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.