LANRE TEJUOSO is the Chairman of the Senate Committee on Health. He spoke with KEMI AJUMOBI on the recent approval of N57.150bn for the BHCPF in the 2018 Appropriation Act and the next point of action which is the NHIS. He also shared on exodus of medical doctors, the need for better Primary Healthcare Centres, among others. Excerpts.
The appropriation of N57.150bn for Basic Health Care Provision Fund (BHCPF), how did you facilitate it being signed to law?
Like you know, I am a first time senator and it was a miracle for me to chair a grade A committee. Normally, it is reserved for second timers, more senior senators however, to be a Senator is enough achievement. I do believe it was based on efficiency because whether you are a first timer or not, you must be proven to be efficient at what you say you know how to do. Luckily too, I am the only medical doctor in the entire senate aside the Senate President. So obviously, putting a round peg in a round hole was the solution. When I got in, I asked the question, how do we move forward? What is the most important aspect of our laws that can make a major difference in our healthcare sector in Nigeria? And I realised that this bill of 2014 was it. All the contents were already spelt out, our duty at the National Assembly is to introduce laws and more however, I realised that there are so many laws that have been done by our predecessors that have not been implemented and here we are again. I then asked myself, are we going to start churning out another set of new laws? I did not want us to play to the gallery rather, let’s ensure implementation and I said that during my tenure, my priority will be to implement the 2014 Act because I looked at all the other countries around the world, the countries that are succeeding in Africa, they are countries that are funding the health sector adequately and they are not as rich as Nigeria.
Countries like Swaziland, Botswana and more. All the African countries sat down in 2001 in Abuja and decided on what we all call Abuja Declaration, where they all agreed that every country in Africa must have at least 15% in their budget for health. That was about 17 years ago. All the countries that are getting near this declaration have their health indices interestingly good. It therefore means that the success of health is subject to funding. So you do not need to reinvent the will. After the 2001 declaration, we never achieved up to 5%, even the 5%, maybe they have released about 3% (5% on paper) so of course you cannot expect our health sector to change because they keep doing the same thing every year. They then decided again in 2014 to introduce this 1% of the CRF as a law to encourage our donors because the 1% is going into a fund and 1% is the minimum expectation of our own contribution to the fund as a Nation. The idea is that other donors like Bill Gates, UNICEF and the rest will put in their funds and Nigeria has been putting in zero. We have surrendered to our foreign partners. How do we now improve our health sector? These and more motivated me to champion the campaign.
I began to campaign round my colleagues in the Senate because the truth is, if you are not a medical doctor, or in any way affiliated with the health sector, you may not be so passionate about health. The others can say health sector is not only the sector that needs funding, there is need for money in education sector, agriculture, defence and so on but I said, all the other sectors are operated by human beings and if so, why not focus on the human beings being healthy to start with? These were the basics of my advocacy within the National Assembly and I got people from outside the country to also help fight for this cause. I also put pressure on relevant people. I had a meeting with the Vice President, Minister for Budget, Minister for Finance; I also pushed for the implementation at the Nutrition Policy program advocacy that I arranged. I invited the World Bank to Nigeria to keep engaging us. I also encouraged the World Bank to host Ministers of Finance and others on Health Policy in Washington as a side meeting. The President of The World Bank was there and I made sure I emphasised that they should help ensure that the 1 per cent is actualised. I also had the privilege of meeting with Bill Gates, a one-on-one meeting which also included the Honourable Minister of Health and I asked Bill Gates to encourage us if he loves us the way he says he does. I needed him to encourage us to be self-sustaining and emphasise on our own contribution because I don’t want us to always depend on others.
Why did it take so long for the 1% to be implemented?
It is political will. Mind you, in Nigeria, we are very good at emergencies. If today, we hear of Ebola crisis, money will come out from somewhere, if we hear there is Monkey Pox, Nigeria will rise to the occasion so it’s a matter of political will.
What change will this budget approval bring to the health sector?
First of all, today, if the average person in the rural area is sick, the nearest hospital or clinic they can go to is maybe about 20-50km, we are therefore saying that every local government, every ward, should have a functional Primary Healthcare Centre that is well staffed, that can offer the basic healthcare to Nigerians, to a pregnant woman, to a child under 5, to our old citizens, such that within a walking distance, they can receive medical attention. What we have at present are people with minor cases going to the tertiary hospitals. Tertiary hospitals are meant for referrals like surgery. Tertiary hospitals should concentrate more on teaching our new doctors and nurses and carrying out major surgeries. The primary Health Centres must be made functional to treat malaria, antenatal care, give nutrition supplements to children and babies, do immunisation for our babies and so on. Today, our Primary Healthcare Centres are used for chicken hatchery and the likes because what happened in the past is that, politicians want their names written down as having done something for their community, and the most common thing they all say they want to do is to build clinics in their names. As such, we have over 30,000 of ‘clinics’ like these and out of that 30,000 maybe about 4,000 is functional. More so, the structures are there with the name of the donor boldly inscribed on it. Some of these structures have been there for 10 years not functioning however, they all say that the donor has “performed” meanwhile, how do you build a clinic without talking to the Minister of Health to know if they have nurses to put there? What about drug availability? Also, is there the possibility of continuity of their salaries for workers who will be working there? So they just have buildings all over the place. Now we are out to ensure that there is content in the buildings and it is well funded.
Is 1% enough?
Considering that for 4 years now nothing has been done, at least we are now guaranteed that at least every year, something will be allocated to the health sector in the budget. It is a fund that will keep on growing. Our partners too will be putting funds in there. We are also going to amend the health insurance scheme, after this budget, it is the next thing to be done. We intend to ensure that every Nigerian contributes at least N200 per month for health. With this, we are targeting about 100 million Nigerians (Perhaps we say the rest are vulnerable and cannot afford) this comes to about N20billion naira every month and in a year, it’s N240billion naira. This is times six of the budget of the health sector capital. An average Nigerian can buy at least N500 recharge card per month so, if they know that with N200, they can walk into any health centre and be attended to, N200 deducted from their account or from their phone or whatever means adopted, will not affect them and that will be a major difference in terms of health funding. We are hoping that this will be done before we go on recess this year which is July.
Why is health insurance difficult for the Nigerian populace to embrace?
It is because they do not trust the system and most importantly, the law has not been fortified to ensure that everyone contributes. It’s only the civil servants that have been contributing. Truth is, there is no point asking people to contribute if they do not have places to go to. They must be a Primary Healthcare Centre close by. We must be ready to receive them for service before we start deducting their money.
Exodus of medical doctors from Nigeria
It is very simple; the question is why do they go? It is because they know they can get more returns for their profession. It is about salaries. We need to change the salary structure of our doctors. We need to isolate the doctors from the system. The problem if that, when a change is effected, every healthcare practitioner in different capacity in the sector also want the change too whereas, it is the exodus of Doctors that the country is feeling the most. We should copy what was done in Delta state. I mean the former governor of Delta state, Uduaghan, and I think it was easy for him to do this because he is a doctor too. What he did was that, he decided that all the Deltans that are medical doctors abroad should give him their pay slip and he offered them exactly that amount to come back to Delta state for their medical practice. That is why some of them are still there today despite the fact he is not the governor. He was paying some as much as N3million per month and some of them are still back home practicing, they are glad to be back. We need to take the bull by the horn. I am actually afraid of the kind of doctors we will be churning out because of our teaching hospitals. I say so because those who are meant to be teaching the younger doctors have gone outside the country. The question is: Who is teaching our young doctors? Perhaps we need to start by saying that those teaching at the tertiary hospitals must have a salary structure that is at par with international standards. We don’t need the doctors in the UK for PHCs, a Youth Corper doctor can do that, young doctors can do that, we need the senior ones at the tertiary hospitals. Some of the doctors do not have their experience in Nigeria, they have it abroad and then they choose to flourish abroad. In the UK and even America now, if they withdraw all the Nigerian Doctors from their system, the system will collapse. These people are eager to come back but they will only do so if the environment is ok.
My take on strike is that of sincerity of purpose. This particular strike, I remember immediately it happened, I invited all the participants to come and brief me what happened. Firstly, I reminded them that it’s not when they have problems they should remember to come to the parliament. They must carry us along with on-goings. They said they had sent a letter 5 months ago but we are not aware. They informed us that there was an agreement they had with the executives spelt out and they all signed, both the Ministry of Health and Ministry of Labour. It was agreed that a certain amount of money was going to be paid and up till now, the agreement has not been fulfilled. We need to start with fulfilling that agreement that they made and signed themselves so it’s a straight forward thing. It has to be implemented. It is the same general problem we have of planning without implementation. The conclusion is that we will see how to appeal with the executives so they pay whatever they agreed because for them to agree on what they will be paid means that they truly deserve it. It’s not about negotiating again, it’s about doing what you have promised and signed to do.
What Nigerians need to know
At this stage, we need to implement together. Every Nigerian should identify the nearest Primary Healthcare Centre to his house. Follow the development after this money has been introduced, they deserve a functioning clinic. If the places are not making a difference, speak up, let us know where. As of now, some people are in charge of the implementation of the approved funds so we need to be policing the development because from where we are, we cannot be at the every place at the same time. We have about 10,00 wards in the country, I am not able to visit all but it is the person close to the place that can give us feedback. We are going to create a pathway of getting information from the public, like phone lines and emails where complains will be coming in. It will be a department for operations.
We have what we are doing at the National Assembly. For instance, I invited the nursing and midwifery school to ascertain what processes the nurses go through. Do they teach them on how to be prepared for such outbreaks? Because if they are properly taught, there will not be so many casualties. It observed that it is after there are casualties that safety measures are being learnt. Therefore this New Year, I told them to include training of Nurses and health workers on how to protect themselves and protect the patient because we need continuous training. We also want to ensure that as part of what they get when they graduate, apart from their certificate, they must also have their personal protective equipment. The doctors need it too. Everybody needs continuous education.
We have been trying to build cancer centres for years and we are still battling. Obasanjo and other past governments spent a lot on equipment yet; people are still going abroad for major diagnostic services. Instead of putting 10 billion in service equipment, let us put 5 billion to pay for services. Let’s say we want to treat 10,000 cancer patients this year, the minimum payment for cancer treatment is 1million naira, so if an investor knows we have money to pay for services, they will rush and build for us because the investor is aware that a certain amount is set aside for equipment already. We are appealing to the private sector to help support this cause because we cannot do it all alone.
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