Primary health needs stronger mandate – Dr. Pate
What progress, if any, has been achieved in the health sector under the present administration? From 2000, there has been slow improvement in some health care delivery indices. In the last 2008 demographic and health survey, the proportion of children who died before the age of one, was 75 per 1,000 live births and maternal […]
What progress, if any, has been achieved in the health sector under the present administration?
From 2000, there has been slow improvement in some health care delivery indices. In the last 2008 demographic and health survey, the proportion of children who died before the age of one, was 75 per 1,000 live births and maternal mortality rate was 545 per 100,000 births. So, while that is showing some improvement, by 2008, that certainly wasn’t enough for what we could do as a country. The other aspect is the equity dimension of those health outputs. For instance, if you disaggregate the health indices that we have, you will see that the poorest segment of our population, the rural poor tend to be worst off when it comes to access and utilisation of basic services compared to the wealth off. That is another dimension, so, in terms of the average figure, it is relatively lower but the distribution of that average figure between different segments of the population is also something of a concern because the poorest segment of the population also tends to have disproportionate burden. That happens in so many countries but ours is also very significant and that is a point by itself. The third pinpoint is to do with the financial protection because most of the health spending in Nigeria is largely from the pockets. The composition of health spending in Nigeria is government spending which comprises of Federal Government, states and local governments, which is about 28 per cent and then 68 per cent of the total health spending is actually household out of pockets spending. So, there is lot of out of pockets spending and what that means is that if you are a relatively poor person and you have one major bout of ill health and you sell your goat to attend to your health, you will end up poorer because of that ill health. So, that financial protection against the catastrophic cost of ill health has not been very sufficient for a number of our citizens. So, these are the three pin points that had been identified in 2008 based on the data that we had at that time. So, from then onward if you ask what we have done, in terms of how to improve health outcomes, the Federal Government partnered with the state governments through the Governors’ Forum on immunisation and other areas to protect and improve health services in the country.
In what ways do you think the National Health Bill will complement the roles of the three tiers of government in implementing the National Health Development Plan?
At the moments, the Federal Government is one of the loudest voices when it comes to advocating for maternal and child health even though it is the local government that ought to be responsible for implementing that. So, when we come to look at the constitution, we should revisit this issue. We should consider guaranteeing access to basic education as something that one level of government, like the Federal Government can take on. That is an issue that need to be debated. To me, I will like to see stronger mandate to leveraginging basic services either Federal Government takes the lead with clear roles defined for the different levels of governments so that every Nigerian will have guaranteed access to the most basic services. For instance, it is just like immunization for polio, if you don’t control polio in one state, you can export it to another, but if you control it in one state, the benefit extends beyond that state. Therefore, the Federal Government has a clear mandate to that because you cannot say you will leave that to the state government because states might not take it as a priority. So, it is the same thing when it comes to access to basic services and protecting the most vulnerable in the society. Basic health ought to have much more stronger mandate in the constitution so that it cannot just be an issue on the concurrent list and people can choose whether or not to spend on it. That is subject that needs to be discussed and we have been exchanging views on that.
What is your ministry’s response to the the agitation for an improved wage for health workers in the country?
Health workers are employed by different levels of governments; some are employed by the local government, state government and others by the Federal Government.
The welfare of the health worker is not only about remuneration in terms of financial remuneration. The welfare also covers things like having the right tools to do what they need to do, having place to stay in their posted areas of assignment and opportunity to progress in their professions and to be trained to develop themselves to go forward. I think the recent relationship between health workers and the Federal Government is a positive one. The government has been trying to meet some of the demands of the health workers, but it is difficult to satisfy everyone at the same time, it is impossible. Health profession is not like mining or some other professions. Health is about saving lives of people that are very vulnerable, very ill. If you don’t take care of them, they could die or get complications. So, it will take both the government and health professional associations to have a clear understanding of the role of health worker for there to be progress in the sector. Instead of having a rancorous relationship that ends in strike, which used to be the case in the past, we hope in future, there will be more dialogue on issues that affect the welfare of the health worker.
What is your view on recent agitation by doctors that only real doctors should be appointed to top jobs in health sector?
The constitution has outlined some positions in the country and it has also stated how such positions would be filled. Appointments into some of these positions are the prerogative of the president and it is not for us to begin to question the wisdom of the president, it is his constitutional right to take any decision on appointments. I think the best thing is for us to focus on what are we doing to improve the health of Nigerians. So, in my opinion, whoever is called to occupy a position like that of a minister should not be an issue. The minister may not be the most senior person in the health sector and to a patient, the most important person in his or her life is the doctor, the nurse that is with him or her at a critical time. So, the most important thing is for us to ensure that those at the frontline are well trained and equipped with the right tools to deliver the basic service to Nigerians.
Nigeria recently celebrated the 2011 World Diabetes Day. Could you identify some of the risks factor of diabetes and how they could be tackled?
The problem is that diabetes is increasing not only in Nigeria but globally as well as other non communicable diseases. Part of that is because of the aging population, as population age, some diseases that were previously not obvious will start to manifest. Some of the reasons have to do with our sedentary lifestyle. For instance, as a Fulani, if not for modern lifestyle changes, I would have been going around with a stick rearing cattle and would have a lot of exercise every day by virtue of my work. The food would have been modest, lest purified.
There is also the type of diabetes that is genetic predispose, so a combination of several factors come into play to make an individual a diabetic or to make others non diabetic. But generally, the progression of diabetes from one level to another can be retarded so that complications like the eyes disease, kidney disease, and heart disease could be controlled by controlling. When somebody pays attention to his medication, diet and exercise, some of those complications would be kept on check. And if we do that as a population, have more efforts on prevention, then you will find out that less people will require dialysis or complication. So, we should give more attention to prevention rather than treatment.