Dr. Fejiro Chinye-Nwoko:‘Despite biases, there are women succeeding and breaking boundaries’

Dr. Fejiro Chinye-Nwoko is the General Manager and Chief Executive Officer of Nigeria Solidarity Support Fund (NSSF), a non-governmental organisation aimed at supporting vulnerable groups, strengthen Nigeria’s healthcare systems, and reskilling Nigerian Youth for a post COVID-19 era. A medical doctor and an accomplished executive with over 10 years of experience in program management, Chinye-Nwoko has a proven track record in designing and implementing multi-donor projects from inception to completion. She is ideally placed to oversee the focus on a vaccination programme for Nigerians, driven by her passion for healthcare delivery.
After qualifying from the University of Port Harcourt in 2010, she spent the first part of her career as a medical doctor with the Lagos State Health Service Commission. She spent four years at the Health Strategy and Delivery Foundation where, amongst other initiatives, led the development of policies and guidelines for the improvement of maternal and child health outcomes in Nigeria. In 2019, she gained a Master’s Degree in Global Health Policy from London School of Hygiene and Tropical Medicine. Through her consultancy work, she has been at the forefront of innovations in telemedicine, and provided programme management for EpiC, the USAID funded programme, which provides support to the Government of Nigeria to mitigate COVID-19 transmission, morbidity, and mortality.
In this interview with IJEOMA THOMAS-ODIA, she shares her passion for improving healthcare services in Nigeria.

Share with us your journey as a medical doctor, how did you venture into public health?
MY childhood desire to serve people motivated me to pursue a career in Medicine. I remember always being enthusiastic about visiting hospitals to help patients. With the support of my parents, I received my medical degree in 2010 and spent the first five years working as a clinician in both public and private institutions across Nigeria. It was a rewarding experience, and quite encouraging to see how much my medical expertise could help others. I enjoyed caring for sick patients, but in 2016, I started to feel compelled to do more for them than just treat them.

Despite being a doctor, I realised there was little I could do to address systemic issues and the overall quality of the healthcare system, like poor hospital care quality, healthcare funding, service delivery planning, staff shortages, and hospital architecture, which bothered me. My thoughts were occupied with policies that allow the health system provide quality care to all people, regardless of their status, race, age, geography, or financial ability. I needed to get more involved at the population and community level. This led me to join Family Health International 360 (FH360), a global NGO, which supplies tertiary services to COVID-19 patients. We collaborated with the federal and state ministries of health in all 36 states of Nigeria to equip hospitals to effectively provide the care that infected patients needed. To effectively curb the pandemic, all patients needed to receive tertiary treatment, regardless of their financial situation. This process, while being successful, revealed the structural and systemic flaws in our healthcare system.

Despite the challenges, we achieved medical equipment supply, developed capacity-building initiatives for healthcare workers, and lowered hospitalisation rates for COVID-19 during the project’s second and third waves. I am now with the Nigeria Solidarity Support Fund (NSSF), which gives me a platform to continue improving Nigeria’s healthcare system. We use a multifaceted strategy to implement the vision for a healthier Nigeria, ensuring that every component is addressed, from population-level issues to policy and advocacy issues to health-system strengthening. In retrospect, it was a worthwhile journey.

How easy was it for you to delve into a non-governmental organisation with your background? How has it helped and improved in your work and activities?
In medical school, we were exposed to a wide range of health topics and community service projects, as we spent six months in a rural community practicing community health intervention. Having a broad perspective on healthcare issues aided my transition from clinical medicine to the non-profit sector. A much broader perspective was needed, which necessitated a thorough examination of the challenges and systems.

For example, COVID-19 stood for a significant shift that needed evaluation at the global, national, community, and individual levels. It was difficult to see things from a systemic standpoint rather than an individual standpoint, which had previously been the focus. Besides this, it was simple to navigate.

Share with us some of your activities and mandate at the NSSF. How are you strengthening the healthcare system and reskilling the Nigerian youth?
The NSSF, born of the collaboration between Global Citizen and the Nigeria Sovereign Investment Authority (NSIA), is a multi-donor institutional framework for raising money for interventions that support our strategic priorities of helping vulnerable populations, strengthening the resilience of health systems, and reskilling Nigerian youths for the post-COVID era. Long before the pandemic, there was a significant unemployment gap, particularly among young people. We anticipated that, as an aftermath of COVID, we would face not only unemployment issues but also under skilled youths lacking the necessary technical and soft skills for the workplace.

With hopes of mitigating these lags, we launched The WeNaija Initiative, a technology campaign for young Nigerians, in 2021. This featured young Nigerians capturing images of the reactions of Nigerians to the COVID-19 pandemic using simple technology such as a phone camera. Throughout the COVID pandemic, the campaign served as an advocacy tool, encouraging vaccination use, while telling the story of Nigerians’ struggles and resilience.

On a vaccination drive for Nigerians, we collaborated with and supported the National Primary Healthcare Development Agency (NPHCDA). As of 2021, Nigeria was lagging in COVID-19 vaccine adoption, so we helped the NPHCDA with supply chain management and logistics to get vaccines to the country’s most remote areas and underserved states. We were able to vaccinate over 1.7 million Nigerians and advocate for vaccine equity, lowering vaccine hesitancy in Nigeria and expanding vaccination and immunization programs. We are still in collaboration with the agency to identify and close human resource gaps in addition to immunisation. We recognise that primary care should meet more than 90 per cent of the country’s healthcare needs, and we are working to strengthen the health system.

Our intervention areas and programmes are geared towards vulnerable Nigerians. We collaborate and provide funding to grassroot and implementing NGOs, and civil society organizations to strengthen the primary healthcare system and improve the delivery of basic healthcare across Nigeria.

What do you consider a major area of focus in revitalising the country health sector?
Vulnerability is a major area of focus for Nigeria. With more than 40 per cent of the population living in poverty, there are still many financial gaps. A healthy nation is a prosperous nation, and an unhealthy population can devastate the economy of any country.

It is therefore imperative that a nation prioritises the vulnerable and ensures their access to healthcare, reskilling, and upliftment. Health is a serious business, and health financing is one of the major impediments. People who are barely above the poverty line can experience a precipitous drop with as little as one illness. To break the cycle of poverty, our priority must be to help our most vulnerable citizens build resiliency.

What were some of the development policies and guidelines for the improvement of maternal and child health outcomes in Nigeria, how viable are they today?
Together with the public sector, the health ministry, we evaluated the implementation of policies for the provision of services that are often overlooked— infrastructure, equipment, labor planning, and operational procedures. We realised if we have everything but do not have a process, we would not be able to provide quality service. It was then imperative to have a process that understands when and how to use technology and interpret data, which we have put into place from 2014 to 2016 in Lagos, and some other local states for overall quality service. This strategy emphasises the importance of rejuvenation; we cannot continue as we did a century ago.

By taking a holistic view of the system and how the many complexities affect the quality of service, we can identify the holes, close the gaps, and analyse the data to determine whether we have done better or worse. The health sector, like the aviation industry, can tailor its services to the needs of its customers. Things began to change slightly after COVID-19. Telemedicine was introduced, giving patients the choice of either visiting the hospital or calling their doctors. We had never done anything like this before in Nigeria and practised medicine the old-fashioned way.

With your goal to impact and improve the healthcare system in Nigeria, what challenges have you been confronted with and how are you able to surmount them?
With every goal set in life, there will be difficulties, and to move forward, one must find a way to work around these obstacles. The variety of issues to be addressed in healthcare, from financing to training workers, infrastructure, and social determinants of health such as an individual’s lifestyle, may be perceived as a setback. There will, however, always be an array of issues to be addressed, but they must be prioritised based on their overall impact on society.

We must investigate an issue to determine that if left unresolved, it could have a negative domino effect of unsustainability and other issues, leading to citizen distrust and a lack of interest in political matters. Health care is not free; someone must pay for it, and the government is typically the largest contributor in this area. People paying for their healthcare is not a practical system; there is, indeed, truly little we can do if the health budget remains less than five per cent of the entire budget. It took India about a decade to achieve her health tourist status. This strengthens the argument that with the right strategy and priorities, there can be significant improvements even with little time.

I like to believe that advocacy is a strategy to invest in. It is also critical to honour outstanding leaders and organisations who have worked closely with us, the NPHCDA, and Dr. Faisal Shuaib to ensure that vaccines reached every region of Nigeria and were administered before their expiration. We need more of this level of dedication at every level of healthcare in our nation.

As a woman who has grown through the ranks, what key lessons have you garnered in your years of practice?
I will say, be diligent. In today’s world of mediocrity, diligence may not be a popular lesson, but it will set you apart from others. Do the required best and outdo your personal standards. Ask yourself, ‘Would I be satisfied with the work I do if I were my boss?’ Focus on your unique path; do not compare your journey to that of others.

I recently spoke with a former schoolmate who works in government, and it occurred to me that everyone’s path would always be different. We all thought we would end up in hospitals as clinicians when we were in medical school. We are doing the same work today, but from different sectors and, amazingly, we are seeing opportunities for collaboration and mutual support. Instead of competing, we should collaborate.

Keep an open mind. Be adaptable, learn new things, and be willing to walk through strange doors because you never know where they will lead you. Do not over-plan your life. While setting goals for the next five to ten years is important, unexpected doors can lead to incredible opportunities. When you encounter a setback, do not take it personally.

Finally, always think positively. Avoid thinking about unfair treatment based on your identity. I am not saying prejudices do not exist; the truth is that we all have unconscious biases and judging ourselves based on those biases leaves little room for improvement. We become what we focus on, so I will bid that you do not concentrate on it. Always keep in mind that despite these biases, there are women succeeding and breaking boundaries.

How can we get more women to become successful and rise to the top as you have done? What tips do you have for younger women?
We must become our own best advocates. We must be audacious enough to recommend other women at the top, as I see our male counterparts do often. It sometimes does not take much to recommend someone else, and it is usually a yes-or-no situation. Also, the more incredible work we produce, the more the gender card is thrown out the window. If we continue to produce high-quality work, the world will have no choice but to pave the way for the next woman. We should recognise that we are ambassadors for women in our workplace and that our actions could help more women climb the ladder.

We should also try to mentor other women, formally or informally. Spend some of your spare time helping younger women. This is because grilling today is not exactly as it used to be. Make certain that they handle things maturely by giving honest advice and following through.

How do you get inspired and stay motivated?
There are various sources of motivation and there is no set structure for motivation, especially as there are intrinsic and extrinsic kinds of motivation. I am intrinsically motivated, which makes work much simpler and more passionate. It is also helpful to build solid relationships that you can rely on when you do not feel motivated. Being able to communicate with and get encouragement from your tribe is a blessing.

Finally, the impact of my work is what drives me the most. I remind myself of why I am doing this when I am scared or have stage fright. I get excited thinking about the boys, girls, men, or women I would never have met if it were not for this job. I am fully aware that what I do will have an impact on people all over the nation and beyond, and I am careful not to jeopardise another’s pipe of hope.

I will briefly talk about my experience. I received scholarships throughout my secondary education and undergraduate studies from Shell and Chevron. Some person sitting in one of these organisations must have thought that giving individuals scholarships is a smart idea, and in fact, a rural leader in my community— Uzoro in the Usoku Local Council —told my mother that he had some slots that could be provided to me without writing the exam when I applied for the scholarship at my secondary school. Thankfully, my mother had insisted that I take the exam, and I was awarded the scholarship based on merit.

How are you able to combine your work, family life and still be at your best?
Work-life balance has long been a point of contention among different schools of thought. While some may believe it is impossible, I believe it is possible if we set our priorities correctly. There are 24 hours in a day, and I spend my non-work hours with my family and doing personal things.

By being intentional, I can structure things well and achieve balance. I sometimes skip my six hours of sleep to work, and other nights, I am available for quality family time. I try to be present during the most significant moments in their lives.

What do you hope to see Nigerian women do differently?
I have met women from various cultures and professions, and I have to say that Nigerian women are amazing and incredibly talented. I would love us to be more courageous. We should not try to fit into societal molds or to be someone else; otherwise, we will lose sight of our unique and amazing identities. With focus on our own strengths, we can achieve remarkable things.