Sola Ogundipe
13 January 2009
interview
EVEN as he takes over the mantle of leadership of the nation's health ministry as Health Minister, Prof. Babatunde Osotimehin knows what is to be done and exactly how he intends to go about doing it.
He has made it clear all too often that what is uppermost is the repositioning of healthcare delivery towards acheiving the goal of a fully functional and integrated health system, with a workable referral mechanism. This, he notes, would be attained through the strengthening of the primary health system. But, as the minister also notes in this interview with Sola Ogundipe, the ultimate goal is the improvement in the quality of life and life expectancy of the average Nigerian. Towards the realisation of this objective, the Minister has been meeting with stakeholders on the way forward in revamping the ailing health system. But, as he notes, attitudes must change. Excerpts:
"We need to get attitudes to change. We have to do things differently from now and there is a lot to be done. We cannot continue like before. The difference now is that we have identified the gaps. We know that at the Federal level we need to identify with and collaborate with the states and we require the political will to sustain this collaboration. What we must do is to leave our offices in Abuja and work with the States to ensure that health care is delivered in a quality way. This will be our major thrust and we must also ensure that resources are available to achieve it.
Funding
To address the funding issues in the budget is priority as is is important to ensure that people at the grassroots get these services for free, however, the Federal government will not do it a s an intervention, but with the leadership of the State. The investment government is putting in would be more meaningful when we try to merge this and the contribution by our international partners. We require more coordination with our international partners in order to add value.
The coordination I am talking about will be at the physical and local levels. If we do this, we will be able to address the structural issues and allied maters that have to do with connectivity between the primary and secondary healthcare. To be more precise, the referral system will be re-established.Also, the State will be the unit of healthcare.
In terms of financing, yes, we have struggled to attain the Abuja Declaration. Most certainly, the health sector could do with more money so the advocacy must be that there is need for more resources.
Health insurance
Without good health, there can be no good or healthy economy. It is only a healthy workforce that can produce a healthy economy. On the demand side it is clear that we need to cultivate NHIS. Of course, it is beginning to take root and be established. One of the interventions we are prsenting is the one of health insurance for pregnant women and under-5 children. We expect to cover all the States but it will largely build on the two pilot projects based on the Dutch initiative. Certainly this is the sustainable way to go. If we establish a viable health insurance system, we'll continue to advocate But more needs to be done.
Primary healthcare
If you look at the demography of Nigeria, you would realise that most of the population comprises the young and women and we must try to ensure that we provide the required resources especially for rural Nigeria. What this means is that primary healthcare must be made to work and to work efficiently.
Secondary and tertiary healthcare
Federal government invested in the refurbishing of the Teaching Hospitals and government is also going to refurbish the Federal Medical Centers and specialist hospitals that will enable care to be delivered. These can then be used as referral centers. We should work with these centers to produce the much required specialist care even though there are so many challenges. We cannot afford not to make the required difference.
Challenges
Challenges I see are those of coordination because Nigeria is quite large. There are many local government areas and getting all of them to participate is crucial. The matter of getting the states and local governments to invest in health is a task that must be done.
Yes resources are there too. We could do with more finances like I said earlier, but it is more about utilisation. Then we come to the aspect of disposition to human resources. Nationwide, it is an issue. Over time, we recognise that we need to develop the culture of research.
Role of the individual
As for the average Nigerian, it is hightime it is realised that that there ais a responsibility to each and everyone. Without doubt, we are aware that the greater aspect of health is outside the of the hospital.
Every individual should endeavour to do those things that promote health. Everyone needs to take responsibility for their own health and protect it accordingly. We have established categorically that there are hazardous things that affect health such as lifesyle and personal hygiene issues. Things like smoking and a sedentary lifestyle to begin with. These are preventable and within control. Same goes for some chronic diseases such as cancer, diabetes and kidney disorders.
It is part of the responsibility of every individual to ensure he or she avoids coming down with disorders such as this. It is their responsibility to see to it that these are controlled.
Then when it comes to the delivery of care it is not only the professionals who should be involved. What I'm saying is that it should not be assumed that the role of healthy lifestyle should not be the duty alone of the professionals alone.
Community involvement
There are so many ways in which the community can add value in the area of care. For instance there could be contribution from the community by way of offering transportation facilities to, say, a pregnant woman who needs to get to the hospital for delivery. The community needs to be involved in things like this.
If we look at the way hospitals are run, we will understand why community associations need to take interest in the general well being of their people. It's all about corporate social responsibility and everyone owes ot to himself or herself first to be healthy. That way, collectively, we can have a much healthier nation.
Life expectancy
The watershed of this adminstration is not just to increase the life expectancy of Nigerians, but to improve the quality of life. It is my belief that as we get to address the root causes of the poor health indices, we would be indirectly, impacting positively on life expectancy. This can be done through addressing three key areas. The first is infant mortality. If we follow the path we have earmarked for ourselves and we successfully cut down on infant mortality, of course that would have a bearing on the overall life expectancy. Next is maternal mortality which is in the same bracket as infant mortality.
Time factor
Addressing disease complexes such as malaria, tuberculosis, hypertension, diabetes and others, is the best way to go about this. To provide all these inecessary interventions will take time, no doubt. Dramatic changes always take time, but what is imporatnt is that we need to set intermediate indicators. By this, I mean things such as the availability of skilled labour in our healthcare institutions or availability of care and treatment services to more people living with HIV or any other similar need. This, in a nutshell, is the system that we need to set up now if we are to see the expected rise in life expectancy in Nigera.
However, we cannot take health in isolation. There is the need to address other concerns. Things such as the welfare of the girl-child and her eductaion, her overall acre and health needs are paramount. Especially, we need to tackle the problem of poverty. Let's not forget gender and other related issues. It is my belief that if all this is done openly and sincerely, our objective of better health for Nigerians would be achieved.
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