Primary healthcare in Nigeria is dysfunctional —Health Minister

Professor Isaac Adewole, Minister of Health, in this interview with YEJIDE GBENGA-OGUNDARE speaks on why primary healthcare centres should be revitalised, the need for preventive healthcare rather than curative and synergy among tiers of government, among other issues.

 

What is the situation of Primary Health Care Centres across the country, any development since you came on board?

I think we should start by saying upfront that Primary Health Care is not the direct responsibility of the federal government, as I have said often and often, our job is to look at the entire architecture of health care management and make sure we get it right. What we have today is a situation whereby the primary health care is dysfunctional; the secondary is begging for help, the only one that is actually doing good work is the tertiary. So people abandon primary and secondary and walk straight to teaching hospitals. This is why we have the problem where a large majority of people visit tertiary hospitals for care, this is not good. So what we are trying to do as the one 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 people will go to primary health care rather than teaching hospitals, that is the reason for the initiative to flag off the programme of revitalization of PHC and it has become a cardinal programme of this administration

 

How do you want to revatalise the PHC since it is the closest to the grass roots?

That it is the healthcare that is closest to the people is the reason we are focusing on PHC, it has become the cardinal programme of Mr. President and he personally flagged off the remodeling of the Kuchingoro PHC on January 10 to really demonstrate his commitment to revitalizing PHC, if you look at the APC manifesto, it identified healthcare system that is affordable, accessible, of good quality and within three to five kilometers to the people and that is why we are focusing on PHC. We looked at what we have on ground, we have about 30, 000 PHC centres for now but only about 20 per cent are working. And so we said if we can make one in every political ward function, each political ward has about 20, 000 people, so if we can revatilise 10, 000 PHCs, we will reach about 100 million Nigerians, if we can give them basic health care, then we will satisfy the yearnings of a large majority of our 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 health care package includes antenatal care, delivery, treating malaria, checking blood pressure, giving vaccines to young ones and treating other basic problems like testing for HIV and TB, checking urine for sugar, this is our package and if we can do that, I can assure you 85 per cent of our people will be taken care of and only 10 to 15 per cent will need to go beyond primary health care

 

How affordable is treatment in tertiary health institutions?

Let me assure you that good and affordable care does not necessarily mean free care, there is nowhere in the manifesto of APC where we talked about free healthcare, but what I can assure you of is when we say affordable, it means those who can afford will pay, then we will pay for those who cannot and that is why we are currently promoting health insurance, encouraging states to take up health contributory scheme and we are also looking at 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 that you have health being free; some people must be paying for it. In UK, the National Health Service depends on taxation, so what we are currently looking at in the context of Nigeria’s system is how can we pull resources together that will afford us to take care of peoples health and one basic provision in the National Health Act is the basic health provision that prescribes giving at least one per cent of the consolidated revenue fund to fund basic healthcare and that money will go straight to primary care. For the first time, the PHC will get money directly from 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.

 

How far have you gone on getting the provision of the act?

For now, we have not succeeded. Basic healthcare is supposed to be funded with at least one percent of the consolidated revenue fund, donor money and also donations from other parties. We are talking to our colleagues in National Budget and Planning, Finance and I have also approached Mr. President to ensure that we put the one per cent in the budget. We have assurances from the National Assembly that if the executive put that one per cent in the budget, they will protect it. I have that assurance from the Senate President and the Chairman, Senate Committee on Health, Dr Lanre Tejuosho that if we put it there, they will protect it, so we are quite optimistic that very soon, we will have that one per cent but pending the time that we will have the one per cent, we are doing what we call a scale up project in three states, Abia, Niger and Osun where we will pilot basic healthcare provision and money will flow directly from central to each of the PHC.

 

Do you support the idea that tertiary health institutions adopt should PHCs within their community for mentorship and supervision?

We are on the same page on that. We have spoken with the CMD of UCH and it is actually a two-faced project, 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 Kudu in Sokoto, there are over 500 doctors in the teaching hospital but the state hospital has less than 100. Zamfara is a case in point, 122 doctors in the federal medical centre in Gusso and less than 24 doctors in the state hospital. So we are trying to build a partnership between federal and state so that each of our teaching hospital or medical centre will then supervise state hospitals and PHCs, it will be good for them in terms of training and the referral system will also be strengthened because if a case can’t be managed at a PHC, it will immediately leave there.

 

Is the Federal Government doing enough in the area of preventive medicine?

This is where we all got it wrong, health is on a concurrent list and one of the things we want to do is change the perception that federal government must do everything. Federal government took over everything and it was okay when we had enough resources but now that we do not have resources, we need to share this responsibility with the state, we are only in charge of policy, state must take care of its people, we can’t have cholera in Kwara and you say federal should come and address it, that is the responsibility of the Kwara state government, it must provide water for the citizen because water is what you need to prevent cholera, it must also ensure that we manage waste properly because we must not defecate along streams that people will drink. What we are doing at federal is to change the way and manner we allocate resources, before we came on board, 80 per cent of resources at the federal level was into curative care, the first we have done now is to change the allocation to preventive, if you look at 2016/2017 budget, a large chunk of our capital allocation is into preventive, we have also given approval for the National Centre for Disease Control that will work with states, the center has trained surveillance officers that have been posted to states to work with the state, detect diseases and nip outbreaks in the bud. We had the case of yellow fever in Kwara and they notified us, we quickly dispatched our surveillance officers to Kwara, we quarantined the place and started looking after that one case of Yellow fever and stopped it from spreading, if we had enough information on time about the meningitis in Zamfara, we would have been able to nip it in the bud because it is treatable but in a case where the system is weak and uncoordinated, it can spread, meningitis was on for three months in Zamfara before we got to know. The case of Lassa fever in Niger, about 50 people already died in a village before we got to know about it. So we can’t work alone, the state needs to work with us, notify us on time so we can strengthen them.

 

As minister, what achievement will make you say you have done well?

The basic healthcare provision fund which is the one per cent of the consolidated revenue fund going to PHC because it is the only thing that will make the PHC survive

 

How will you rate this government in two years going by your manifesto?

Grade A. one, we arrested the decay which is obvious to everybody, government has plugged the leaking holes and we are taking this country out of recession through transparency in the way and manner we use money, through prioritizing infrastructure, focusing on agriculture taking us away from overdependence on oil. We are doing well, with the little we have, we have done better, when Nigeria had polio, for the first time in the history of this country, government released 9.7bn, we have never released such even when we had enough money. We are working on measles campaign and for the first time in the history of Nigeria, government has released 2.5bn across the country, the international health community said this has never happened before. So in terms of commitment, this administration has done so much than any previous administration.

 

What do you have to say to Nigerians?

It is to plead for patience because we are working hard and we are beginning to see the dividends of the hard work in the health sector, our partners have shown interest in the PHC revitalisation, the British government is helping us with about 950 PHCs, world bank about 1400,, European Union about 700 and from our funds between now and next year, we should be able to do 1000. Many people are coming on board, I will do one in my local government and Mrs Saraki said she will do one in each state making 36 and many states are coming up too, Kaduna has done 250, FCT will do about 200, Niger, Gombe, they are all doing well.

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