Sunday 20th August, 2017
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It doesn't make sense for FG to dabble into every level of health care - Okara

It doesn't make sense for FG to dabble into every level of health care - Okara

Dr. Godswill Okara, President, Assembly of Healthcare Professional Association (AHPA), is no doubt, a strong voice in Nigeria’s health sector. In this interview with HASSAN ZAGGI, he criticized the plan by the federal government to revitalise Primary Healthcare Centres (PHCs) in the country, describing it as “doing the same thing and expecting different results.” He also spoke extensively on this year’s budget and the best way forward for the health sector in 2017.

Health sector in 2016
In 2016, I will give it to the current Minister of Health, Professor Isaac Adewole, because he tried by making concerted efforts to convince governments at the federal and state levels to be committed to implementing the health agen­da. He was able to put through the new national health policy. He was also able to convince development partners to make available substantial amount of money which has been distrib­uted to the state governments with conditions that once they are able to show evidence of what had been done with the one million dollars disbursed and the millstones assessed, then further disbursement will be made.
We hope that in this 2017, they will be able to do that assessment and enable us to know which state has done what with what was made available.
He also tried to put on the front burner the need to revi­talize primary health care sys­tem in Nigeria so as to lessen the burden on secondary and tertiary levels to allow these levels actually give attention and focus on specialized cases that cannot be handled at the primary level. That, I will say, is the noticeable achievement in the health sector in 2016.
Having said that, one is not particularly happy that pro­gressively, we don’t seem to be meeting up the goals and the targets, both the ones set by our national health policy and the ones agreed with other Af­rican governments.
I recall that in 2001 here in Abuja, there was a declaration by the African heads of states that African government were encouraged to devote mini­mum of 15 per cent of their annual budget to health pur­poses and health budget. Un­fortunately, last year was just a little over 6 per cent and in 2017 it came down to a little over 4 per cent.
So, you wonder, are we real­ly making progress? Are we re­ally moving ahead? Even when concerned stakeholders have made concerted efforts to pre­vail on the executive and the legislative arm of government to implement all these declara­tions and targets and also put down the necessary resourc­es for their achievement, there doesn’t seem to be any positive outcome from all the pressures.
For example, since 2016, the National Health Act (NHA) was passed by the administra­tion of former president Good­luck Jonathan, but up till now, it has not been implemented. You wonder whether we are just playing lips service to the rule of law in Nigeria. If we re­ally say we are running a civil­ian democracy which is hinged on the rule of law and due pro­cess, there must be a concert­ed effort to implement and en­force laws. That is what makes the difference between a mili­tary and a civilian regime.
The pressure to make the government to implement the NHA is what has informed the rallies you are seeing here and there now.
Where do you think the health sector should focus in 2017?
In 2017, we should bring about a change in focus. There is no how the federal govern­ment alone can intervene in both the primary, secondary and also intervene in tertia­ry health care. That is doing the same thing and expecting a different result. This has al­ways been the pattern several decades ago in Nigeria.
The federal government wants to dabble into virtual­ly everything and it does not make sense and does not also give us the desired result. A sit­uation whereby you see a lot of emphases in going to build pri­mary health care centres and do all sorts of things, you won­der what are the local govern­ment authorities doing? The government should make con­certed efforts to empower the local and state governments to do what they are supposed to do as enshrined in our consti­tution.
Is FG’s effort to revitalize the PHCs a wrong step?
I will not say that it is a wrong step in the wrong direc­tion in the sense that the lo­cal governments that are sup­posed to drive the primary health care service are virtually doing nothing. The reasons are not far- fetched. It is because they are not given the statu­tory allocations as required in the Nigerian constitution. So, if the money is made available for the local governments and you make them accountable for the resources allocated that tier of government, the feder­al government will then give its attention to other things like ensuring that we have su­per specialized health centres at the tertiary and quaternary level. But all that is abandoned and we keep hearing about pri­mary health care which is a usurpation of the constitution­al function of the local govern­ment areas. It should not be. This is because, at the end of the day, it will still be the same results of the yester-years.
 Discontent by some groups in the sector and how it will affect 2017
There is the need to respect agreement. This is almost the same thing we are talking about the rule of law and due process.
When government will en­ter into collective bargain­ing with various stakehold­ers in the health sector only to turn around and renege is detrimental to industrial har­mony. Promises and commit­ments unfulfilled will usually lead to agitations, upheavals and disharmony in the system.
We will still appeal to the government, governance is a continuum, there is no how the present government will claim that it is starting afresh laying foundation for every­thing. No. Foundation had been laid, things were done that were handed over to the gov­ernment, it is for the govern­ment to look at those things and say, okay stakeholders we are aware that these were ne­gotiated and agreed by the pre­vious government, come let us see how we can implement it considering the realities on the ground at the moment. If changes are needed, we take them into confidence and ne­gotiate such changes. But to start behaving as if government is just there to do things they like, it doesn’t make for good labour relations in the country.
No matter the type of inter­vention and kind of funds you make available to the health sector, without the workforce, it will amount to nothing. A situ­ation where you see the work­ers of every Medical Centre and Teaching Hospital agitat­ing everyday about unpaid sal­aries and allowances or unful­filled promises and agreements and so on, it doesn’t augur well for the health sector.
We really like to appeal to the current minister of health to ensure that he represents the stakeholders in the health sec­tor, carry along the associations and the unions and ensure that a sense of belonging is engen­dered by way of implementing already negotiated agreements. Without this, all the plans and aspirations of the government in the sector will end up in a mirage.
2017 budget for the health sector, is it good enough?
I will say yes and no. Yes in the sense that in quantum of money, it has come down. But I also do know that if we have a good managerial system in place that will be able to man­age the little that is available to the health sector, we will still make a lot of progress.
I know of many other coun­tries that don’t have as much as Nigeria is devoting to the health sector, but because of good management and a health system they have in place, they are able to deliver. A situation where from over 6 per cent, we are now talking of 4.06 per cent in 2017, it doesn’t make any­body happy.
Advice to the President


What I will tell the president is that, just as the government is doing with the academic staff union of universities, they should engage the unions and associations in the health sec­tor so as to bring about calm and harmony.