Exclusive Interview with Prof. Onyebuchi on the State of Healthcare in Nigeria

Professor Onyebuchi Chukwu was the Minister of Health between 2010 and 2014. He resigned from this position in 2014 to contest for the governorship position in Ebonyi state. He lost in the race but found solace in his first love, teaching. He is presently a lecturer at the Federal University Ndufu-Alike Ikwo (FUNAI) in Ebonyi state. In this interview with PWG, this erudite orthopedic surgeon outlines the bare essentials of all the concerns affecting the Nigeria healthcare system and the untold tales of our fight against Ebola virus.

Excerpts!

How would you rate the Nigerian healthcare systems. Are we close to achieving Universal Health Coverage?

Well, we have not yet achieved Universal Health Coverage in Nigeria but we are on the road. And so what is important now is the speed but we are on the right direction and universal health coverage simply means that your entire citizen should be able to afford affordable healthcare. That is quality healthcare at a cost that will not really be catastrophic to them and so we haven’t achieved that but I believe that we are on the road.

What is keeping us from achieving this?

Before I left office, I laid the ground work but unfortunately it took a long time to plan. So, we were able to get the president then to host a summit in March 2014 and everybody was involved, the private sector, the public sector, multilateral partners, our bilateral friends and all the relevant agencies of government. In fact, everybody that mattered in health, including the World Bank and its subsidiary IFC International Financial Corporation was involved and I also decided to invite all my predecessors in office, all the former ministers of health who were alive and I think 80% of them actually attended. The senate president was involved because we involved the legislatures.

There, the government as it were accepted to begin the journey towards universal coverage. So, the pronouncements that were made were well articulated, they were read out in the presence of Mr. Vice President and everybody bought into it, including the National Assembly. So, what I did before I left office was to set up committees to begin the work and I understand that when I left office, my successor continued with it and I believe the committees may have completed their work.

I believe the new administration will take it further because there are many aspects to Universal Health Coverage, you have to look at the availability of facilities, the referral system, you also have to look at quality; is there anybody monitoring quality and then off course you have to look at insurance. The recommendation was that Nigeria ought to move toward mandatory health insurance but we still don’t understand it. I was listening to the radio this morning and somewhere some people were still talking about national health insurance. It has to go beyond what national health insurance is doing now.

If you recall, the immediate past president was given about 41 bills to sign but it wasn’t possible for him to sign them within the few months he had. He signed a few but you know he needed to go through it to be convinced he needed to sign it. He wasn’t able to sign the amended bill for national health insurance. The critical thing we would have done was compelling all employers of labour to ensure that they bought health insurance cover for their staff but we didn’t get into that. Right now what we have is purely voluntary and so the only thing national health insurance can do is to continue to preach to us, continue to market but they can’t force any of us but I think we need to be forced. We can’t drive any kind of vehicle on the road without being forced to buy insurance so why can’t we be forced to buy insurance for ourselves. We need to do that and I believe the government will take it on.

What critical thing did your administration do to achieve universal health coverage and why was it not achieved in your time?

The other thing we did by way towards Universal Health Coverage is the National Health Act. As you are well aware of it didn’t start with me, it started with Professor Eyitayo Lambo who worked with ex President Obasanjo. He took it up to the level my own immediate predecessor, Professor Osotimehin, was able to get it through to the National Assembly. The National Assembly actually passed it at that time but later it was withdrawn. The President didn’t sign it because they said there were some technical issues involved and so that was why it fell on me when I became minister to get it and take it back to National Assembly. The first time it was passed under my tenure was actually in 2010 but when it was passed, Some Nigerians applauded it while some said no. Some aspects of Labour were against it, some religious bodies were against it, some Civil Society Organization were also against it  and President Jonathan, being someone who listens to people, said he needed some time . SO, we had series of meetings and even the president sat through two of those meetings that I participated in but I as minister was involved in five different meetings where arguments for and against sections of the act were discussed.

By the time President Jonathan finished listening to everybody, he was convinced there wasn’t really much to change but at the time he made up his mind 30 days has elapsed and he couldn’t sign it. So, when the 7thAssembly came on stream we took it back to the senate and kudos to the then chairmen of Senate Committee on Health and the House Committee on Health and working with us then were Civil Society Organizations and all those in the health sector that were really interested in getting on. There were some modifications and even as minister I still had to address religious bodies. We tried to remove areas they didn’t quite like but we were able to get it passed again. Mr. President, having made that promise that this time around he would sign, signed it. So, it is a law in Nigeria and we are hoping that the present government, since President (Buhari) has read things in the media about it and has actually said he was going to implement the National Health Act and I believe him, would implement it. So, I think it is just a matter of time.

During the outbreak of Ebola virus disease in 2014 you did a terrific job in containing the disease as quickly as possible, what was your secret and are we ready to contain future health emergencies in Nigeria nay Africa?

Firstly, thank you for the compliments but the compliments should actually go to all Nigerians. Why do I say that? I think for once the country did what we had always hoped for when we say we are the giant of Africa. That was the only time since I became an adult that I can recall that Nigerians proved to the whole that indeed we are the giant of Africa and should be one of the leading countries in the world. The reason simply was because of good leadership. As the minister of health I was the only one coordinating everybody but I must say that the President gave me a lot of support when saw what I was doing. I can’t accuse Mr. President then of having denied me of anything I asked for. He was up to the it, he provided leadership for the country. At my own level what enabled me to succeed was that I decided to take away politics from it. Remember that I was a member of PDP, I was a politician and still a politician but this was a health matter. You see, there’s a limit to which you can play politics with health matters. There must be some red light drawn somewhere and so I told everyone we cannot play politics with it and that enabled me to work with the Governor of Lagos state and the Lagos state Commissioner for Health, that enabled me to work with the governor of Rivers state and the Rivers state Commissioner for Health, despite the fact that they belonged to another party. When they saw that I removed politics from health they were cooperating with me.

The second thing that helped us was saying the truth. The first job of government is to provide welfare for its citizens and the ingredient in providing such welfare is that government must be honest to its citizens. That is the secret, there’s nothing special about it. The reason why we are having issues in Nigeria today is because overtime people in government will say one thing and they don’t do it and people generally have lost confidence but we tried to bring that confidence back. Initially when I started talking to them as a minister they were very skeptical, very cynical and some of them said “well, let’s see what he wants to do” and after sometime I think they started believing and cooperating with me and that really helped us.

The third thing that enabled us to succeed was that we were listening to people and probably you are lucky that am saying this for the first time. I remember one early morning, it has to be early morning in Nigeria for me to be able to speak with the Director of USCDC and normally two of us were exchanging views, either he called me or I called him but it was around 2am in Nigeria and he said some of his own people who were working with us were complaining of certain aspects in Lagos in terms of coordination and then I took it upon myself, looked into what the problem was, diagnosed what the problem was and it was there I rigid the emergency operation centre. I brought in a young person from the National Primary Healthcare Development Agency, who from interviewing him I felt could do the job. He organized the team and that was the game changer from then on and that is what the rest of the world did today, they have copied from Nigeria in terms of how to fight disease. I wasn’t looking at people’s face, initially they said that I brought in a relatively junior person but I was only looking for competence. So, sticking to competence, merit and skills is key to fighting health crisis anywhere in the world. These were the things that made us to succeed.

So now, are we prepared for future outbreaks giving by what happened with Lassa this year?

Well, even in 2014 Lassa was with us but I can’t remember the last time Nigeria had the kind of mortality we had this year and that’s the difference. Now, Lassa fever is endemic but Ebola Viral Disease is not endemic. If you go to parts of Edo State today it may be possible there are one or two persons who are suffering from Lassa as we speak right now. So, it is endemic in some parts of Nigeria and I think researchers are still looking at the connection but the truth is that the particular area of West Africa where Ebola outbreak was observed is the same area that is endemic for Lassa Fever. Guinea, Liberia, Sierra Leone and Cote D’ivoire belong to what is known as the Mano River Union. That area is the greatest endemic city for Lassa fever. Also Nigeria, where Ebola visited, is also endemic for Lassa Fever. So, Lassa is with us but the only difference is that we have never had it in terms of mortality and probably the reason may be the transition from one administration to the other. I believe if the Minister of Health was appointed a little earlier maybe we wouldn’t have had that mortality rate. That gap wasn’t a good thing for Nigeria, having a long period without Ministers. Ministers are the drivers of government otherwise many countries including US would have abolished the position. Civil servants are not the drivers, they are the implementers of the policies. They do the usual bureaucratic job but if you want government to progress you must have ministers because a minister knows that his tenure is not secured, his appointment is at the pleasure of Mr. President and his position is only guaranteed by his performance so every day a minster is leaving his house he would ask himself ‘what do I do to ensure that Mr. president does not remove me from office’, not for civil servants, their jobs is guaranteed. To remove a civil servant you would sweat. Don’t get me wrong, civil servants are important but everybody has his job. Ministers are necessary because Ministers are the drivers of government, they help to achieve whatever anybody who has been elected as governor or president intends to achieve. So, that delay to me was what gave us that much mortality because there was no direction, everywhere was a vacuum.

So, are we ready now?

Difficult question! Giving by what we achieved during Ebola Virus we ought to now be ready because right now we are teaching the rest of the world. I don’t intend to sound immodest but we were part of those who, through our heads of state, instigated the AU to establish the Africa’s Centre for Disease Control. They have 5 hubs and the hub for West Africa is located in Nigeria. The reason why they ended up putting it in Nigeria is simply because we already have the NCDC. Then the West Africa Health Organization took a cue from what happened with Ebola fight in the West Africa region and established their own centre and again they want Nigeria to anchor it and that’s why they appointed the erstwhile Director of NCDC as its interim director. So, everybody is looking up to Nigeria in terms of control of disease but the problem is that we must overcome the human factor and that’s why leadership is important. I believe if we apply that leadership we should be ready and I also believe that with what happened with Lassa, the present minister must have looked at certain things and then decided that never again should this happen and I think we are on the right path.

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