‘How to reverse brain drain, medical tourism’

Dr. Osagie Emmanuel Ehanire was appointed as the Minister of Health in August 2019. Osagie Ehanire is a certified General and Orthopaedic Trauma Surgeon. Osagie Ehanire worked to a great extent in Germany as Resident Anesthesiologist, Resident Vascular Surgeon, and Resident-General Surgeon in Thoracic Surgery at various hospitals. He also served as Clinical Instructor, Fracture Internal Fixation Course at BG Accident Hospital in Duisburg, Germany. On his return to Nigeria in 1982, he worked at the University of Benin Teaching Hospital as Senior Registrar in the Department of Surgery (Orthopedic Surgery), a position he held until 1984. Between 1985 and 1990, he joined the Shell Petroleum Development Company Hospital as a Divisional Consultant Surgeon. He also served at various times on the medical review board of Edo State Hospital Management Board and remains as a Trustee of TY Danjuma Foundation. The Minister in this online interview with The Guardian, among other things, unveiled his blueprint on how to reverse the brain drain and medical tourism as well as improve healthcare indices in the country. CHUKWUMA MUANYA writes. Excerpts:

What is your blueprint on how to reverse the brain drain and medical tourism?
BRAIN drain arises from lack of employment at home or offers better opportunities abroad to highly skilled workers. I urge, especially State governments to offer employment to doctors particularly where there is an alarming shortage. We are also studying how to find capital at an affordable interest rate to help young doctors start a private practice.

Do you have plans to involve Nigerian doctors in the diaspora like the United States (U.S.)- based Dr. Oluwatoyin Olutoye in your efforts to improve health sector performance?
Yes, we are piloting an initiative to bring home Nigerian doctors from Europe and America, who volunteer to work in our hospitals during their leave time, share cutting-edge skills and knowledge with home-based colleagues. Dr. Olutoye could be one of such doctors we shall be glad to invite.

Why is the budgetary allocation to health still less than five per cent?
I would like allocation to health to reach 15 per cent recommended in the Abuja Declaration, but we do understand that for now we have seriously competing national and food security priorities that the government must urgently address. I feel health-funding will improve with time. We also must appreciate that despite this, the Basic Healthcare Provision Fund (BHCPF), as a new funding stream, is now annually released to the sector.

The threat of Ebola and pathogen X persists. What are you doing to be ready to contain a possible outbreak in Nigeria?
We are glad the Nigeria Centre for Disease Control (NCDC) has taken off smoothly and is doing a good job to prevent, detect, and control disease outbreaks. We screen visitors arriving Nigeria at international airports and give vaccination and Yellow card to travelers

There are concerns that the gains made on polio may be eradicated due to continued insecurity in the North East. What is doing to ensure that the country remains polio-free?
We are hopefully on track to be certified polio-free in months. Critical to it is a unique collaboration between the Ministry of Health and the Ministry of Defence. With the approval of His Excellency (H.E.) the President, Nigeria is pioneering a scheme that has Nigeria Army soldiers helping health workers to vaccinate children in less secure, hard to reach parts of the Northeast, to boost coverage. Interested foreign countries have been asking questions about it.

December 1 is World AIDS Day. As a country, do we have anything to celebrate?
There is something to be proud of. The just-released “National Aids Indicator and Impact Survey”, NAIIS of 2018, the largest such survey conducted, now shows Nigeria has Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) prevalence of 1.4 per cent, down from three a few years ago. It gives us an idea of our problem, so we can target and scale up interventions to the 90-90-90 target: to detect 90 percent of all HIV cases, treat 90 percent and ensure 90 percent are suppressed virally. We can build on that achievement.

How many Nigerians are living with HIV? How many are receiving treatment?
About 1.9 million Nigerians are infected with HIV, and about one million get treatment free. Many of the rest do not even know their status. “Know your status”, ‘“test and treat” are part of the strategy of the Federal Ministry of Health (FMoH).

Nigeria has one of the worst statistics in terms of pediatric HIV treatment. Any improvement?
Pediatric HIV derives largely from mother to child transmission during delivery. PMTCT (Prevention of Mother To Child Transmission) is an important item in our HIV elimination strategy. It is done by detecting the mother’s HIV status during antenatal care visits, putting positive ones at once on treatment, to defeat most transmissions. To scale this and such intervention up to rural and underserved areas, we advocate the need for functional Primary Healthcare Centres (PHCs) in every Ward in Nigeria.

Over 70 per cent of HIV activities in Nigeria are funded by the US. Is there any money for HIV in the 2020 appropriation bill?
The US government is a great partner, not just in fighting HIV/AIDS but other challenges. We also get support from Global Fund and other partners, without whom it would not be easy. The government of Nigeria does its best in the circumstances. All must work together to eliminate diseases of global concern by 2030.

There have been claims and counterclaims on HIV cure, especially by Dr. Abalaka. What are you doing to probe these claims?
We are interested in all serious claims aiming to address challenges to the health and well being of mankind. But, to be taken seriously in the outside world, we do work with scientific tools and evidence. Claims that can’t stand scientific scrutiny will fall by the wayside by themselves, while others bounce upward.

What have been the challenges to HIV control in Nigeria?
Funding in the midst of national priorities is a great challenge. I hope it improves as public revenue increases and pressure on the budget from security, food, and energy urgencies are satisfied. Behavior risk communication needs to be stepped up, with high priority to youths in age-appropriate and culture-sensitive HIV education. Key groups need to be addressed too.

Persons living with HIV in prisons are often neglected, according to a new report by the World Health Organisation (WHO). What are you doing about this?
Nigerian prisons have medical units to take care of persons in custody. The Ministry of Health is not directly in charge of these units but we are ready to support Correctional Institutions in all their needs, including HIV.

What is your blueprint on how to improve healthcare in Nigeria especially on HIV control?
We are working on our country-specific National Action Plan for Universal Health Coverage (NAPUHC), derived from the Global Action Plan for UHC, urged by WHO at the last United Nations (UN) General Assembly. It is based on a robust system of Primary Healthcare Centres, as platforms from where to conduct very many health interventions to reduce disease burden by over 50 per cent. It includes deliveries, vaccination, health education and check-ups, testing for HIV, malaria, tuberculosis (TB), etc., and mass administration of preventive drugs, even disease surveillance and notification. Though the Federal Government supports the development of PHCs financially and technically, they are statutorily under Local and State Governments. It is why the President has been calling for more State attention to this segment of the Health sector.

You recently distanced yourself from a publication titled “Nigeria to import doctors from Europe, United States”. What is your position on this?

The FMoH had released a rejoinder on this, which has been published.

In the alarming story, the Honourable Minister of Health, Dr. Osagie Ehanire was falsely reported to have said that Nigeria is to “import medical doctors from abroad”.

The Ministry hereby states that the story is absolutely incorrect as it is reported in the publication and is misrepresentative of the Minister’s statement.

To set records straight, it should be noted that the Minister spoke in reference to questions raised by Honourable members of the House Committee, on what is being done to reduce medical tourism and another on medical missions to Nigeria, of diaspora Nigerian specialists, to work with Government in schemes that afford foreign based experts an opportunity to serve their country for short periods and share their experience with their Nigerian colleagues. It is important to stress that both initiatives are not about recruitment, but about volunteers, who are willing to visit Nigeria for limited periods of time to help build the capacity of practitioners in Nigeria. The steps, the Minister said, are to improve the service delivery quality in our hospitals. No mention was made of “import”.

The Ministry of Health, therefore, regards the published newspaper story as misleading and injurious to the actual intention of the Federal Government.

In view of this, we request that the misrepresentation be corrected with the same prominence given to the earlier wrong one.