How Tinubu’s Health Sector Reforms Will Lead To Massive Job Creation
Nigeria’s Coordinating Minister of Health and Social Welfare, Professor Mohammed Ali Pate, is a renowned physician of global repute. The Professor of Public Health Leadership in the Department of Global Health and Population at Harvard University recently served as the Global Director for Health, Nutrition and Population and Director of the Global Financing Facility for Women, Children and Adolescents (GFF) at the World Bank Group.
Pate, a former Minister of State for Health in Nigeria, between 2011 and 2013, also served as the Executive Director of the National Primary Health Care Development Agency, NPHCDA, in Abuja. In February 2023, the eminent Nigerian physician was appointed as the Chief Executive Officer of GAVI, the Vaccine Alliance, which works to provide vaccines in low-income countries.
During his maiden stint as Nigeria’s health minister, Pate launched significant initiatives with the ambitious objective of “Saving One Million Lives”. Just within a few months upon his historic return to the Ministry of Health, the Bauchi State-born world class physician is assiduously changing the narrative through the formulation and implementation of beneficial medical programmes and activities.
The Editorial Crew of Economic Confidential recently caught up with the Minister, at his office in Abuja, where he eloquently and articulately highlighted the measures the President Bola Ahmed Tinubu-led administration is adopting to address teething challenges bedeviling Nigeria’s health sector, his vision for medical industrialisation and making the health sector add value to the economy in terms of job creation.
Excerpts:
Sir, you are back to a familiar terrain, exactly a decade after you quit the Federal Executive Council of former President Goodluck Jonathan. How has the journey been so far, this time around?
I will begin by first registering my utmost gratitude to Almighty Allah who made it possible for me to return to this familiar terrain, like you called it. I also wish to thank Mr. President, Asiwaju Bola Ahmed Tinubu, GCFR, for finding me worthy to become part of his Federal Executive Council, FEC, and not only that, assigning me to a strategic ministry.
When we took over affairs at the Federal Ministry of Health and Social Welfare, as it is now called, we came with the sole objective of taking the Nigerian health sector to the Next Level. But that cannot be done without laying a strong foundation.
So, the first thing we did was to intellectually engage the management and entire staff of the Ministry. We held meetings, for about three days, with the Permanent Secretary, Directors, and staff of the Ministry with a view to understanding their challenges, what were the constraints, what was going well and where the gaps were.
I visited Kano, Nasarawa and Borno States. I went to communities, primary healthcare centres, general hospitals, and teaching hospitals in the three states, with the sole aim of feeling the pulse of citizens and knowing their challenges in seeking quality healthcare services. We also re-introduced the People’s Voices Survey which was started in my first stint at the Ministry. The survey is an instrument that asked 2,500 Nigerians about their expectations, their experiences, and what issue is bothering them so that we understand what Nigerian people expect from us.
Again, we also engaged with development partners who have been supporting Nigeria, like the World Health Organisation, WHO, and civil society bodies. During our induction retreat, we engaged the media because it is a key stakeholder in the assignment we are executing.
At the end of the retreat, we came up with a robust blueprint of what we think Nigeria should have in terms of its health system, in line with the President’s vision for a prosperous country where the health and well-being of the people are guaranteed.
We identified that all that we do from the health sector perspective is to save lives, and reduce physical and financial pain for all Nigerians, meaning that we cannot leave anyone behind.
So, what programmes and activities have you unveiled or flagged off in order to tackle some teething challenges affecting the country’s health sector?
We articulated four key pillars to focus our attention on. We had a conversation with the Governors’ Forum, through their Commissioners for Health. The four pillars summarise the cornerstone of the effort we are putting forth to reposition the country’s healthcare system. The first is to deal with the governance of health in Nigeria, taking into account the fiscally-decentralised system of government that we have, where health is a concurrent item, that the federal and state governments have partial control over.
Again, to deal with the governance of health, we will need good data systems to tell us where we are, whether they are doing well or not doing well and how to correct them. All these are meant to achieve mechanisms for enhancing transparency and accountability; accountability from the point of view of answerability. Answering when things are going well or not and hopefully consequences in terms of incentives or disincentives when things aren’t going well.
So that’s the realm of governance and that includes how we operate with external actors that are supporting Nigeria’s health sector. The second pillar is Population Health Outcomes. That is the life expectancy, mobility and mortality.
Boosting population health outcome demands immunisation and revamping our immunisation programme, together with introducing new vaccines like the HPV. Some have to do with the primary healthcare system and we took the basic Healthcare Provision Fund as an anchor and the President approved for us a sector-wide program for health, to be complemented by the efforts of the states, and other external actors to drive improvements in the primary health care system; to make the 8,000 facilities that currently using the National Primary Healthcare Development Agency, NPHCDA, platform more functional and to extend them to 17,000.
This is very practical and we have started developing a programme to also retrain 120,000 frontline health workers and that effort is on the way. We have identified the resources and will soon update their training guidelines so that they are trained.
We also want to fix our hospital infrastructure, some of the challenges that they are facing like power deficit, human resources and inadequate equipment for health challenges like cancer.
The third pillar is to develop the Healthcare Value Chain that will ensure we produce the things that we need like consumables, generic pharmaceuticals and medical equipment. We cannot be entirely dependent on others all the time. In that regard, the President also approved for us an initiative to unlock the healthcare value chain and recently appointed a coordinator to work with us, and I will be chairing that initiative to drive that value chain so that we produce what we need.
In doing so, we shall be creating economic value and jobs for our youth through the health sector. The health sector can be a job creator. In the United States almost one out of 9 or 10 jobs created in the last 10 years is in the health sector because the health sector is human resource-intensive.
The fourth pillar is Health Security, to learn from the lessons of the pandemic, Ebola and other outbreaks. How do we ensure health security? Meaning that when outbreaks occur we know of them quickly, and we prevent them from happening if we can. We respond quickly and we ensure that we are ready when things like a pandemic occur so that people will have minimal impact as we saw with COVID.
Alongside the four pillars of our agenda are some enablers that will catalyse our vision.
The first enabler is data and digitalisation. How do we systematically collect data? There are a lot of innovations in the data space that can help advance healthcare closer to the people.
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The second enabler is in defragmenting the financing landscape. It’s really ensuring that there is coherence and that we allocate resources to what will affect the people in the frontline the most.
The third enabler is to build the talent within the health sector and reorient human culture within the sector to make it service-oriented. In the last few months, as you may have gathered we met with various unions in the sector and I think they began to understand that yes, if we put Nigerians at the centre of our agenda, we all win.
Foreign medical tourism is common among Nigerians. What are you doing to address that and in a way, also attract investment for our health sector?
Very good. So I think, first of all, the medical tourists that travel out of this country, when they go to their destination countries, they don’t go to their government hospitals. They go to private facilities and they pay out of pocket.
Those amounts that they pay amount to between 1 to 2 billion dollars every year. So in line with the President’s direction, we need to find ways to retain some of those spending domestically.
That requires expanding the capacities of our hospitals and their equipment. The Government’s own resources are limited, but the private sector has probabilities that you can deploy. So in the last few weeks, I would say we’ve had two important conversations. I will not divulge the entities that we’ve spoken with.
One is renowned, one of the best hospital systems in the world. We’ve expressed interest in taking one service line in Nigeria and developing an endovascular testing capability. We’re going to discuss which hospital we’ll look at. Our prayer is that Nigerians will feel patriotic enough to use those facilities. Let me also add that the federal government is assiduously taking steps to boost health business in the country.
In the first-quarter of 2024, we will be co-hosting, together with the International Finance Corporation, IFC, a summit here and investment forum for health so, wait and see how that unfolds.
Do you think the Nigerian health sector has that potential to also help address the problem of unemployment in the country? If yes, what measures do you think needs to be put in place to see that the Nigerian health sector, just like the United States, becomes one of the largest creators of jobs in the country?
Pate: To create jobs, we need to grow our economy. If you look at the priorities of Mr. President, it is to grow this economy fast to a trillion and even double it. If you grow the economy at that rate, the economy will create job opportunities. Our hope is that the health sector will be a contributor to this larger effort to create jobs for our youth and it is possible to do that.
Health is not just a consumption sector where it just provides services and then that is it. If we produce pharmaceuticals of high quality, we can export them to other African countries. At least 70 percent of our generic pharmaceuticals are imported. The jobs are in the countries that produce these things. Let me give you an example, bed nets for mosquitoes and malaria is not a medical product, it is a textile product.
For the last seven years, we have had a malaria programme in Nigeria. We have 30 percent of the world’s burden of malaria, and 600 million or so bed nets have been distributed in last 10 to 20 years in Nigeria. I doubt if one or two million were actually produced here, they were produced elsewhere at two or three dollars per one.
So, the jobs are elsewhere and we receive the produced items as consumers. That discipline to produce for ourselves, we have not woken up to it and Mr. President said we have to renew the hope. We have to believe in ourselves and do the hard work to build this country. We must stop buying all the things others are producing. I am not saying we do everything and be isolated from everyone else, we are part of the global community, we are saying that Nigeria is global Nigeria not Nigeria in isolation, that Nigeria is a contributor.
There are things that are sophisticated and we shall continue to buy from other countries, but those that are not so sophisticated we should at least produce them locally. When the COVID pandemic broke out, we saw how some countries were not able to ship things to other countries and because we are not producing, we had to be improvising, sewing masks.
The introduction of the HPV vaccine was greeted with controversy. Tell us about its impact, especially with regards to checkmating the menace of cervical cancer among Nigerian women.
As you are aware, the vaccine was launched on the 24th of October 2023, in 16 states. It was a successful launch because parents realise we can prevent this deadly cervical cancer by immunising with the vaccine that is safe and effective.
I have vaccinated all my daughters.
Beyond vaccination, every woman should have routine cervical cancer screening, as the disease can be detected early. The second batch (phase) of states will start in the first-quarter of 2024. We had to phase it so we learn from the first phase states and then improve how we plan for the next phase. If we go across all the 36 states, we will stretch ourselves so; we are focusing to learn from the first phase.
What plans do you have to improve routine immunisation, especially in rural areas, and among children under the age of five?
Pate: The thing is, diphtheria outbreak and other diseases are manifestation of low vaccination rate. When I went to Maiduguri three weeks ago, 98 percent of the children who had diphtheria were unvaccinated which means that if they had been vaccinated, they could have been prevented from diphtheria.
When you hear these outbreaks, they represent a fallout, lack of parent accessing vaccine for their children. So, since we came into office with the Coordinating Minister of Economy, we have ensured that the financing for vaccines is put in place, because the government buys the vaccines, even though they are given to people free.
As we begin 2024, there is provision for continuation so that we do not have stock outs. Also, the National Primary Healthcare Development Agency has put in place the necessary mechanism to work with state governments to train workers to have infrastructure so that the vaccine will reach people.
The second portion of your portfolio is “Social Welfare”. Can you kindly tell us what is it all about?
The coordination role has different dimension, there is coordination within government and others. People are at the centre of the agenda of Mr. President, people go through a life course, from adolescent, delivery, early childhood, early school, secondary school, transition to university, transition to job market, to productive adults, to aging and death.
Across this life course, there are different points of intersection by government ministries whether it is Women Affairs, Health, Education, Youth, Finance and Pensions. Mr. President’s vision is that his team all across those ministries will do their best to touch the lives of Nigerians across the life course, and we have platform of ensuring that there is coherence in what we do in government, as we do not want to leave anyone behind. We prioritise the elderly, poor or those affected by crisis.
There is also a level of coordination between us and different levels of government. I mentioned the governors much earlier in this discussion and also the National Council of Health. We cannot, alone improve the health of Nigerians at the federal government level, we have to do it with the states. We want to get their buy-in and work in the same direction.
Then, there is coordination with external actors. If they come and want to help Nigeria, they should know what Nigerians priorities are and how they can key-in. So, we have to keep them in line if not we go different ways and that will not yield result.
Before we go Sir, what do you want Nigerians to remember you for after serving as the Minister of Health?
I would say that if what we do as government in this country is an orchestra and we have the lead conductor of the orchestra as the President, and he has appointed many of us to be different instruments of his government, so I will like to be remembered as someone who had the honour and privilege to serve in the orchestra that births a Nigeria that we will all be proud of, and that is the President’s vision, and that is enough for me.