Professor C. Onyebuchi Chukwu is the Minister of Health. Before this meeting, the impression was one of a happy-go-professor.However, when you begin to throw questions at him, you discover that beneath that youthful look is a bundle of knowledge and information, both rolled into one, is power. In this encounter which had been long in coming, the Minister explains why Nigerians should be more information savvy especially when they hear that doctors or professionals in the health sector are embarking on industrial action.To  the Minister, the health sector is getting better.He talks of his plans for the ministry and how President Goodluck Jonathan’s commitment to good health for all has helped the ministry.According to him, “President Jonathan initiated one meeting for maternal and child health and he invited us – the Minister of State, the Permanent Secretary and I, along with his aides and, when we finished, he became happy because his thinking was that he would set up a committee to help but, after our presentation, he became impressed and directed that we should go before the National Economic Council where the governors are involved and we went there”.

Excerpts:

When you assumed duties as Minister of Health,  one of the things you’d hoped to achieve was industrial harmony.  How far would you say you’ve gone? And what were the challenges?

Well, we wouldn’t say  we’ve achieved our target of having a proper harmony.

But we started by getting the different parties involved to start talking – that was a good first step.  It is, however, surprising that, at this stage, one was hoping that the presidential committee would have submitted its report.  I’m anxious to receive that report but I know that they’ve been discussing on that platform.  I also know that a number of bodies in the health sector have made the issue of industrial harmony at different fora the focus – the issue of industrial harmony and that is quite pleasing.

The industrial actions were becoming rather incessant and it was not just restricted to the doctors but the no-doctors too were getting involved and, on different occasions, I’ve had cause to decry the spate of strikes in the health sector.

Those were major challenges because when there are strikes, apart from the impact on the citizens, it also stops the minister in charge from carrying out his mandate as a minister and the country loses and anytime they resume work, it is as if we are starting all over again.  These were the challenges.

In some states of the federation, when you hear that doctors are on strike, what sort of feeling does it invoke from within you?

When I hear that doctors are going on strike, it is an unusual phenomenon and strike is a weapon to be used; mind you, elsewhere in the world, doctors, too, do go on strike, but then, when you hear that doctors are on strike, the main thing that would strike you is that something very serious is in the offing and that,  perhaps, doctors have exhausted all avenues of mediation and negotiation and the government is not disposed to continuing with the dialogue and, therefore, suggesting that it is a failure on the part of the government because we expect that, for doctors to stop seeing patients, then the blame should lay squarely on the doorsteps of government.  But, at the end of the day, when you now get to know of the reasons doctors are on strike, then you become disappointed.

Professor C. Onyebuchi Chukwu.

At some point, some people had misquoted you or quoted you rightly, that you’ve been disappointed at the conduct of the doctors or that you’ve actually had cause to plead with them. Now, which had been and is your position between these two extremes?

My position has never changed. Ordinarily, doctors providing essential services should never be seen to be going on strike.  They should never go on strike.

However, if they are pushed to the wall, they can invoke that right which workers have, but then, they have to do it properly.

It would have been clear to government that negotiations have indeed broken down; it would have been clear that government is no longer willing to give in; it would have been clear that what the doctors are asking for are so basic and so important that if the prayers are not granted, then the doctors won’t be able to perform, then for that reason, they are free to exercise that right – but such conditions are very few and I don’t see such conditions happening every year let alone happening frequently the way it has been in the last few months.

Doctors, like people providing essential services ought not to go on strike, but there may be occasions where these things can happen but, under my tenure as minister, I don’t see these things happening.

There is supposed to be a National Health Bill and Nigerians are hoping that this should have been passed.  What is causing the delay?

The only thing we’re hoping for is the resumption by the National Assembly.

One is hopeful that the two chambers can harmonise.  It’s been passed in both chambers and pressure is being put on them.  Even the members are also interested and committed to having the bill passed before the end of this session of the National Assembly.

That is where the separation of powers comes in because much as the executive – as represented by the minister and the president- want the bill passed on time, the National Assembly must be allowed to do its job and the members are doing it. We are eager to have it.

To what extent do you see the bill solving the problems in  the health sector?

The bill is something that would guide all of us.  It is not as if the bill is a magic wand that would solve all the problems of the health sector but the idea is that the bill would let local governments, state governments and the federal government work together, performing and coordinating among themselves and,  right now, there is nothing that guides us in that regard.

However, the bill, when passed, would not be a toothless bulldog.  The bill would strengthen our health care policy and it starts at the primary level.

The thinking is that if we get it right at the primary healthcare level, then we will get it right overall.

Primary healthcare would also be better funded because it would then mean that by law, special allocation is made, without recourse to the budgetary allocation  for primary healthcare and it also means that, in terms of coordination, in terms of working together, which is very vital to providing healthcare to Nigerians, things would be properly done.

Nigeria’s newborn mortality rate is very embarrassing, even by African standards.  Now, as the Minister of Health, when you look at the realities on ground and the efforts of the ministry, what would you say is responsible for this in a country where people believe that things are not right?

There are many factors that are used to determine  life expectancy and some of them are not in the hands of the health sector or the Minister of Health.

Take, for instance, what has been happening regarding the killings in the north over the election, the deaths are going to be used to compute the life expectancy of Nigerians because the deaths from that violence are going to be computed and I do not see how the Minister of Health is culpable.

Apart from joining other well-meaning Nigerians in condemning the killings and pray that politicians learn that this matter is not a do or die affair, things like road traffic accidents are used and it is those who survive that are my responsibility.  We do not have natural disaster here.

All the things that happen in the health sector impact positively or negatively.  A good example is if  a pregnant woman dies in the process of moving from point A to point B and because of bad roads or lack of transportation.
We should be happy that natural disasters do not happen in this part of the world.

We know the areas where we are supposed to continue to improve health care delivery system and the life expectancy of Nigerians and we’re doing them.
Like which areas?

We are rehabilitating and re-equipping many of the tertiary hospitals and some of them are ready for commissioning but we are not waiting for that because some of them are already in use.  We’ve also been able to introduce a new drug on our essential drugs list.

That drug is so useful that it reduces the problem of losing blood when in labour. Even the midwifery services scheme, we’re also working on that by getting new midwives and some of those who are retired to come on board; and we have been able to dispatch about 4,000 of them to 1,000 places – the scheme is still on Traditional birth attendant people are being incorporated into the holistic healthcare programme and the incentive would not be by how many people they can treat but by how many they can refer to the government hospitals – they’ll be compensated.

We’re looking at ways of campaigning for the isolated reduction of maternal fatalities.
And to that end, we’ve declared two weeks in a year to celebrate maternal health care. In those weeks, we offer those things related to maternal healthcare free of charge.

The issue of breast feeding, de-worming and all that which are related to maternal healthcare, we dedicated May and November and we didn’t just choose these two months arbitrarily.  They held last year  Children’s Day in May and the other in November for World International Women’s Day.

We’re introducing new vaccines to reduce child mortality and we’re aiming for the reduction of child mortality. Apart from polio, there are other things that kill children.

We’re adding rota virus which if children are immunized with that vaccine, 70 percent of causes of diarrhea in children caused by virus and not bacteria then we’ll be saving more children.  This would also reduce infant mortality.

The other killer is pneumonia caused by influenza and we have now introduced a vaccine.
On polio, we’re doing well and we’re continuing to get people more aware.

We’re intensifying out efforts on polio and this report I was reading before you came in is about polio.
Anybody listening would think it has been rosy.  What is the greatest challenge?

It is getting the message to the grassroots. President Jonathan has shown commitment.
He is interested and committed.

He initiated one meeting for maternal and child health and he invited us – the Minister of State, the Permanent Secretary and I, along with his aides-and when we finished, he became happy because his thinking was that he would set up a committee to help but, after our presentation, he became impressed and directed that we should go before the National Economic Council where the governors are involved and we went there.

A lot of healthcare matters are in the hands of state governments. We went as a ministry, minister of state and perm sec and…

It was successful although some of the governors were not happy with our report because they felt we didn’t give them a good score.

For us in the ministry, we liked it because it meant the governors would have to do more.
There is a maternal council which has a state governor from each of the zones to participate in the task force for that objective.

Looking back at your tenure, what would you want to point at as a high point?

Virtually everything we’ve done here as a ministry has been very productive. So much have been achieved in 11 months!  The fact that we were able to get the Federal Executive Council, FEC, to approve the plan of an MDA, the National Strategic Health Plan, for our ministry, the first, is an achievement.  We presented our plan to the Planning Ministry and then to the FEC and it was the first to be approved within the context of the 20:2020 arrangement and the president launched that plan.

That is one. Then we produced a document, the Minister of State for Health and I, produced a document that can be used to judge what we’ve been able to do while in office and we called it the Action Push Agenda for Health and almost everything there has been approved apart from the National Health Bill because at the time I came on board, the bill was beginning its life all over again and for them to have passed it and awaiting harmonization is an achievement.

We came in at a time when the new salary for the health sector was creating some concerns and despite the fact that we didn’t have it in the budget, we were able to get it  into the supplementary budget and some arrears have been cleared and some monetisation issues too have been resolved.

When it comes to health, we are respected in the world today and you can verify the claims from people who have attended some of those fora.

As a Minister and as President Jonathan is the Chairman of ECOWAS, I chair the health ministers’ group, too.
In the area of disease control and prevention, for the first time any where in the world – and the World Health Organisation, WHO, attested to this – we invited our neighbours, not to discuss cross_border smuggling but to discuss how diseases move across our borders and we perfected an easier protocol for everybody to follow.
We’ve also been able to drive down the transmission of polio by as much as 98 percent.

It’s not as if I am the one doing it but by my action things are moving.  Look at the president, by his action, the country is moving, he radiates a positive aura.

We’ve been able to maintain a clean slate on the issue of guinea worm and we’ve increased the bounty now.  People can make money by picking cases of guineaworm and, for each case, we pay N25,000. You give us a case that you discovered,  then we give you N25,000.

N25,000! Why are you doing that?

It is because we are on the verge of getting certified as a guineaworm free country and we have just nine months to get that done and we don’t want people to get complacent and the only way is to get more cases and bring them to our awareness with a view to re-doubling our efforts.

The residency programme, for the first time, we started it locally, we’re doing the audit for the first time. In the area of malaria, we’re working harder. I want to tell Nigerians that things are now being done well under the present regime.

I see a change and by the leadership and example in this ministry, there is hope. There are new things, look at cancer of the cervix, we’ve almost abandoned the need for its cure but it is being focused on now. We’re planning a massive nationwide campaign against cancer.

Last year, we flagged off an immunisation programme for our girls to avoid cervical cancer for which someone won a Nobel Prize and we’re working with the company that manufactures it. It’s for girls from between 9years and 15years.
I’ve been working with the people I met on ground in the ministry and some of the programmes that we have seen through were initiated by my predecessors.

We’re hoping that by 2015, we’ll have most people on the National Health Insurance Scheme, NHIS.