Aiming for minimal effort, maximum returns on healthcare

Dear Health Minister, wetin you dey find for Sokoto, dey inside your Şòkòtò. This can be summarised thus…minimal effort, maximum returns. If like me, you follow Nigeria’s incumbent Coordinating Minister of Health and Social Welfare, Prof. Muhammad Ali Pate, on the popular X app, then you must know that he is highly learned, with a resume that one can only dream of.

The minister’s page on X is a haven of ‘global health vocabulary’, full of buzzwords like ‘unlocking the healthcare value chains’. You immediately get the impression that he is a world class player who ‘feels at home’ in large conference rooms, with fellow ‘global’ health players.

My imagination may not be farfetched from reality. Prof Ali Pate was the CEO of GAVI as at when he was called back home by the government to try his hands again ( he resigned as the minister of state for health in 2013 to accept a professorship at Duke University’s Global Health Institute in the United States) on Nigeria’s recalcitrant healthcare system. 

The problem is that while the health minister is looking for the key to open the padlock, to unchain Nigeria’s healthcare values, Nigerians – both patients and healthcare professionals- are crying out for the basic minimum. Don’t just take my word for it, check out the comments under the minister’s post on X.

So far, amidst the plethora of problems plaguing the healthcare sector – like rising prices of medicines as a result of pharma giants GSK and Sanofi leaving the country- the minister has only been able to offer us promises of more partnerships and expressions of interest. Begs the question, have the factors that caused these pharma giants to pull out of the country been addressed? Or is it just another classic case of two birds in the bush are better than one in hand?

I reckon the minister may be under pressure to perform, the kind of pressure that we put on our foreign football coaches, to turn our long neglected football players into world cup winners overnight. Fortunately for the honorable minister, our health sector just wants to make the group qualifying stage.

On December 13, in a series of impressive posts on X, Prof Pate announced the ‘unveiling’ of the Health Sector Renewal Investment Initiative (HSRII). The minister described the initiative as, “a bold effort, a historic window of opportunity, and a call to action, to reform and implement the National Health System as provided for in the National Health Act”

Although the health minister’s posts on X about the ambitious HSRII has become a mantra, he fails at communicating how the initiative will solve the health sector’s notorious primary problems. At best, he brushes over medical brain drain, and at worst, he makes no mention of other problems, like health insurance and emergency medical services. 

Perhaps, with the minister’s impressive resume, he understandably wants to focus on high level problems, like ‘restructuring the ecosystem of health product manufacturing’. Unfortunately, Nigeria’s healthcare system is yet to deliver on primary needs like health insurance enrollment, emergency medical services, adequate number of health professionals, conducive work environment, satisfied or even near-satisfied health professionals, etc. 

As a Nigerian who’s spent all her years in this country, I can boldly say that I speak for the average Nigerian when I say, that we have been traumatised by years of dysfunctional systems, so badly that, like the biblical rich man, languishing in hell, desperate for Lazarus to dip the tip of his finger in water and cool his tongue, we are always grateful to receive the basic minimum from our public office holders and would even elevate such officers to hero status.

Systems are built to meet the needs of the people (in this case, patients and health workers) and not just for the sake of building to demonstrate our prowess. The hierarchy of needs makes a hierarchy of problems inevitable, meaning that problems that cause the needs at the base of the hierarchy must be solved first. The minister’s focus on unlocking the healthcare value chain, when Nigerians are dying and health professionals are leaving in droves, is akin to building a house that upon completion, there will be no one left to live in it. 

The HSRII is unarguably a brilliant initiative, however, for the many times the minister has mentioned this initiative, he is yet to include a timeline of actions. Nevertheless, it is glaringly obvious that it is long term in nature, beyond Nigeria’s 4-year election cycle. Therein lies the problem. ‘Long term’ is the Achilles heel of projects in Nigeria.

Nigerian politicians and public officers are notoriously anti-continuity, preferring to birth their own initiatives instead of continuing from where their predecessors left off. Former minister of health, Prof. Eyitayo Lambo blames this lack of continuity for the failure of the NHIS. It is also important to note that in recent history, no Nigerian health minister has completed a 4-year tenure (with the exception of Prof. Eyitayo Lambo and Olikoye Ransonme-Kuti). What then becomes of the HSRII when the minister is no longer in office? Your guess is as good as mine.

I believe that it will be a win-win situation for us (citizens and health professionals) and the health minister, if he were to focus on primary issues that have a higher probability of being completed within his tenure. This way, he can be remembered for something, just like his predecessor, Prof. Eyitayo Lambo, who will forever be remembered as the man who birthed Nigeria’s NHIS. 

As a Nigerian and a health professional, I dare suggest to the minister thus: 
Reform the malignant tumor that is the NHIS. Almost 20 years since the former health minister Prof. Eyitayo Lambo launched the NHIS, it has ironically refused to metastasie into meaningful enrollments. It shouldn’t be difficult to copy and paste from successful health insurance schemes all over the world, while adjusting for our own peculiarities.  In 2023 alone, the United States’ Affordable Care Act, popular known as Obamacare, recorded over 20 million enrollments.

In contrast, Nigeria’s NHIS has achieved a disappointing estimated 10 million enrollments (about five per cent of 200 million people) after 20 years of existence. This means that, coupled with the high burden of multi-dimensional poverty in Nigeria, about 80 per cent of the population still has to pay out-of-pocket for healthcare expenditures; causing them to fall further into extreme poverty.

Establish Emergency Medical Services (EMS) in Nigeria. It is absurd that in 2024, Nigeria cannot boast of any form of emergency medical services system. Over 40,000 Nigerians die annually from road accidents and other numerous deaths from medical emergencies that could have been averted if we had a functional EMS system. Instead of building more medical schools, to train and supply health workers to other countries, pursue paramedical training and establish ambulance services in the country.

Curb the medical brain drain crisis by putting the welfare of healthcare professionals on the front burner. Thousands of health workers are fleeing from Nigeria daily. The World Health Organisation (WHO) says, at least 2,000 Nigerian doctors emigrate yearly to the United States, the United Kingdom, and Canada. The situation has deteriorated further as we’re now fleeing to other African countries.

Presently, information on the content of the Health Sector Renewal Investment Initiative is near non-existent in the public domain. The extent that the minister has shared on his official X handle, seems to imply that the initiative will be majorly focused on increasing the fiscal space for health.

Perhaps, funds realised from the initiative will be channeled towards addressing the three aforementioned issues. If so, the minister will do well to communicate this to Nigerians, in lay man’s language, so we can keep renewing our hope, obidiently.

But if otherwise, then let me say, Prof Sir, you don’t need to go to Sokoto, just chook hand inside your pristine white Şòkòtò, give us these three goodies, and watch yourself go down in history as a hero.
Onyekwele is a medical laboratory scientist, healthcare entreptreneur and the founder of The White Coat.
She wrote via:[email protected]
08033351571.