Nigeria has, in recent years, been burdened with disease outbreaks, the most recent, being Lassa fever, which, according to the Nigeria Centre for Disease Control (NCDC), has spread to 10 states across the country. The disease, which has claimed several lives, including health workers, has continued to put fears in the minds of many Nigerians. In this interview with LEADERSHIP Friday, the Minister of Health, Prof Isaac Adewole, talks about prospects and the way forward.
There’s this notion that federal government tends to be reactionary in its approach to issues rather than prevention. Why is this so?
Technically speaking, it will be inappropriate to call It an outbreak, this is because when a disease is endemic, it is no more an outbreak. We have an endemic problem which has actually also acquired a new dimension; the rst dimension is that previously, you only have it during dry season but what is surprising in the last two years is that, it is as if we are having it in the wet season and that is worrisome. Secondly, case mentality is also higher and we are also worried that a lot of healthcare workers are also becoming infected and that is worrisome. You will appreciate the fact that we lost some of our colleagues and it is painful because these are the generals. It is like a general dying at the war front, and it is going to a ect, and in fact, frighten other people especially in the health industry. So, we quite sympathize with our colleagues who lost their lives and we can only pray for the families. It is quite unfortunate.
What is the federal government doing about this Lassa fever issue?
When you say the federal government, you miss the issue. It has to be collective, I have just spoken to Ondo State governor, advising Ondo State government on what should be done in Ondo State because when you say federal, we will miss the point. Federal has no exclusive responsibility for it. It is a concurrent responsibility; hence it is for local, state government and federal. The federal government will help them when it is beyond their control but basic things like educating the people, using the state media to inform them,particularly the way farmers store their food; when you dry cassava and garri on the road side, and rat, particularly rats that are infected defecate on it, then we are at risk. So, we need to educate the people and to me, this is what we have to
For people to say we have not implemented the National Health Act, it is not true. We have not achieved 100 per cent implementa- tion but we are moving towards it do together. But if we start calling on federal government, things must have gotten out of hand and we don’t want that. We are also putting in place, a reporting system. What has helped us is that the reporting system that we have put in place has enabled us to know quickly when things go wrong. In 2017, we lost 17 people in one village in Niger State before anybody knew about Lassa fever. That won’t happen again now because we have our surveillance all over the country. We are trying to partner with them. Fortunately, in the last two weeks, WHO gave us 853 bikes that would also enable them to reach the di cult areas. So to us, we provide the policy document, training zonal laboratories, we would make sure that we provide drugs because we have to treat free of charge. We also make sure that we provide PP and fortunately, Nigerians now produce the PP. It is being made in Onitsha by local person, so we don’t have to import it.
There is this notion that governments tend to be reactionary in response to health issues instead of preventing. Why is it so?
Well, Nigerians want to put everything on government. What is their own responsibility.? I did tell a group of people that when we live in a lthy environment, we are sending invitation to Lassa fever, yellow fever, malaria and that is not the duty of government to clean your environment. So we must clean our environment, make sure there is no stagnant water. The government cannot do that so we must take responsibility for our health. We must ensure we live in clean environment. When we do that, there will be no Lassa fever, there will be no malaria.
Now, we still have policies like the National Health Act, National Tobaccol Control Act that have not been implemented. Why is this so?
When you look at the National Health Act, we’ve put in place, the policy framework, National Council on Health is meeting, we’ve activated all the committees that are located in the act, we’ve also started training people for the basic health provision fund and when you look at the basic health provision, it said it shall be funded from one, not less than 1per cent of the consolidated revenue fund with support from international donors, partners and other grants. So, the only thing that is missing is the one per cent. We are using international donor fund to even kick start the basic healthcare provision fund. So, for people to say we have not implemented the National Health Act, it is not true. We have not achieved 100 per cent implementation but we are moving towards it.
The National Tobacco Control we’ve also put in place. What is left is the guideline which has been sent to the secretariat of the Federal Executive Council (FEC). Once it is approved by FEC, it will go to National Assembly. So, we are working. We have alerted every organ that is relevant. We have asked them to appoint control o cers, we have control o cers, we have the committee, we have the desk now to work 24/7 on the issue of tobacco control. We’ve made progress in the last two years than has ever been done in even 20 years of Nigeria’s history
There is a call for increased taxation on tobacco products. What is your take on that?
There is a committee that is working on that even though it is not peculiar to Nigeria. The entire ECOWAS sub-region is working on them and we are trying to work within that harmonized sector to increase the taxation on tobacco. Our love would be to see that increased money on tobacco products pumped into health and that would gladden our heart.
Where are we in our polio eradication effort?
Well, let me start by appreciating Rotary International. It happens to be one of the major pillars of support for polio. For now, we’ve not detected any case in Nigeria for almost two years. The last case was in July 2016 and it was a setback. But what was actually interesting was that the president said if you search more, you will nd because he was concerned that a part of Nigeria was inaccessible and as a scientist, I thought Nigeria should not have been declared polio- free when we were. What we should have done is to say that part of Nigeria that was accessible is polio- free and till today, is polio- free because those four cases came from lake Chad area where we had no access. But then, we’ve worked with the military, we have a programme called the ‘reach inaccessible children.’ We must have reached over 250,000 children in the compromised area. The military is helping us to create security corridors. They are also helping us to immunize and we continue to search. What has also happened is that under the president, we have agged o the Presidential Task Force on polio, it has met severally, which, to me, demonstrates the political will. In 2016, immediately it happened, the president ordered the release of N9.7billion for polio eradication, and we are working together with international agencies to ensure that polio is eradicated not from Nigeria alone but from Africa. We are also working with countries in the lake chad region.
Last year, there was one inside the crate , and there was an old one that was waking and dying but what we’ve done is to install that one that was in the crate for three years. It is now working, in addition to the brand new machine. We are happy that at least in Nigeria today, anybody with cancer can go there. But we are not resting, we’ve approached the private sector, there is a second machine brand new for National Hospital that is presently at the port, donated by shell, and we are expecting it to be cleared in the next one week or so. That is good news. So, National Hospital will have two brand new machines. But in our budget, there is a project called Strategic Intervention with Nigeria Sovereign Wealth Authority where we plan to include seven other hospitals with ultramodern cancer machines and that is one. We’ve budgeted N9 billion for it and a lot of this has been released, about 80 per cent so far. We are in the process of modernizing one hospital in each geopolitical zone in addition to National Hospital and LUTH. So it is a gradual thing. We will want each of the hospitals to specialize in cancer and either cardiac or renal. We are also working to make Ibadan and Sokoto centres of excellence for neurosurgery. The University of Maiduguri will also specialise in trauma. So it is an ongoing thing to upgrade our facilities and make sure that they o er rst rate treatment to Nigerians and attract people from other countries.
How would you rate Nigeria health indices under your watch?
The indices are not done every year. It is done every ve years. So, there is no way you will know. We are just planning. The last survey was done in 2013, one is planned for this year; the Demographic Health Survey. However, what we know over the years is that both the neonatal and under ve mortality decreased slightly but not where we want to be. The maternal mortality increased from 2008 to 2013 but what we are doing is to do some targeting. Six of our states have the worst maternal mortality rate and we have set up a committee to produce a work plan that will help us crash the maternal mortality in those six states and we believe when we crash that, the maternal mortality rate in Nigeria will go down
What is your message to health workers attending to Lassa fever cases?
Well, it is to repeat what I said in Abakaleke, which was misquoted. They needed to protect themselves.
What about the issue of primary health care?
The rehabilitation is ongoing. We are happy that a lot of peopler are joining the wagon, the private sector is joining, I have just had a meeting with DAI as well as Intra Health. They are working with the Wellbeing Foundation. So far, I think over 3,000 PHCs have been revitalized and with support from World Bank, EU and many state governments and there are promises that we are still counting.
What are the challenges and the opportunities?
I would rather want to talk about the opportunities because a job like this, without challenges, to me, would mean nothing. But the opportunity is that we have a tremendous opportunity to change things, to bring health to the doorsteps of our people, improve their health and wellbeing and bring government closer to the people. To me, these are the opportunities and it is the legacy we want to leave behind, to show the ordinary Nigerians that this government cares for them and if you look at many of the things we have done, it is to endear us to our people. It is a legacy of honesty, every week I brief the FEC about the state of diseases, and what is ongoing because we want to leave behind a culture a honesty where we will not deceive our people.
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