The co-chair of the Bill and Melinda Gates Foundation, Bill Gates, has said that he would wish that the quality and funding of the primary health care system in Nigeria achieved the level of some other countries that have lower income but have done a better job with the primary health care system.
Speaking with selected journalists around the world in a conference call ahead of the release of the 2019 Goalkeepers Report today, Bill Gates said one challenge that Nigeria has is that the amount of money that the government raises domestically is quite small compared to other countries.
The Goalkeeper Report is the foundation annual report card on the world's progress toward the Sustainable Development Goals.
"A lot of countries at that level will be raising closer to 15 percent of GDP and Nigeria is one of the lowest in the world down at about 6 percent. " And so, it is a huge challenge that when you want to fund infrastructure, health, education, all those things, that over time the tax collection, the domestic resources are going to have to go up quite a bit.
"That's a long-term effort and I think partly by making sure the current resources are spent well like on primary health care, you gain the credibility that the citizens will say, okay, we want more of these things. If we don't raise the quality, you can get into a trap where they don't feel like paying the taxes actually has that much impact, and so they're not supportive of that.
He said his foundation is working hard in the country, "Nigeria is a super-important country and one that the foundation has an office . We did a lot of work in Nigeria on polio and we learned a lot doing that. Nigeria has gone almost three years now without having a polio case.
"The biggest priority we have, although making absolutely sure we're done with polio remains a big priority, now we're able to focus even more on the primary health care system.
Bill Gates said when he was in Nigeria sometime ago that he had video conferences with state governors. " If we can make the six states into exemplars, then these practices can be extended to all 18 of the northern states.
" There are best practices down in the south as well that we can learn from that as well. And so, you know, building on what we were able to achieve with polio and the relationships we've built there and our commitment, starting with primary health care, we think that Nigeria can tackle its inequality."
Bill Gates then said "if I had one wish for Nigeria, it would be that the quality and funding of the primary health care system would achieve the level of some other countries that are lower income but have done a better job with the primary health care system. So, it definitely is doable.
"In Nigeria for a lot of the work we do there we're partnered with Aliko Dangote, who helps us understand who the good partners are and exactly how we can reach out to groups like the traditional leaders and get them involved in these efforts as well.
Speaking on what the foundation is doing in low and middle-income countries to enable them achieve or attain self-equality for them to achieve Sustainable Development Goals in the long run.
Bill Gates said "we use our Global Burden of Disease that our partner International Health Metrics and Evaluation compiles on a yearly basis to really understand why is it that children in these poor countries are so much at risk of dying or having malnutrition that affects them their entire life.
"And the data is quite stark. In a developed country your chance of dying is less than 1 percent. There are still parts of the world where that is as high as 15 or even 20 percent. And so, the priorities for the global health community are these diseases that create this disparity.
"Malaria, pneumonia, diarrhea and a variety of things that put a child at risk during the first 30 days, those between them account for over 90 percent of the difference in health outcomes in developing countries versus rich countries.
" And so, you know, we're lucky that it's not thousands of diseases, it's a few dozen things that we have to go after, and there has been, you could say, a market failure that the investment in the tools like how do you help a premature baby be able to breathe. There's some really expensive tools that are used in the rich world that require a very trained doctor to use.
"The foundation now has some great inventors that are coming up with that lung surfactant capability in a form that is both very cheap and you don't have to be trained to use it. And so, that would increase childhood survival in these developing countries and help close that gap. And so, by looking at exactly what the causes are and remedying the fact that there's not much investment in those areas, we have been able to make progress.
"That's why the childhood deaths have been cut down. A lot of that was reductions in diarrhea and pneumonia with new vaccines, and that's meant that this first 30 days problem is a high percentage, and in some countries over half of the deaths are in those first 30 days. And that's been a challenge to the global health community to figure out, okay, what effective tools that actually is possible to deliver we can get out and that's the path to reducing the disparity.