Before the passage of the last budget, padding became an issue. What is the 2018 budget for the Ministry of Health like?
Nobody complained about padding when Mr President presented the budget; it has never happened, even with previous budgets. The issue of padding evolved at the budget defence, not when Mr President presented the budget. The word, padding, did not come from us. It came as a result of red flags that we issued when we noticed some disparity between what Mr President presented and what we saw.
Many people quite agreed that health needs to be a priority, what is Nigeria’s health budget in 2018 like?
Health cannot stand alone; health cannot stand in isolation. We need to look at health in the context of the overall national development. If you ask me, will I want health without water? I will say no. Will I want health without electricity, I will say no. So, there are certain other critical sectors that are equally important. If Nigeria remains in recession, then health cannot really survive. So, if the government decided to investment in some other sectors in order to take Nigeria out of recession, I will support it.
Non-communicable diseases are gaining ascendancy in the country; in fact, experts are saying some of them may have reached epidemic level. What provisions do you have for this in the 2018 budget?
How did you come by epidemic? The fact that you have one case here, one case there does not imply that they are coming up. They are always there; we will need robust statistic to really document that, truly, we are having an epidemic. But we expect that there will be an increase for two reasons. Many of the non- communicable diseases (NCDs) are related to age; the older you are, the higher the likelihood that you will have hypertension, diabetes and cancer. So, as we grow and Nigerians live longer, that is likely to happen. Also, as we become wealthier, as people change their lifestyle, they seat in air-conditioned homes, air-conditioned cars; they exercise less and they eat junk food, there is the chance that such things can happen. It is like a prediction that is likely to happen and it has happened all over the world; each country will transit from communicable to non-communicable diseases. But in addition to that, we must also be on the lookout for trauma and accidents because as you become more affluent, you have more cars you drive around. Like in the US today, do not be shocked if someone decides to fly himself and crashes and it happens. That is part of the price we have to pay for development.
What do you have in your budget for geriatric care?
Well, we have health promotion for geriatric age group; we have provision to do a step survey in our budget. The last time anybody did a step survey was in 2000. So, for 17 years, the nation or the Ministry of Health does not have data on ageing; it does not have data on hypertension and diabetes and those NCDs you are worried about. Now we want to do a nationwide survey to even let us know what situations are we facing and all over the world it is called an NCD Step Survey. It is in our 2018 survey.
Retrospectively, can the ministry say it has achieved its set target for 2017 and what are we hoping for in 2018?
The first thing is to start by saying that it is too early to assess the 2017 budget. It was passed in June, or thereabout and we had the first quarter release in September and we have had only one release. What government plans to do is to ensure that we implement the budget for 2017 so that we can carry the rest into 2018, because of the desire to streamline the budget year, January to December. So assessing 2017 is a bit early, if you ask me. Within the ministry, what we have done is to make sure that nothing is left out and we are taking care of all the sectors. But in terms of assessment, you cannot assess just one quarter release.
Are we looking at a situation whereby there will be a carryover in the budget?
Oh yes! If you look at the budget, there is a lot of resemblance between 2017 and 2018 because we recognised that we need to carry over many things.
In which areas are we carrying over, as related to non-communicable diseases and in view of your promise, last year, that by the end of this year, we would have installed at least one new cancer machine?
Correct, it is ready for work; it is in the National Hospital, Abuja and we are likely to have a second one by end of December, two brand new ones. We saw one that has been in the crate for three years; it has been installed. They are training people on it because it is a brand new machine with a lot of electronic gadgets and even those people working on the old one, they have to train them. In fact, as of last week, they said they will want more training. So, we are expecting two people to join them this week to put them through. The original plan was to flag it off by last Monday in October. But we just said, ‘let’s wait for two more weeks so that they are comfortable with the machine and all the electronic data’.
Don’t you think having those two machines in Abuja alone is still crippling cancer treatment. There are many cancer patients all over the country and if everybody has to travel down to Abuja for treatment, it would still be a challenge?
What you want us to do, to put a quarter of the machine in hospital?
That is why I am asking, what is the plan to ensure improved access to cancer treatment?
The plan is for those eight hospitals to have, at least, two cancer treatment machines over time. But what we have done, if you listen to my speech, I said by first quarter next year, we hope that, at least, two of them should have two each. We have not only done that, we have also repaired some of the machines. We have repaired the one in Sokoto; it is now working. We have repaired the one in Enugu that even people thought will never work. So, the linac cancer treatment machine in Enugu is working, the linac in Sokoto is working; what Ibadan needs is a treatment planning machine which we will get for them.
Will there be some palliatives as part of the plans for the 60th anniversary of the University College Hospital (UCH), Ibadan?
I would not know the plan for 60th anniversary. I know that UCH is one of the centres that we want to upgrade.
The theme for this year’s National Council for Health is ‘Economic Recovery and Growth Plan (ERGP) in the Health Sector: Matters arising”. Based on your projected plans when you came in as the health minister at a time there was economic recession, will you say we are recovering, as implied by the theme?
You need, at least, two positive growths in two quarters to really talk about been out of recession. Government has not really said that we are out; it said we are coming out.
Is this also applicable to the health sector?
Yes, we are also recovering.
But with the crisis that has dealt with the health sector in the last one year, we are yet to be out of the wood and many strikes have been put on hold. How are we recovering in this area? Secondly, with regards to Primary Health Care, how far have you realised your goals?
The country has about 30,000 PHCs, with about 20 per cent of them functioning. The target we set is that if across the country, we can make 10,000 of these PHC functional, we will be fairly okay. But we are also fortunate; we have some implementing partners working with us. The World Bank has worked on about 1,400 of the PHCs; DFID, through a programme called MSH2, is working on 950; the EU signed an agreement with us to do 774 in three states, apart from what the states themselves are doing: Kaduna State has done 254; I met the Bauchi State governor about two weeks ago; Ogun State has done some, too. So all over, we are saying we would be going around and even documenting where we are. I think the 10,000 target is the minimum. At the end of the day, we will have more than that because we are also encouraging the states.
Even WHO has taken it on as on issue to say that for us to achieve universal health coverage, we should use primary healthcare revitalised a platform. That is the healthcare closest to the people in the grassroots. In fact, if you watch that Nollywood drama, because that was the whole essence of it, to really highlight the need to invest in PHCs because it is healthcare closest to the people and for the ministry, last year, we made provision for 110. One of them, I went to commission in Niger State; in fact, it was the Etsu Nupe who commissioned it in Fuka. Mr President commissioned the one in Kuchengoro. So as we move on, we will be flagging them off.
What is the budget for PHC in 2018?
In 2018, the budget for PHC is N21 billion as against N19 billion in 2017; so there is an increase. In addition to that N19 billion in 2017, the Federal Government released N3.5 billion for measles, so that is N22.5 billion in 2017.
Will you say you are satisfied with the 2018 budget for the health sector?
I will be happy to have all the money in the country.
For the first time, the health sector has been overtaken by the education sector in terms of capital…
Well, I am not going to look at it that way; I want to see both the health and education sectors moving forward. I have mentioned it somewhere: I said I will be prepared, even if you allow education to have more than health because when people are educated, their lifestyle would change; they respond better and you can talk to them saying, ‘this is what to do to prevent illnesses. So, education boosts health; water will boost health; food will boost health’. The fact that government is also investing in agriculture will impart on health. When people are well fed, they are not likely to fall sick; when there is water, you would not have cholera; when people are educated, I do not have to go and preach to them to have their children immunised. So, education builds a complete person. It is the vaccine for poverty, ill health and oppression.
You have been in the saddle for about two years, can you share your experience and the challenges so far?
I came into office on November 11, 2017. I think I will love to keep those challenges for my memoirs. I am an optimist. I want to talk more about what we have achieved than those challenges because you cannot carry challenges on your head and I do not want addressing challenges to become an obsession. The health sector is very challenging for several factors: one, we need to give the health the priority it deserves; that is a challenge. We need to ensure that we attract more resources to health; that is a challenge. We need to make sure that the various actors work together; that is a challenge. We need to minimise strikes; that is a challenge. So, there are many challenges and we have to address all of them.
We need to encourage the Nigerian citizen to be fair; we also need the Nigerian citizens to invest in health. I was in one hospital in the US: as I walked into the corridor, I kept on seeing endowments; this ward was donated by this family, this equipment is donated by this person, but you cannot see that in Nigeria. It appears that we want government to do everything. There are very few of the Dangotes and the Danjumas in Nigeria and yet we have a lot of wealthy people who can also help.
Will you wish to invite such people to contribute and build the health sector in the next few years and how do you intend doing that?
I will love it, working with the media. By, one, appreciating what they have done for the society, because many of them have done things in other areas; some have built schools and some have invested in sports. I want to see them investing in health and one of the ways will be, in fact, at a point I spoke to Alhaji Aliko Dangote that he should help us to talk to many other people and he said he is trying. He has brought together a private health sector alliance group. These are business leaders: they are investing in malaria, nutrition and polio, but they can do more.
In which particular areas do you want them to do more?
I will want them to do more in immunisation, investing in infrastructure and equipments.
The budget for the health sector in 2017 seems to be more than that of 2018…
That is not correct.
What is the situation?
Well, I will start with the capital budget for health for 2016, it was N28billion. In 2017, it grew to N55billion and in 2018, it is N71.1billion. This is capital; I am not talking about salaries. The Federal Government has never failed on the payment of salaries. The personnel for health this year is about N252billion or N260billion. Last year, I think it was about N250billion. It has gone up a bit this year and when you add both capital and personnel, it is higher than 2017.
On the need for every Nigerian to have access to good healthcare…
Correct, that is our aspiration.
Globally, that is always achieved through health insurance…
You are wrong: I have a book and I will give it to you. The title is In Search of a Perfect Health System. The author looked into about 18 health systems in different countries. The health insurance is good, but it is an imperfect way of funding healthcare. The surest way of funding healthcare is direct public health funding, through taxation and allocation. That is the only one that is certain and in many countries you have both. In the UK, NHS is public funding; it is not health insurance.
So, what is the way forward with the present reality in Nigeria?
The reality is for Nigerians to pay tax. Many people do not pay tax. You see, people just say it must be free, but then I ask who is paying for it? A colleague of mine, the last time I saw her in the UK, she was paying 60 per cent of her earnings as tax and that is what is funding the health sector. People do not pay tax in Nigeria; we pay probably one of the lowest taxes in the world after those countries that do not even pay tax, like the oil-rich Saudi Arabia. So, you see, we must not only talk about sharing this national cake, how can we put more money there?; how can we grow the national income beyond oil? Part of how we can grow it is tax and when the cake becomes bigger, then we can have better share.
You were at LUTH to deliver a lecture on cancer and you mentioned traditional medicine as the way forward in seeking cure for the disease. You said anybody that has traditional cure also for it should come forward…
Today, what did I say about traditional medicine? I said, let them come out. When I was moving around, I saw someone who said he has cure for hypertension and I said we must validate it and the only way to validate it is that we must bring people with hypertension. Some of them will say ‘stop taking your drugs, let’s take this. But we must continue to monitor your blood pressure so that if it is going to jump out of the window, we will say stop, this is not working’. If it is working, we will be very happy. Without those tests, I cannot take the medication, she gave me some but I said I cannot take it except I am certain that it will work.
Chile has just gone beyond this law on abortion, but in Nigeria, who will help us to address the law on abortion, even as it is not a secret that women still undergo unsafe abortion?
Unfortunately, the abortion law in Nigeria is complex. Do you know why it is complex? It is complex because it penalises the offender as well as the offended and that is why nobody is being caught. Secondly, the law is not even implementable. If today, let’s say I apply it on you and you go to the police, they will call me. They will give the person who committed the offence 14 years and the victim gets seven years. So, are you going to report to the police? That is why the law is not implementable. No one will come forward and say I have done illegal abortion; those who go to do illegal abortion give fake names and it is because of that law. Many of us, in the past, called for a review of that law because even if you are against abortion, that law is bad.
Zambia has a very robust malaria elimination programme. What is happening to the same programme here in Nigeria?
What is the population of Zambia? It is about 15million, but they have a target there. What is the population of Nigeria? Nigeria’s population is about 180million. We have made success in Nigeria; we have reduced the burden of malaria. We have increased the number of Nigerians sleeping under the net; in fact, what is also interesting about the Nigerian data is that poor people use nets better than the rich. So we have done well; our real commitment to malaria elimination is to reduce malaria-related mortality by 2020. We are quite modest in our target; we are saying that by 2020, no Nigerian should die from malaria and so when some people said some people died in Jigawa State and some people were saying that maybe it was malaria, it is painful because no one should die of malaria as it is treatable. There are no simple tests for diagnosing malaria.
Apart from the 2020 target, what are the other programmes for the elimination of malaria?
We do not plan to eliminate malaria by 2020. We want to eliminate deaths, so that no one will die; that is our first step. We are being careful, but we hope that by 2025, the global target is by 2030, but we said that by 2025, Nigeria should be able to, at least, say we are near elimination because we are at the pre-elimination phase in which case, we are almost there. Now, we have five years to mop up so that by 2030, we can join countries that would have done away with malaria.
How far with the eradication of polio?
One, we have not recorded any case of polio in the last 14 months, but the international community is a bit unhappy as they thought that we are relaxing. People are anxious because of the scare of monkeypox disease. They believe that the disease could set us back and then there is some apathy at the state level. That is why I told the state commissioners for health that we need to wake up. We are not there until we are there and the international community is not going to recertify us until we meet some tough criteria. Before, it was going to be free certification, now we have to earn it.
Nigeria has witnessed several disease outbreaks like meningitis, monkeypox, yellow fever and the recent one in Jigawa State they the House of Representatives asked to be investigated. What steps are you putting in place to prevent further spread epidemics?
Mr President actually referred to that in his address by appreciating the good work of the federal and state ministries of health, the implementing partners. He also pleaded with the National Assembly to pass the bill for the establishment for the Nigerian Centre for Disease Control because that is like the implementation arm for managing outbreaks. If you also care to listen to me, I said that what we need to have is that all of us should be disease detectives; we call them surveillance officers so that when there is a disease anywhere you will quickly call to notify us of something unusual. We do not have to wait until 200 people die before we give the alert, because what happens in Nigeria is that we would not scream or raise the alarm until we allow about 20 people to die in about the last six months. You ask yourself, what type of people are we? Once you have one case of epidemic, you should be able to inform the appropriate authority. So, so all of us, including the media, should raise the flag; all of us should be surveillance officers.
Some official reports from the states would buttress what you have just said that the attitude to disease surveillance is poor. How do you think that the Federal Ministry of Health can put the states on their toes?
The media should help us. When the Federal Government had plenty money, it can do so many things. But now that we resource constraint, the states also should be alive to their responsibility. You know what happens? The Federal Government will buy vaccines, take them to the states, pay for the cold store and pay for electricity bill of that store? What kind of country are we in? Some few days ago, there was a fake report that over 200 people died from snake bites because we have no anti-snake venom. But the report is not true because we have anti-snake venom; we still have as of today. What happened was that we said that if you must collect, you must come with an application and tell us who got them from you, with their names and hospital numbers.
But what we find was that some of these drugs got expired in some states…
Why did they take the drugs if they do not need them? And if they had expired, let them say so and return them. The drugs cannot disappear; the era of just collecting drugs without documentation is over. We do not have money to just spend endlessly, so why will you not want to account for what you collected?
Why has the issue of accountability, monitoring and evaluation and follow up by the state ministries been difficult?
The states must also wake up, I tell you. We should have started the yellow fever campaign in Kwara and Kogi states. We have been reaching out to the commissioners for health and the Secretary to the State Government (SSG) in the two states, but they keep on saying they don’t have money. What we need is just N36million from Kwara and N6million from Kogi. But I told them wait, we cannot be begging WHO to find us the money. It also a question of access; maybe the commissioner was not keen on talking to the governor or scared. I called one of the governors and I said I have a problem. He asked, what is it? I told him, ‘I want you to give me N36 million’ and he asked what I wanted it for. I told him that it was for the yellow fever campaign for his people and he said he will find the money.
and then