Lagos — Penultimate week, the Minister of Health, Prof. Babatunde Osotimehin was at the corporate headquarters of THISDAY in Lagos where he fielded questions from the Board of Editors.

After the grueling session, the minister left no one in doubt about his passion and preparedness to tackle the salient health concerns of Nigerians. Godwin Haruna writes on some of the issues he raised during the visit

Nigeria's Health Minister, Prof. Babatunde Osotimehin has set for himself both short and long term targets to deliver affordable healthcare to Nigerians. Widely regarded as a round peg in a round hole, his choice as health minister last year elicited optimism in the country that Nigeria's scary health index might be headed for a sure-footed recovery and massive improvement. Of immediate concern to Osotimehin and his team at the moment is the template to rejuvenate the primary health care working in concert with states and local governments across the country. Another issue of importance to the team is to deal with the malaria menace ravaging the country and reduce its prevalence and morbidity by as much as 50 per cent in the shortest possible time.

One of the ways the minister intends to wage the war on malaria is to launch a large-scale campaign on the use of insecticide treated nets and make them available in households throughout the country. "Malaria is responsible for the largest mortality in Nigeria. If you take children and adults together, it kills more children than any other disease and it kills more pregnant women than any other disease and we think and believe that if we do what we have to do, we can cut mortality by the end of 2010 and we have started.

"What we proposed to do is to distribute two nets per household in Nigeria, we are going to have access to an excess of 60 million nets, which we would be distributing. We started in Kano, we are giving in Anambra and then, we are going to move to the rest of the states. The reason why we have to stagger it is the issue of production. We are not going to get all that we need at the same time so we have to stagger its distribution. We are also providing free treatment in public health facilities for malaria and I think that would reduce the level of parasite in the community and we are also going to do indoor residual spraying, we will come here and spray this room and do it say about four times in a year and that would reduce the mosquito density, especially in areas of Nigeria where this is a big problem. I think that that integrated approach is what we propose to do and we believe that if we do it conscientiously, we can reduce malaria, the prevalence and the mortality and morbidity by more than 50 percent".

The minister stated that the ministry has the resources since they applied for a global fund grant, which has been approved, and there is also budgetary allocation and from the World Bank, there would grants as well. Osotimehin expressed the optimism that there is going to be a major boost in the next year or two. He said this would involve having to have Nigeria know about it in terms of public enlightenment campaigns.

He explained that they have had experiences where nets were distributed and there were not used and also, there had been cases where people used them for fishing, wedding gowns so Nigerians need to be re-educated in a systematic way so that they would understand the value of these nets. He added that even if you open it and leave it in your room, it has an effect and when you now sleep under it, it is very effective. He said there are examples of countries in the world that have done very well with nets and a few other things.

"Even just hanging bed nets and all of that, it is a major intervention, if you do this and you do it effectively, you can cut mortality from malaria by 50 percent. So those are the sorts of things that we need to put in place and of course, for the primary care, once you talk about malaria, you talk about diarrhea, pregnancy medical care, etc. When you use community effort, for instance to access water, to ensure that there is cleanliness around, we are working with the ministry of the environment now to re-introduce sanitary inspectors. Those kinds of things are very cheap interventions, but they are effective. You don't have to do any big thing for us to get back to some basic health within our community, if you do that, then we can have primary health in place," Osotimehin said.

Part of his long term plans is the upgrading of at least; four tertiary healthcare institutions in the country to provide the kind of excellent services that people seek abroad. That way, Nigeria, he said would save a lot of money from medical tourism that appears to be draining the nation's resources yearly.

He explained that the problem that has pervaded for a long time is that everybody expects good health, but nobody invests in good health. He gave the example of the University College Hospital, which was built in the late 50s and operated with x-ray facilities put in there at the initial stage until two years ago. According to the minister, when it was commissioned and started working, in the first five years of its existence, it was the fourth best and that was where he trained and very proud of. He said the facilities put there in the late 60s in UCH were not changed until two years ago. He said if there was steady investment in UCH, you would today get the same kind of services that you get in London, which were comparable at some point.

"That is one, the other which is very important, which people don't even pay attention to is the issue of systems. One of the most important issues we have is data, how do you gather data, how do you validate data and how do you ensure that you can use data to improve on the quality of what we are doing. For example, how many women deliver in Lagos State? Who looks after them when they deliver? Where do they deliver, and what sort of facilities is available for them to deliver?

"It might sound mundane, but it is such an important thing because if we don't know, it would be difficult for us to plan for the next generation of women who would come. It is going to be difficult for us to plan for children who are going to take immunization. It is going to be difficult for us to plan for children who will go to school and so that is not even in place, it is not in place because we have not invested in it at all. There are various data bases here and there, which you can tap into, but to have a national data system which all of us can say yes, it is not now that the national bureau of statistics is trying to insist on those things. Data gathering and data management is not cheap, it is something you have to actually do something and make sure that it works.

"The third example relates to our procurement and supply management system. One of the things that I believe we would have done very easily with fake drugs in this country is just managing the procurement supply management system if we decide that we would tender, say for all the essential drugs that we buy in this country as government and say, you will sell to us paracetamol, you will sell to us this, you will sell to us that, with the guarantee that if you supply it from Pfizer or from or any other company, what you are getting is good quality drugs. And if you then say, for this country we need 500 million doses of those drugs and we then get the supplies in the manner in which you can feed it to the system, so you never have drugs lying anywhere, but you have them at points of service and you have a distribution system, which is robust and for which people can begin to put things in. It will get to the point of service and the drugs that you will get at hospitals will be good quality drugs. So, there are many things that we need to structure a little, which we have not done. It is not politically certain because it is not something that you can show and tell, but you need to have those things in place to have a good health system," Osotimehin stated.

He said the late Prof. Olikoye Ransom Kuti started the movement of a sound health care, which is the right thing to do, and which he is also an apostle. The best way to affect the lives of 70 percent of our people, he said, is by providing health close to them. He said what the late health minister started 30 years ago or thereabout, was not followed through.

"So, we started with the philosophy, we also built something, we trained a lot of people, but we did not coordinate or manage it effectively, so you have a situation where the investment in primary care is the least and when you look at the investment in teaching hospitals, it is about a hundred times what investment in primary care is now. That in itself, is not good because the people who access teaching hospitals are far less than five percent of the population, whereas, 80 percent are supposed to access health through primary care. So, what we need to do now and what we are doing is to say how do you now empower people to be able to access health at the primary health and the way to do it is to get the state government because this is a matter for state, it is not a matter for Federal Government. The state governments should now work with their local governments so that they can put structures in place, structures that would ensure access in the physical sense," the minister declared.

He cited the example of Shonga in Kwara State as a good example of moving health nearer to the people. He said Governor Bukola Saraki has experimented with that and they now have a situation where people there are taking their health in their own hands. He added that the consultation in that primary health care was about 30 or 40 per week two years ago. However, today, he said it is almost 2,000 per week because they moved up, they mobilised the community, they provided resources there and it worked so it is about state governments taking control and doing what they have to do and they have to provide physical access.

"From the Federal Government, one of the things that we have to do and which we are doing is to ensure that there is also resources for states, the National Health Insurance Scheme is a case in point and that we provide additional resources for states because if they buy into national insurance scheme, then, they can have resources to invest in their health system. As of today, in order to accelerate that, from our debt relief gains, we are giving states money now for free health for pregnant women and under-five children and this year, we would have done about 12 to 15 states. So, it is these sorts of intervention that we believe would make all the difference and when we finally have a primary health care system in place, we believe that number one, we would be able to provide ante-natal care, immunization for our children, care for treatment of malaria, provide for treatment of tuberculosis, these things will happen at primary care level. And then, they will then take away the burden that LUTH, UCH and places like that are now taking because those hospitals are serving as primary health, secondary health care systems and that is not the way it was supposed to be. And then, you will begin to see some clarity and some specialisation. But, it is going to take some time and it is going to take a lot of work. We believe, as I said governors are central and we are talking to them. We have had two meetings at least with the governors' forum just driving that and making sure that they understand that that is where they have to go. So, they need to invest. One thing that I believe will help us also considerably is that as I speak, the national health bill has been harmonised and is ready for assent now by the president. Once that is assented into law, the bill has several things, one of which is that it states rules and responsibilities of the three different layers of government in terms of what they are supposed to do for health care. I think if that law is back, it will help us and enhance our stewardship role at the ministry of health to ensure that these things are better done.