ONE year after he was sworn in as the Minister of Health, Professor Isaac Adewole x-rays how the health sector has fared under his watch and the strategies already on ground to ensure quality and affordable health for all Nigerians especially the rural poor. The minister touched on numerous issues ranging from the new Rapid Results Initiative, Saving one million lives, Lassa fever, polio, and many others.
Adewole disclosed that the Federal government has been able to cage Lassa fever while coming up with a new health policy and a bank of health that will address major issues in the sector. Chioma Obinna was there for Good Health Weekly. Excerpts:
CHALLENGES at the beginning
Having been on ground for one year, one can officially appreciate the challenges on ground and to now say what exactly is needed to do in order to create impact.
Shortly after we came on board, we were faced with Lassa fever. We thought we should look at the performance of the health sector. The health indicators were such that no one was happy. Maternal mortality was like what you find in war-torn countries, child mortality was very bad. Malaria very bad; HIV was a problem. For mother-to-child-transmission of HIV, we were the largest contributor of paediatric HIV in the world.
There were a lot of challenges in the health sector. Doctors were fighting nurses, and we also had to build trust because our sector appeared better known for strikes than for services. While trying to look at the various indicators, we also stumbled on something that was particularly challenging. The healthcare indicators for wealthy Nigerians is like what you find in Europe and USA but looking at the immunisation coverage for poor people, antenatal coverage, skilled birth attendants for the poor, contraceptive usage, etc., is poor.
For instance, 95 percent of educated urban Nigerians receive antenatal care while only 24.6 percent of rural people will access ante natal care. When you look at those who have access to skilled birth attendance at delivery, 85 percent of the rich urban Nigerians will have supervised delivery. They are likely to deliver well. Their babies are likely to survive, but only 5.7 percent of poor rural people have supervised delivery. They are the ones who will die during labour and the ones who will have anaemia and VVF and many other things. So we recognised clearly that we should develop programmes that will target poor people in the rural areas.
While we are working on that, we were struck with Lassa fever. It appeared as if Lassa fever just came to Nigeria. While we were doing that we were to contend with the challenges in the north east. Then polio came.
Rapid Result Initiative
We are also looking at things we can do as a big win. We therefore conceived the Rapid Result Initiative, RRI. We gave a caption better health for all Nigerians and when you talk about providing access to people within 5 kilometre radius, you are talking about universal health coverage.
We have made that the policy platform in terms of health and that is where we want to be. And when you talk about universal health coverage we are talking about health for all. It must be accessible and must be of good quality. When 80 percent of the population can achieve that we will say that we have delivered. We have made up our minds that we must deliver that through a real invigorated primary care structure.
We are partnering with the state to rehabilitate their structure and also take care of the tertiary system. But then, we realize that what we have now is the pyramid sitting on the tip. The ideal pyramid should sit on the base. The middle part should be the secondary and the tip will be the tertiary. But the reverse is the case in Nigeria. About 10 percent of Nigerians should be seen at the Tertiary hospital but now, everybody with diarrhoea and other minor illnesses go to Teaching Hospitals.
Unfortunately, these hospitals are not made for that. We want to take them back to the old good days.
We want to draw attention to the health sector. For many years no one regarded health priority. We want to create attention. What are those quick things we want to do? First, we want to change the perception of Nigerians about the health sector.
But to do that we want to work with the media and get feedback. We also want to change the perception of health sector as unproductive sector, build trust and project ourselves as one that is competitive and productive that can be really be involved in transparent issues. And that is why we have been transparent in our budget. We are also telling our partners to also be transparent.
Primary Health Centres
We thought we could pilot tests on the revitalization of our Primary HealthCare Centres, PHCs. We picked 110 PHCs on the basis of three from each state and one from each senatorial district and that will give you 109. We also picked one from foca village making it 110. Fuca village happens to be the epicentre of Lassa fever this year. When I visited there having started there, they lost about 17 Nigerians before we got to know sources. The rumour was that if you are putting up a new market, for that market to thrive people must die.
Once they fall ill they take them to the bush. I visited the village and I discovered that there was no primary health centre. The only one there was bad. The new one was still under construction. You could see an absence of a health facility. If there was a healthcare facility, that must have been the first point of call. Now the new PHC in the area is ready for commissioning.
We want to have revitalised our PHCs to deliver quality care for our pour people. The other things we are looking at the concept of mutual health association. About 30,000 PHCs are on ground and what we want to do is to make 10,000 working, In Osun state, many of the PHCs have been overgrown by weeds. Nobody is working there. The only place we can build new PHCs is in Borno state where 60 percent of the facilities are gone, Yobe and Adamawa due to the insurgency there but that will be taken care of by the Presidential committee on North East Initiative. We have model we are using.
Free surgery for 10,000 Nigerians
We found out that there were many poor Nigerians with surgery ailments, so we decided to pick 10,000 poor people to kick start with this year. The only criterion is that you must be poor. We have also identified 46 tertiary institutions to take care o these surgeries. These have started at Maiduguri Teaching Hospital and we hope to sustain it. There are thousands of Nigerian women with VVF and they are mostly poor people. Next year we hope to do more. The 10,000 surgeries this year is costing us about N500 million. We cannot say health will be free across board.
Chains of laboratories
Again, because of our experiences with Lassa fever, we believe we should revitalize a chain of laboratories across the country where some of these diseases can be diagnosed. What was peculiar about the Lassa fever this year was that the case fatality was very high. Ordinarily, case fatality for Lassa used to be very low. Sometimes, less than 10 percent or 2 percent, the peak was in 2012 when we had about 2000 cases and fatality was low.
HIV and AIDS
Now that the world is saying test and treat, we are upgrading to test and treat instead of 350. We are looking at the implication and the resources needed. There are about 500,000 Nigerians on ground that need to be put on treatment. And we do not have the resources to put them on treatment this year.