifesto of APC where we talked about free health care but what I can assure you is that when we say it is affordable, that means those who can afford will pay and then we pay for those who cannot. And that is why we are promoting health insurance, encouraging states to set up health or contributing scheme and we are also looking into setting up a National Health Insurance Commission that will make health insurance compulsory and universal in the country. When you have that, you will be able to put together resources to take care of health. Anywhere health is free, some people must be paying for it. In the United Kingdom (UK), the National Health Service depends on taxation. So what we are currently looking into in the context of Nigeria is how can we put resources together that will afford us the opportunity to take care of health? And one basic provision in the national health care is the prescription giving at least one per cent of the consolidated revenue fund to health to fund basic healthcare and that money will go straight to primary health care. For the first time the PHCs will get money direct from the federal. If we get that right, then this country has actually arrived at what we call a comfortable stage where we can deliver basic healthcare to our people. For now, we have not succeeded. We are talking to our colleagues in the Ministry of Budget and Planning and that of Finance and I have also approached Mr. President to ensure that we put the one per cent in it. We have assurances from the National Assembly that if the Executive contributes that one per cent, they will protect it. So we are quite optimistic that very soon we would have that one per cent. But pending the time that we would have the one per cent, we are doing what we call a scale-up project in three states: Abia, Niger and Osun where we would pilot basic healthcare provision fund, where money directly will flow from central to each of the PHCs. We would open account at the local facility and also engender ownership because the people must own it. We don’t want a situation where federal government will own the facility. It must belong to the people. We would then partner with the states to set up a state primary healthcare development board and a ward development committee so that the people can own the facility.
The Chief medical Director (CMD) of University College Hospital (UCH), Ibadan, Prof. Temitope Alonge, recently suggested the idea that the federal government can make an arrangement for tertiary health institutions to adopt a number of PHCs within their locality to be able to mentor them since they have enough manpower and better facilities. Why can’t this happen?
We are on the same page with the CMD. I have discussed with him how we can get this done. It is actually a two-phased process. The first thing is to partner with the state to also support their secondary facility. We have more than enough human resources in our teaching hospitals. For example, you get to Sokoto Teaching Hospital there are over 500 doctors there. But if you go to the state hospital, I am sure they have less than 100. Zamfara is a case in point with 122 doctors in the Federal Medical Centre in Gusau. But here are less than 24 doctors in the state hospitals. So, one of the things we are trying to build is a partnership between federal and the states so that they can oversee. In the example in Sokoto, the teaching hospital will also oversee the local government and if we do that, each of our teaching hospitals or medical centres will then supervise the PHCs and it will be good for them for training. It will be good in terms of supervision and we can ensure that the people get good healthcare. The federal system will also be strengthened because if a case cannot be managed at a PHC, that case will immediately leave the PHC. We expect that normal delivery should take place at PHC but if we have complications, hypertensions, convulsion, and baby lying across in the tummy, multiple pregnancy, baby coming by the buttock; those cases should moved to a higher level because we don’t want to risk the lives of women at that level.
Sir, in medical practice generally or health sector generally, it is believed that prevention is actually better than cure. Do you think government is doing enough in running campaigns to help people embrace practices that prevent sickness?
This is where we all got it wrong. Health is on the concurrent list. One of the things we want to do is change the perception that the federal government must do everything. That is where we got it wrong. Federal government took over everything; that was okay when we had enough resources. Now that we do not have enough resources we need to share the resources with the states. We are only in charge of policy. States must take care of the people in their states. We cannot have cholera in Kwara and say federal should come and look after them. No, that is the responsibility of Kwara State Government. Kwara must provide water for the citizens because water is what you need to prevent cholera and also ensure that we mange waste properly so that they will not defecate along streams that people will drink. What we are doing at the federal is to change the way and manner we allocate resources. Before we came on board, 80 per cent of the resources at federal level were into curative care. The first we have done now is to change the allocation to preventive care. If you look at the 2016/2017 budget, a large chunk of our capital allocation now is into preventive. We have also given approval for the National Centre for Disease Control that is out to work with states. The disease control centres have trained surveillance officers; these are disease detectives. We have posted them to all the states; we are working with the states so that if there is an outbreak we can quickly nip it in the bud.
Before now we use to think that VVF is a thing that is restricted to the northern states but now we are talking of VVF in the Southwest and other places…
There are many southerners who also share that wrong impression or perspective. When we flagged off the VVF repair at Wesley Hill Hospital Ilesa, Osun Sate, the Deputy Governor came and was shocked. In fact, I did not realize why she was asking for the name of the patient we operated on. In one week, we operated about 25 patients. And the Deputy Governor said what is your name? Where are you from? And they said Ikire, Lagos, Osogbo, she was shocked. She said I thought VVF was confined to the North and I said that VVF is all over Nigeria. But what we are doing now is to set up more VVF hospitals, train more people, increase awareness, actively campaign against child marriage and also promote ante-natal care and supervise delivery. Both must work together. If a girl of seven years old gets pregnant and is managed properly, that girl won’t develop VVF. So, we need to combine good care with advocacy and education.
How would you rate the advocacy of VVF from your ministry so far?
We are doing well and as I told you, we are not only working alone, we are working with states and we are being supported by the United States government. The USAID has a good programme to engender health working together to improve advocacy. We are working with the Ministry of Women Affairs to improve education of young girls, delay marriage and also make sure that where you get pregnant you go for ante-natal care and supervised delivery.
As the Minister of Health, what is that one thing that will make you feel fulfilled if your ministry is able to push through today?
The basic healthcare provision fund.
What is it about?
It is one per cent of the consolidated revenue funds going to PHCs because that is the only thing that will make the PHCs survive.
What is your ministry doing to address this huge shortage of fund for tertiary health institutions?
Well, I think we must look at the situation from two perspectives. The first thing is to move patients away from the tertiary and that’s why taking care of primary healthcare is good. When I trained in the UCH, you can’t just walk in to the UCH and say I have fever, cough. No. You must come with a referral. If you fail to come with a referral they will send you to the Out-patient Department where someone will see you and may send you back to state hospital or treat you there and say ‘Go away’ or ‘this is a complex case, go and see a consultant.’ When you do that, the consultants in UCH will have more time for those complex cases. There will be enough materials for them, and no one will complain. So that is why it is important to make sure the PHC and secondary healthcare are working. Secondly, we need to put more resources in the tertiary. No doubt about that. We need to upgrade the condition, make sure their water and electricity are efficient, upgrade their equipment and upgrade the skills of the health professionals working there. That is the only thing we can do correctly to stop people from going out and we can save a lot of money. We estimate that we can save up to $1 billion a year if we upgrade our tertiary care centres and government is committed to doing that. In our 2017 budget appropriation, we have money allocated for that strategic investment in tertiary hospitals. We are going to upgrade eight of our facilities – one in each geo-political zone, including the National Hospital, Abuja and LUTH.
