6 April 2011

Nigeria: The Nation in Need of Systemic Implementation of Healthcare Interventions - Osotimehin


Recently appointed Director General of the United Nations Population Fund (UNFPA) and immediate past Health Minister, Professor Babatunde Osotimehin, was in Nigeria on an official visit. In this interview with our Correspondent, Kemi Yesufu, he spoke on developmental issues including girl-child education and healthcare delivery especially in Nigeria, among other issues. Excerpts:

At an earlier forum, you asserted that for Nigeria to make headway in healthcare delivery, there must be a systematic change, which will have the councillor in local councils executing the same programmes with the Minister of Health. What informed this?

Yes, I made that statement in the sense that as we move forward, the way to make progress is to get the Health Bill passed and to have co-ordination across board because when the local councils don't know what the state is doing and the states don't know what the federal government is doing, it leads to duplication. Already, the resources we have are not adequate, then, we are not using them efficiently to get the outcomes we are chasing. So I believe that as we should pursue the passage of the Health Bill, we should put in place a system that is better coordinated so that funds are properly used. This will lead to our getting better results.

You equally talked about Nigeria setting aside 15 percent of its budget for Health as proffered by the UN. What do we do to get government to this?

As the Director General of the UNFPA, I understand that the President Goodluck Jonathan administration is disposed to increasing funding for healthcare to 15 percent. But we must not get fixated on 15 percent because it is the minimum not the maximum amount. We should be thinking towards a higher percentage than the minimum. We should convince government to invest in other sectors that have direct effect on health such as water resources. We were at the National Population Commission; they have the figures of people that have access to clean water. It is small. There is also the issue of sanitation. We advocate that government deals with issues that have direct consequences on health. Issues like roads, housing, have great impact on health. This makes it pertinent that as we advocate on increased funding for health we should also focus on the allied sectors. Beyond increasing budgetary allocation, implementation is also a major issue. We have to ensure that budgets buy the services Nigerians need. Are children getting clean water and a good education? Are we providing the right services because these ultimately affect the outcomes in the health sector?

With hindsight how can government remove the bottlenecks that slow down healthcare delivery?

I think that if we have the Health Bill passed and it is followed by political will from the executive arm, it will have good effect. The Health Bill says that government should spend two percent of the budget on health and this is huge. It says that we use majority of the funding at the primary healthcare level. It also says that we spend on human resource development and the NHIS. The bill covers a substantial part of what I would love to see being done for the health sector. The challenge I envisage with the passage of the Health Bill is having a strong, well-coordinated structure to see that the Health Bill is fully in force.

Still talking about your pronouncements, you equally stated that the lopsided distribution of healthcare workers must be addressed. How can this be done considering that many think that situation is one that will remain the way it is for a very long time?

It is difficult because it's about people's right to choose where they want to work. With the political reality in Nigeria the only thing I can imagine would happen is that state governments will provide professionals like nurses, midwives and doctors the same kind of wages and welfare packages as the federal government. Some of the strikes in recent time were based on the difference in wages at the state and federal levels. We can also expand on the Midwives Service Scheme established during my tenure in the ministry of health. This encourages people to go to parts of Nigeria they are not interested in going.

There are great expectations as you fully commence your tenure as UNFPA boss. What are your goals?

The UNFPA is a United Nations Organisation agency that has the responsibility of looking after issues in population, gender equality and reproductive health/rights. Our work is determined by what was agreed to at the international conference on population and development in Cairo. We are positioned to help governments look after population and its dynamics, particularly among young girls. We also provide information and services in the area of reproductive health, maternal health, family planning, Sexually Transmitted Diseases and issues on neonatal health. My team and I are fully prepared to carry out our role to in all the countries we are presently in.

In Nigeria girl-child education remains a major challenge, how will your agency help improve the situation?

We had a meeting with Minister of Women Affairs and Social Development. I propose to talk with Minister of Education during my next visit. I met with the Ministers of Finance and Health. But I do know that statistics show that girls have better access to education. The enrolment rates are on the increase, so we will continue with advocating that young girls remain in school. This is because education has proven to help women make better choices.

Reproductive health experts decry the minimal budgeting for reproductive health commodities. How will you use your position to help remedy the situation?

We are going to be great advocates. We will carry our advocacy to the Ministers of Health, Finance and the National Assembly. Our advocacy will not just be about providing figures. We will also have to make them see the investments that other countries have made that make the difference in saving the lives of women and young girls.

How can women get reproductive health commodities in the Nigerian setting where majority of them are denied their rights to make decisions on family planning?

We just concluded a meeting before you came in. We spoke with community leaders and religious leaders. This is one sure way of providing women with better options without offending cultural or religious sensibilities. We know that with the kind of leaders we met today, we can penetrate communities.

Experts often talk about Nigeria having one of the best population demographics in the world. We have youths in the majority. How can government move from stating the obvious to utilising this advantageous demographic?

It's not just Nigeria that has this kind of population; it is a re-occurring characteristic in the developing world. My focus in UNFPA is working with young people. We will engage young people the world over to create programs through which they will have better access to education, credit, and employment. We will ensure that youths are positioned in a way that they can contribute to the development of their country.

Do you agree that it is a paradox that you come from a country that the services that you mentioned constitute a major challenge to government?

I don't think it is a paradox in the sense that I can use the office I hold now to interface with the Nigerian government to make rapid progress along those lines. These problems are not peculiar with Nigeria. If you follow the global trends, the Millennium Development Goals five, (MDG 5) is the least accomplished and these issues fall under it. This has made it necessary for us in UNFPA and our partners to adjust our programs aimed at achieving the MDG 5.

In this regard, are you satisfied with the programs designed by UNFPA and its partners?

I must say I am. We are also satisfied with our input to the National Health Framework. What we now have to do post elections is to accelerate our interventions.

Looking back to your tenure at the Ministry of Health, what would you do differently if you were given a second chance?

I would have worked more vigorously for the passage of the Health Bill because it is important to how we do things. I would have begun to implement the health framework. I would also have ensured the integration of important services at the primary healthcare level and I would have addressed the challenges of covering the informal sector in the National Health Insurance Scheme (NHIS). A large chunk of the Nigerian population doesn't work for government. So to improve the demand for the NHIS, we must extend its services beyond the formal sector. Today 70 percent of what we pay for health comes from our pockets and this is not good.

Judging by the structure of health care delivery in Nigeria, do you see us achieving MDG 5 and 6?

I am an optimist. My take is that after the elections, the Health Bill will be passed and things will improve greatly. I also want to say that some states are doing well and are meeting the MDGs 5 and 6 as we speak because of the way there are structured. We should ensure that the central co-coordinating systems at all levels are effective; we should encourage states doing well not to relent. This way, they serve as models for others to emulate.

How will you use your office to assist Nigeria?

The important thing is that I have worked in Nigeria so I understand how the system works. So as we implement our country programme I will ensure that I make an input. From experience of the immeasurable benefits of advocacy, I will equally ensure that we carry far-reaching advocacy campaigns.

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