Why I’m passionate about promoting women’s health, empowerment, wellbeing —Okedo-Alex

Ijeoma Okedo-Alex, a medical doctor and fellow of the faculty of public health of the National Postgraduate Medical College of Nigeria, is currently pursuing her PhD in Canada. Prior to this, she has worked as a Consultant Public Health Physician with the Department of Community Medicine, Alex Ekwueme Federal University Teaching Hospital Abakaliki. In this interview with IFEDAYO OGUNYEMI, she spoke on her work which focuses on women’s health, maternal health,  promoting evidence-based policymaking and strengthening health systems.

 

Can we do a short dive into your background? 

I am a medical doctor and Public Health Physician with over ten years of both research, work, and practice experience. I am a fellow of the Faculty of Public Health and Community Medicine of the National Postgraduate Medical College of Nigeria having undergone residency training and met the requisite qualifying requirements. I hold a Masters in Public Health and another in Health Policy and Health Systems. I am currently doing my doctoral studies at the University of British Columbia, Vancouver. Prior to my embarking on my Ph.D studies, I worked as a consultant public health physician in one of the federal teaching hospitals in the country. I also work as a researcher and course instructor at the African Institute for Health Policy and Health Systems, Ebonyi State University. I am particularly keen on women’s health, maternal health and promoting evidence use in policymaking for stronger and more resilient health systems. 

 

What does your work on the ground here in Nigeria centre on?

Essentially my work centered on patient care, research, and training. For patient care, I provided primary health care in rural areas. This involved general adult outpatient and inpatient care, maternal and child health services spanning prenatal, intrapartum and postnatal care, child preventive services and treatment of common childhood illnesses, health promotive services like health education, community mobilisation and screening for common diseases such as cervical cancer. I have also been specially trained to provide care to people living with HIV and tuberculosis and this was a consistent part of my work role. As a consultant, I led a clinical team made up of senior and junior resident doctors in various stages of their training to whom I provided mentorship, clinical guidance, and supportive supervision. As a clinical team lead, I also provided support to other health workers we worked with such as nurses and community health workers. For the resident doctors, my commitment went beyond clinical leadership to mentorship and support towards their training and residency examinations. This involved reviewing proposals and dissertations, judging presentations and signing them off for postings; a trainer’s supervision and sign-off is a key requirement to become eligible for the residency examinations. The research front is not just my outlet for contributing to the body of knowledge, it is a delightful opportunity to impact the lives of people and practice the theories and concepts. My research experience has focused on a wide variety of public health and health systems research but true to my fervour, a lot of it have been about women’s health, maternal health and promoting research evidence use by policymakers. Some examples of these are my research projects on community-level interventions to reduce malaria in pregnancy and another one to reduce stigma against women who have experienced skin Neglected Tropical Diseases (NTDs) such as elephantiasis, systematic reviews on antenatal care utilisation, family planning, catastrophic expenditure and antimicrobial resistance as well as others like mistreatment during childbirth. I have also hosted, facilitated and participated in multi-stakeholder-related events and programmes like convening, policy dialogues, advocacy, and workshops geared at creating demand, building capacity and supporting policymakers towards making evidence-informed decisions. Overall, I have published over 50 journal publications on different areas of public health.  

 

You have also had some moments with international awards and research, what has the experience been like and are there key takeaways you will like to share?

Yes, thankfully I have had a few opportunities and I am looking forward to having more. I have built experience in grantsmanship and project management. The experience has been great; with funding, you are able to do more as a researcher rather than spend out of pocket given the financial constraints and competing needs. There are also other non-financial grants such as travel and publication grants, both of which help researchers from low and income countries overcome the barriers to knowledge dissemination by funding conference abstract presentations and publishing our research.  My first grant was in 2018 and that came from the Joint World Health Organisation Tropical Disease Research (WHO/TDR) and European and Developing Countries Clinical Trials Partnership (EDCTP) small grant. I was among the 30 researchers from up to 47 countries in the World Health Organisation (WHO) African region (AFRO) to win this grant and eight of us came from Nigeria. My research focused on malaria in pregnancy, a known cause of illnesses and deaths among pregnant mothers in Nigeria. Conventionally, preventive treatment for this is usually only obtainable in health facilities but we face a peculiar problem; a large number of our pregnant women in Nigeria don’t use the antenatal care services. To mitigate this, I took the preventive drugs to pregnant women in the community alongside advocacy to leaders, health education male engagement on malaria prevention. We found that this reduced malaria in pregnancy, improved antenatal care coverage, and the women were satisfied with this approach. In the same year, I won the Alliance for Health Policy and Health Systems research Publication mentorship programme award for women which led to the publication of my much-cited systematic review on antenatal care use in sub-Saharan Africa. 

In 2020, I was one of the 15 researchers to win a research grant of the USAID and UKAid Project on the Coalition for Operational Research on Neglected Tropical Diseases (COR-NTD) administered  by the African Research Network for Neglected Tropical Diseases (ARNTD). This funding enabled me carry out a rural community project to decrease stigma against women, promote knowledge of NTD prevention and build the capacity of the local health providers to identify and refer cases appropriately. In the same year, I received funding from Health Systems Global (HSG) with which I convened high-level meeting of policymakers, practitioners, researchers, and civil society organisations from states in South-Eastern Nigeria to deliberate on strategies for improving health research funding for health systems strengthening. For my doctoral research, I have received funding from the International Development Center for Research, Canadian Institute for Health research and the University of British Columbia.

 

You seem to have a strong interest in women’s health, what’s your drive for this area of specialisation?

Well, women are the bedrock of a healthy society due to God’s physiological design and the role they play in families. Being a woman who’s practicing medicine, I am quite attuned to the unique challenges and barriers that women face in accessing health and social systems. A lot of the health problems that women face are preventive and so it is quite saddening to see women, especially those with low social status, suffer from avoidable health conditions. These underpin my drive for promoting women’s health, empowerment, and wellbeing. 

 

One other strong theme emerging from your work is your passion for evidence use in policymaking and building resilient health systems. What have you done to advocate for this? 

Over time, we have realised that producing quality research is not just enough. Without a strong nexus between researchers and policymakers as well as implementers, the research findings might as well gather all the dust they can on library shelves. Health policymakers often have to make hard decisions to use the existing limited resources to solve public health problems. To do this effectively, they need to be armed with quality evidence and the capacity to use this for decision-making. If we can get to this point where decisions are not made based on sentiments, favours, or knee-jerk reflexes then we are steps closer to building the health systems that can take care of us as a nation. While other health systems issues may exist, this cuts across them all. Working in the policy space with the African Institute for Health Policy and Health Systems (AIHPHS) gave me opportunities for both research, policymaker engagement, advocacy, intersectoral collaboration, and leadership. I must mention that I have benefitted immensely from mentorship from the director of the institute and learnt essentially by doing.  I have played key roles with engaging federal and state ministries of health and allied parastatals, national and subnational parliamentary policymakers on evidence-informed policymaking. I have facilitated several policy dialogues, brainstorming, and consultative events and advocacy at different policymaking levels. The AIHPHS serves as the World Health Organisation’s (WHO) mentorship and fellowship centre for policymakers in Africa on evidence-informed policymaking. I coordinated the mentorship programmes which attracted national and sub-national public sector policy and decision makers across Nigeria. These mentees came from different sectors such as health, environment, security, agriculture, education, and the legislature. These have improved the evidence demand and use culture in these organisations.

 

Based on your past research and practice, what is your assessment of current health policies and what insights would you put forward towards ensuring that we optimise our health systems?

I know for a fact that Nigeria has good policies in place in line with global best practices and our contextual uniqueness. However, we have some more ground to cover in terms of implementing, evaluating, learning from these policies and revising accordingly. We must admit that our multi-faceted diversity and pluripotent health problems contribute to our unique challenges. I do not intend to propose a one-size-fits-all approach to the solutions as we need to engage systems thinking, carefully considering all aspects of the health systems at different levels and the context in which they are situated. This said, a few things that we can put in place include the need to rev up efforts in intersectoral collaboration to mitigate some of these challenges. For example, girl-child education and women empowerment can integrate health education and the financial autonomy needed to promote decision-making and avoid catastrophic health expenditure. The health literacy will also serve for promoting health and preventing disease in the other family members. The limited health insurance coverage is a grave issue of concern although we must commend governmental efforts in this regard. Given our tendency to go for the new programmes, especially as political administrations change, we have to become more intentional with learning from the past and the existing with the intention of institutionalising success and not jettisoning them. A good example of this would be the usual recurring policy of most incoming political leadership on constructing new primary health care centers whereas the imminent need may be more of provider and resource gaps in the existing ones. Another would be the obsession with added layers or new names of primary health care community support staff either as CHIPS, CORPS or other nomenclature. What happens to the existing framework or the ones proven to be successful? How do we strengthen the ward health committees and health leadership at the lower rungs of the ladder? The use of evidence not sentiments comes up again! We need to empower and allow the citizens to demand accountability for the use of resources from all responsible. We need to create sustainably safe and enabling working conditions for our healthcare workers including incentivising those who stayed given the brain drain plague. Many left due to these welfare and safety concerns. As a nation, we must sit tighter in the driving seat and actually own our health system rather than the dependence on donor technical support and funding. Of course, these are all encased within the wider need for positive changes in the societal issues that impact on the health system such as corruption and insecurity. 

 

Given your international exposure, are there lessons that can be learnt and applied to the Nigerian context in terms of health systems and public health?

Certainly, lessons abound and you’ll be surprised to know that I think that it should be lesson-sharing as both contexts have something to learn from each other. One thing that stands out in the Western world is that systems and structures regulate human behaviour and actions (or inactions) have consequences. For instance, people obey traffic lights not just because they love to uphold the law but because the consequences for breaking it are direr. Rules don’t respect status and political leaders are not spared. The health system relies heavily on labs and imaging for patient diagnosis whereas we build heavily on clinical acumen because of our resource constraints. Although not having the needed amenities contribute to the avoidable deaths we have, our high index of clinical suspicion as health providers is a highly coveted skill we should strive to retain in our quivers even as we aim to equip our facilities better. We need to invest heavily in our public health systems and have working insurance systems that leave no one behind. This needs to be heavily supported by data-driven approaches just like you have in Western countries. While not having great public health systems is an undoing, the fact that private health care is still available and accessible (not necessarily affordable) is a comforting ameliorating factor. This helps with long waiting times typically seen in the public health facilities as against the Western context where people can wait for up to a year or more to see a specialist.  Another thing worthy of note about the West is the high public awareness, care-seeking behaviour and care ownership. In Nigeria, many, regardless of educational status, do not know how to prevent disease, do not recognise early signs of disease, lack autonomy for health decision-making neither do they present early for care. Additionally, they don’t know what drugs they have been placed on or why; essentially they don’t own their care. This is a low hanging fruit that can be worked on in partnership with other non-health sectors and organisations. The rapidity of emergency service response in these countries is worthy of emulation as time (even in seconds) can make the difference between life and death. We basically don’t have this and so a patient who needs emergency care has to overcome so many barriers to get to a health facility where they can be treated whilst praying that the services they need are available on their arrival. We need to work on these things, so many people don’t have to die when and how they die currently. Certainly, we have to have better diagnostics and treatment in place as well. As someone once said, you need to plan more when your resources are limited as against when you have so much to spend from. As a resource-limited country, we need to harp on prevention and early diagnosis and treatment compared to our global North counterparts. 

 

You’re presently researching into violence against healthcare workers, which is quite a thing in the sector today. What is your motivation for this research? 

Yeah, for my doctoral research, I will be working on emergent violence against healthcare workers. Violence against healthcare workers drives health inequity by impeding access to healthcare as healthcare workers seek safer areas to work, resulting in health workforce shortages, and reduced quality of care. My interest in research was born out of tragic events that affected me personally and then having to see the plight of my medical colleagues who constantly have to live in fear whilst playing their role.  I observed that there was limited research on the emerging violence against health workers emanating from Southern Nigeria which is a non-conflict area. So, I want to play my role on beaming research spotlight on this as well as engaging with policymakers, health workers and other stakeholders on how to best curb this menace.

 

Having gotten to the height of specialist medical practice in Nigeria, how will you advise young health professionals to position themselves for both local and global relevance?

I strongly opine that we have great untapped potential in up-and-coming health professionals. Amidst adversity, we thrive and push for global relevance from the rubbles and the disadvantages that we are born into. I will start by saying that you need to define early on what your path is. You can seek out local and international exposures in this area to test your interests and then keep refining them as you go along. What has worked for me and for many, I believe, is to have that unwavering faith in one’s self. As my pastor would say, “there is nothing good that is too good for you.” That’s the mindset to have. If you see a call or opportunity, apply for it. “We don’t fail, we learn,” is a re-echoing statement from my director. Commit to excellence and consistent growth. Connect to mentorship and drive it by showing your commitment to work and learning. Be the best of you at all times and never jeopardise any opportunity you are given. As you learn and grow, become a mentor to others because this not only helps them but helps you as well. Of course, ensure good work-life balance and always rely on the grace of God at every point in time.