When about 20 years ago the Federal Government established the National Primary Health Care Development Authority to cater for the basic health care needs of the Nigerian people, the expectations were high. And to demonstrate government’s resolve, credible experts like the late Olikoye Ransome-Kuti were brought into the scheme. But the objectives appeared to have derailed soon after with successive leaders of the agency not giving a hoot about the mandate. Therefore, not much could be said to have been achieved. The failings in the system are largely blamed on large scale corruption, inefficiency misplaced priority and inadequate funding by government. It was in the light of this that President Umaru Musa Yar’Adua sacked the former Executive Director of the National Primary Health Care Deveopment Authority, Mrs Titilayo Koleosho Adelekan. About N700million was said to have been brazenly looted from the agency through inflated contracts broken into parts against the federal government’s financial regulations. To make the looting hitch-free, the Departments of Finance, Account, Admin and Supply were bundled into one and headed by a Director who became untouchable. Yet, Titilayo’s sack came as the culmination of a N300million scam which also saw the exit of the former Minister of Health, Adenike Grange and his junior minister. In short, corruption has never been far from the heath sector. In this interview with DESMOND UTOMWEN of our Abuja Bureau, Executive Director of the Agency, Dr Muhammad Ali Pate, a World Bank consultant on health explains the current efforts to tackle the rot in the sector in a bid to deliver on the mandate of the agency. Excerpts:
Q: Your appointment came at a time the health sector was under serious threat from corrupt practices. What did you meet on ground and what have you done to tackle the menace that saw the exit of your predecessor?
A: What we have tried to do is to carry out a diagnosis of the financial management system of the agency and the procurement processes to understand how well we have the agency positioned to comply with all applicable rules and regulations guiding procurement as well as financial management. That assessment is on-going and at the moment and we do hope to have specific concrete actions taken to mitigate and reduce instances of corrupt practices. As you know, corruption is a social epidemic that goes beyond just the agency. But we have to do our best to improve the situation. We have launched anti-corruption unit, ACTU within the agency. We invited the ICPC to come and give our team a seminar on government rules and regulations regarding corrupt practices, the ICPC Acts and others which have been very helpful. We recruited a consultant, Tajudeen Oyawole to help our procurement unit ensure that we are in full compliance with the provisions of the Procurement Act. Beyond that, there is the cultural aspect of it. We have tried to encourage more openness, more transparency, more teamwork and more accountability in all the work that we do. In doing these, we have created an environment that is less conducive for sharp practices. As I said, corruption is not peculiar to this agency or any other government agency. It is more of a social epidemic which everybody must fight. But within this institutional context, we have mechanisms put in place to reduce the chances of deviant behaviour.
Q: Did you envisage the magnitude of corruption in the sector before you came into office?
A: I think yes. We know what happened in the health sector a couple of years ago, especially in 2008. We know what has been going on across government and efforts have been made to stem the tide. As I said, it is not just an institutional thing; it is a cultural epidemic people have to deal with at different levels. So, the task for us within the NPHCDA is to address our procurement system, financial management system, accountability mechanism to make sure that we minimise the risk and this we have been doing. We have also been trying to take care of the attitude and behaviours of some people and also encourage our staff to do what is right.
Q: Was the unbundling of the Finance Department which hitherto had the Account Dept, Finance Dept and Supply Dept rolled into one in line with this effort to check corruption?
A: As you may know, checks and balances have to be in place to minimise chances of some deviant behaviour that may occur when you concentrate power in one place. So, a couple of months ago, we took steps to unbundle that department. It took the agency so long to implement but Iam glad we managed to do it, and that has improved the environment to foster transparency and accountability. To the best of my knowledge it has nothing to do with a desire to victimise anyone. We have a public agency which has public resources intended for particular projects that will serve the interest of the people. We have laid down government rules and regulations guiding how these resources will be used. We also have government policies and guidelines on how institutions should be structured. What we have just done is to implement those structural reforms that government mandated us to implement. We have to take steps to block all gaps and loopholes that will expose government resources to abuse. And we will keep trying to improve the integrity of the system. It has absolutely nothing to do with any particular individual.
Q: Considering that some people must have benefited from the system. Was there any resistance to the unbundling process?
A: I have to say that for six months that I have been here, I have had a very supportive set of core staff that nurtured this idea of wanting to do what is right. Though there might have been some environmental factors that might make it difficult to manifest, but again, people have come around to the fact that for us to move forward in the health sector in this country, we have to make sure that public resources are used judiciously, efficiently and for the intended purposes. But I cannot speak for all staff. There could be some that may not be able to come out to say we are not in support. If we discover any, we will try to encourage them to go in the right direction and work with those who are already supportive of the good things we are doing and are ready to follow the guidelines of the government so that there can be improvement in the Primary Health Care system. Let me say also that corruption in any sector is bad but corruption in the health sector, if it occurs is one of the worst forms of corruption because it deals with lives of people, especially the poor and vulnerable ones. Health is a sector that should be corruption-free but unfortunately we are still trying to do that. We are making progress within the agency and we will continue.
Q: Many believe that the health sector is in total decay with leaders flying abroad for health care. Beyond fighting corruption in the sector, what has your agency been doing to address this trend?
A: For a very long time in this country, Primary Health Care was the central strategy of health sector to achieve better result. In 1988, the country’s National Health Care policy said PHC is the way to go. Since then we have been trying to build a PHC system. Though we had successes in the 1980s, we know that our health system has not delivered as it ought to in terms of better health for our people. Given that we have for about 30 years been trying to build a health system, and we are still where we are now, just six months of our leadership will not be enough to change things completely. But with the advent of the new leadership of the Health sector, under the Minister, Prof Babatunde Osotimehin, we have managed to accomplish some results. In particular, you will know that polio virus is one of the failings of our health sector as routine immunisation has not been adequate. The country has relied on campaigns but this has not been of high enough quality to interrupt the transmission of polio. So what we have tried to do in the last month is to improve the quality of campaign by improving the supervision and monitoring of the campaign. We have improved the logistics, planning and with the support of the FG through resources, we will ensure that we have good quality vaccines. In April, we had an expert review committee which stated that we are beginning to make real tangible progress. This year, we are having three times less WPV1 than we had in 2008. When you look at the immunity gap as measured by experts from 2007, you will see that it is closing. That means that more children have had their immunity increased. We are doing this with all stakeholders, governors, traditional rules, religious leaders and others. Our efforts are already yielding results but it is too early to say we have done it, but we are encouraged by the signs that we are seeing. That is on the Polio front.
Q: Does it bother you that Nigeria is among the last four countries still battling to successfully eradicate Polio despite global attention?
A: It is not a comfortable position to be among one of the last four countries. Everybody wants to be among the first to say we have done it. The reason why we have not is because we have left our PHC to degenerate over the years, and routine immunisation has not been able to provide the needed immunity. While there have been several efforts in the last eight years, those efforts were a lot more on the campaign than a real building system that will ensure that routine immunisation is available. But we have seen in the last six months that if we can improve on the qualities of the IPD, we can achieve some quick results which we need to sustain. But at the same time, we have to lean on the states and local governments to contribute their quota in terms of revitalising the operations of the PHC system in their various states by helping in providing logistics to ensure that vaccines and drugs are available at the PHC centres so that people can go there as a matter of routine to get basic care, including immunisation.
Q: Nigeria is prone to different epidemics, Measles, Meningitis, Lassa fever and all that, yet there are no rapid response mechanisms. How are you correcting this?
A: Since we came on board, we have done a lot. For the Spinal Meningitis, when we got wind of the outbreak, we quickly made the vaccines available to both the affected areas and other areas for reactive vaccination campaign which the states executed with our support. We are carrying out training of health workers in terms of surveillance. The Lassa fever was also promptly dealt with. More importantly is to ensure that as we move forward, we have resources put aside for dealing with such outbreaks instead of scampering around to get resources to respond whenever there are outbreaks/epidemics, which are recurring.
Q: How are you coping with funding?
A: The realities are that resources are limited and there is always going to be limitations of resources for everything, including health sector. So we can always look for more resources to achieve more. But if the available resources are used judiciously and applied to various priorities, we can achieve better results. If you look at the health sector broadly and all the spending that we have in the sector, if it is focused on the basic level, it will achieve a lot more in terms of improving the health status than if we spend it on high level services. As it is, even if we double the resources we have today and the incremental resources is only applied to the high level services that are not really necessary for the generality of the population, we would not be able to see the impact. But if we use a little bit more of what we currently have for PHC, we would see improvement in terms of the health of our children and women.
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