Agenda for next health minister

*Stakeholders want urgent convocation of national summit on innovative funding for sector
*Players call for mandatory insurance, reform of NHIS to perform regulatory functions only
*Want revamp of hospitals in two years with focus on emergency care, life-threatening ailments

Who is fit to be the next health minister? What should be his or her qualification? What should the next minister focus on to revive the ailing sector?

These are some of the questions on the minds of some stakeholders and observers as President Muhammadu Buhari gets set to present the list of nominees for ministerial positions to the National Assembly.

Setting agenda for the next health minister, stakeholders want him or her as a matter of urgency to convoke a national summit on innovative funding for health and be ready to deploy the outcome as soon as the Summit is over and not to consign the outcome to history.

The stakeholders who spoke to The Guardian include: Former President, Pharmaceutical Society of Nigeria (PSN), Olumide Akintayo; President, Nigerian Medical Association (NMA), Dr. Francis Faduyile; and President, National Association of Resident Doctors (NARD), Dr. Segun Olaopa.

They said to achieve universal health coverage, health insurance should be made compulsory but with a choice for Nigerians to freely decide whether to buy public or private sector health plans. They said no one should be forced by any guise to subscribe to the Federal Government or state government plans and that it must be by free choice of operator and provider if it must be compulsory.

The stakeholders said the National Health Insurance Scheme (NHIS) must be reformed to solely be a regulator instead of being both a regulator and an operator. They said the government must ensure that at least 60 per cent of Nigerians are enrolled on the national health insurance scheme to increase financial access to health. The stakeholders said the NHIS should regulate the operations by both public and private operators at all levels and provide guidelines for all categories of players/operators and providers.

They said the next health minister must ensure that this current administration works on clearly defined job description and responsibilities for all staff in the health sector and that the era where unions define the roles of staff employed and paid by the government must be stemmed. They said the government should also ensure regular engagement of all professional groups, and unions to foster harmony and eliminate suspicions in the administration of government processes.

The stakeholders said hospitals at all levels must be revamped within the first two years with major focus on emergency care and life-threatening ailments.

They want the new minister to encourage research and development through forging collaborations with the private sector and evolve strategies to boost local drug manufacturing to ensure national security.

The stakeholders, however, differed on who should be the next health minister. While Akintayo say the new minister should not be a medical doctor, Faduyile insists that the helmsman must be a physician with managerial qualification.

What should be the priority issues to tackle by the next minister? Olaopa said the government started paying attention to Primary Health Care (PHC) since the last the last tenure of the President Muhammadu Buhari (PMB)-administration and it is critical the government ensures that this initiative is re-birth and crystallized. “At least a corps doctor be made to man every primary care center with nurses and community health officers to complement, if human resource for health is being much of a challenge. There is also need for the primary health care to be strongly developed in battling the scourge of maternal and child health,” he said.

The NARD President said employment and proper remuneration of human resource for health especially the doctors and nurses who seems to top the list of personnel that Nigeria is losing in escalating dimension. He said other health professionals must also be protected and catered for so that everyone is motivated to give his/her best. Olaopa said there should also be other incentives that are based on output and efficiency. The government must ensure that arrears of salaries and other allowances are paid to health personnel

What should be the priority issues to tackle by the next minister? The NMA President said the challenges in the health sector could not be totally solved in four years. He said the next Minister for Health must be able to work with industry stakeholders to sincerely prioritize the issues in the sector and begin with those issues that available resources can effectively resolve

Faduyile said increasing human resources for health might be amongst the top priority and fashioning a robust uniform performance monitoring template for all Chief Executives of all the Federal Tertiary Health Institutions to check and determine and reward performance while naming and shaming unproductivity

Faduyile said other parastatals under the Ministry of Health like the National Primary Healthcare Development Agency (NPHCDA); Nigeria Institute of Medical Research (NIMR); Nigeria Institute of Pharmaceutical Research and Development (NIPRD); the National Agency for Food and Drug Administration and Control (NAFDAC) should be made to have a productivity output reporting timelines

He said the next minister should aim to achieve some components of the Sustainable Development Goals (SDGs) that are possible within the four-year tenure. Doing some of the above would achieve that; should attempt to reverse the brain drain in the sector; must be a father to all health sector stakeholders and must be seen to do so; and meritocracy must be allowed to reign in all aspects of the administration of the sector.

Akintayo said there are those who should not be appointed health minister in view of our experience in the last eight years at the Federal Ministry of Health (FMoH). The pharmacist said the last set of substantive ministers in charge of the FMoH in the period 2011 to 2019 were near disaster especially in the area of relationship management between the myriad of health professions. “The style of these persons compelled us to perpetually suspect the motives of these vindictive ministers rather than respect them,” he said.

Akintayo argued that healthcare is a global practice and so the country cannot continue to advocate a Nigerian variant of healthcare standards and values. He said in all developed nations the norm is to appoint credible bureaucrats in charge of the health system.

The pharmacist cited the World Health Organisation (WHO), the apex structure that anchors global health systems, which is today led by a scientist who graduated 33 years ago in Ethiopia. “He continues to excel in that capacity because the requisite professional structures which drives the competencies and efficacy in the value chain of healthcare is embellished in the system,” Akintayo said.

Former PSN President, Olumide Akintayo

He explained: “Here at home, one of the few positives of the Obasanjo administration was that the Health Sector was not perpetually embroiled in entropy like we have witnessed since 2007. This is because seasoned administrators and managers of cognate experience were in charge for seven and half of the eight-year duration of that regime. The only doctor Obasanjo appointed was Dr. Tim Menakaya from Anambra State who lasted for only the first six months. It is on record that Nigeria’s most successful Health Minister in contemporary times is Prof. Eyitayo Lambo, an economist and WHO consultant served in the Obasanjo era.

“In view of the unprecedented labour crisis in the health sector, which is the creation of the last three successive substantive Ministers in charge of the FMoH which their doctor colleague in the labour ministry further mismanaged, these horrible appointees should not find their way back to the FMoH.”

Akintayo said the FMoH, which some dub the “Ministry of Hell” would do better with neutral elements who are not even core health workers in the first place. He such experienced administrators and managers will bring a new lease of life to the health sector.

Akintayo added: “My preceding response clarifies this. Doctors are well-trained scientists and professionals. Often times, many of them who have not diversified their horizon beyond medicine are wretched managers of resources. You will observe that even many doctor-owned facilities are now run by Chief Executive Officers (CEOs) who are seasoned administrators and managers.”

He said the administration need to break the cycle of delinquency in healthcare by resisting the temptation to appoint inexperienced and biased health workers in charge of FMoH.

Akintayo said the new health minister should do among other things: restoration of inter-professional harmony; alignment of workforce cadre with global inclinations; encourage research and development through forging collaborations with the private sector; and ensure the appointment of fit and proper persons to head the various Boards of Federal Health Institutions (FHIs), regulatory agencies and other parastatals.

But Olaopa said the headship of the health sector is a critical social issue and in the context of Nigeria it must be seen not as a business venture geared towards profit making but as a purely humanitarian necessity that is centered on the people, the patients.

He explained: “Anyone that understands that the essence of healthcare in Nigeria is patient-centered and with clear plans that puts the patient and public in the middle of all program is best to handle the sector. One of the greatest challenges that face the sector is the general evil of our society in general. Not much about power, not much about education, not much about the economy, unemployment that cripples the system and so on. The next minister of health must be able to understand these grave challenges that face the common man and make the system accessible for them.

“It is in the interest of the nation for the government to appoint someone who can advise the government in the highest professional capacity in addition to sound administrative experiences. The doctor provides, as always, that opportunity.”

On must he or she be a doctor or what profession? Olaopa said: “The prerogative of appointment into the position of the Minister of Health in Nigeria is that of the President with confirmation by the National Assembly. There are however many positions, which are exclusive, preserve of lawyers such as the Attorney General, Solicitor-General that have never been an issue for other judiciary officers to share.

“We must understand that the minister in the context of Nigeria is both the administrative and operational head of the health sector who must understand how health related matters affect and impact on the people. That means you must understand health as it affects the people and not just for profit making. Apart from having sound medical knowledge, the doctor that will earn the thrust of such office of responsibility must possess additional qualification, mainly in human management and economics or related management discipline. Since 2015 or so, the Nigerian health sector has gained some stability in terms of human management even though like most other sectors of the economy, there is still a lot to achieve.”

The physician said he is constrained to add that researches around the world where there are effective systems in place (emphasis mine), reveals that doctors have managed healthcare systems better than administrators.

He further explained: “The major reason for the paradigm shift from the era of having administrators in charge of our health system was the decadence that pervaded the sector and no one was willing to take ownership. Despite inadequate funding and other bureaucratic challenges, the sector is surviving because the ideology of operation is the patient. World over, placement and promotion is done with respect to qualification and competence.

“The doctor is the focal person in patient care and is naturally placed to administer the ministry saddled with the responsibility of formulating policies that is related to health of individuals, communities and the country. This is without prejudice to the other allied health professionals who can always work in varying capacities to complement the job of the minister. There have been various arguments from different quarters about various ominous health indices and sometimes these are blamed on the doctor. The question that proponents of such have refused to answer is how these systemic problems affect every other sector of our economy. They tend to get carried away by the ill feelings they have towards professionals that fight to sustain the system everyday.

“However, if the desire of the government is to run the health ministry that is tasked with provision of health like every other business venture, for returns and profit, any technocrat will do. It must be emphasized that healthcare is a major factor that drives the people to poverty in the Nigerian state today due to out of pocket system. The ministers of health that we have had have in recent years put the minimal resources available into relatively effective use in recent years.

“If we recognize health as a basic human right; that healthcare is a humane science and art; that there is need to preserve the dignity of the average Nigerian, then it will be just right to put the doctor who understands the processes and procedure to steer the sector.”

On who do should be the next health minister and why? Faduyile said: “Any doctor with requisite experience, managerial exposure and tact for human resource relational diplomacy. Of all the professionals in the health sector; the doctor still remains the most trained; most versatile in terms of human health promotion and treatment of diseases.”