This is the part two of our interview with Professor Onyebuchi Chukwu, a former Minister of Health of the Federal Republic of Nigeria. In this part, we looked at the crippling incessant industrial action of the Medical and Health Workers Union of Nigeria, the fight between the Health Workers Union of Nigeria and the Nigerian Medical Association over principal positions in government hospitals and the delay in the implementation of the National Health ACT.
If you missed the part one of this interview click here
The continuous industrial action embarked upon by the Nigeria’s health workers union has become a thing of great concern. What do you think should be done now?
Well, am a surgeon and when a disease is drastic you also apply drastic measures. Honestly, without mincing words we need to rethink what we are doing in the health sector. Time has come now to involve lots of non-government actors as it were in the health sector. We need to decide to bring in people who are not too unionized. Union is good because most times when union is not there government tend to look away from staff welfare but right now those who are managing our different unions are no longer realistic. I think every newly elected union leader thinks what he needs to achieve is one or two strikes against the government. Strike should be used when it is necessary and it should be the last resort such that in any sector, say with doctors for instance, we should be seeing one strike in say 15 years, but when you are getting about 5 strikes in a year what it means is that they hardly work. So the only answer now is to begin to involve the private sector more and it is possible. That’s my own recommendation, we can do it.
You said union is very good, can you throw more light on that?
Not very good but union is good. Every union must be well regulated and we hope that we can have union leaders who are patriotic enough to understand when a strike is necessary and when it is not necessary.
The Health Workers Union is always at logger-heads with the Nigerian Medical Association over principal positions in government hospitals, what’s your take on this?
Well, when I was a minister we tried to solve it. I think the answer is already there and I am surprised the present administration is not implementing it. President Goodluck Jonathan set up a very high powered committee of experts and they produced a report but unfortunately for him, he did not have the time to look at their report before his exit. One of the big problems we have in government in this country is that we keep reinventing the wheel. Like they do in other countries, a new administration should be able to look at some of the good things done by its predecessors and continue. It’s also part of the reason I did a whole lot of things in the health sector. That was just my secret. It is an open secret that I continued with a lot of good things my predecessors, even up to three generations of health ministers, started but could not complete. I actually concluded them and started a few on my own. That’s the way government functions, this idea that everybody wants to launch a new policy should be out. So, already a report is sitting in the presidency and why they’ve not looked at it for implementation is what I don’t understand. They don’t need to set up any body. There’s no point asking anybody anymore questions, the answer has already been provided, let them look at the report and begin to implement. I think there will be relatively peace in the health sector when they do that.
Do you have any idea of what’s in that report?
That committee report addressed areas of its terms of reference and its terms of reference were those sticky areas that have been causing the dispute between the medical doctors and the non-medical doctors working in public health facilities, particularly our specialist hospitals. The report addressed the issue of who should head a hospital for instance, that report addressed issue of relativity in salaries- what it should be like. The report described the issue of job description because if you recall even the pathologists and the medical lab scientist are now beginning to struggle for province in terms of their function. The report also addresses the issue of Private Sector Participation (PPP) in government facilities, because people have accused the current managers of taking their jobs or of not taking their jobs. The report also addresses the issue of other welfare packages because apart from salaries that you know there are other welfare packages- who should get what, even in terms of qualifications that is needed. The report addresses everything you know that today has been a sub point in the relationship among the professionals working in the health sector. The committee had everything it needed to bring out that report, the medical doctors had a representative on that committee, very senior people, the pharmacists, medical laboratory scientists, nurses they had representatives. They were merged with people who didn’t belong to the health sector at all and that kind of provided the balance. These were very experienced people, remember that the committee was headed by someone who I think is one of the Nigerians who is so well experienced in government and public affairs, Alhaji Yayale Ahmed whose last position was as the Secretary to the Government of the Federation. Before that he had been Minister of the Federal Republic, and before that too he had been head of the Civil Service of the Federation. So, that kind of person was quite qualified to head such a very difficult assignment. We also had former perm secs from the Ministry of Labour and Employment as members and people from universities. So, these were people who understood the issues and could be relied upon to be neutral, objective and patriotic.
Is the NCDC that you established some years back living up to its mandate?
Well, it’s a new organization. I indeed established it but the idea didn’t start from me. It actually started with Professor Adenike Grange, the only woman that has ever been Minister of Health in Nigeria. It was in her tenure as the Minister of Health that the idea for a centre for disease control in Nigeria came. Unfortunately, by the time she left nothing was done apart from the concept. When I took over I looked at what my predecessor have done like I earlier told you and I found out that the concept was there sitting and nobody has done anything about it. I called people, they briefed me on it and I said fine this is what we are going to establish. Some people opposed it but I knew it was the right thing to do. So, we got the full support of the then Vice President of the country and through him we had the full support of Mr. President for the establishment of the Nigerian Centre for Disease Control. When we got it established we were thinking of it to be a fully fledged Parastatal, right now they are still working on it. We started the work before I left office. We sent a bill to the National Assemble as an Executive Bill for the establishment of the NCDC but already it has started functioning. We had provided them with laboratories and administrative blocks in Abuja. But by the time I left we hadn’t quite serviced it the way I wanted. Yes, they did well during the Ebola Viral Disease by sending teams to Sierra Leone and Liberia but my vision for it hasn’t been realized. So, I think it is an organization that is still in progress as it were, it has been established but so many things still need to be done and I am hopeful that with the appointment of a new person maybe he can also bring in his own new ideas but more importantly they need to quickly pass a bill to the National Assembly, get it passed so that it stands firmly on a law. It should be a fully fledged parastatal and not directly under the control of directors in the ministry. It should be like any of the parastatals that are supervised by the Minister of Health. So, that is what is lacking now but I believe that it can be taken further.
The National Health Act was signed by the then President under your purview but the implementation of the act has been a big issue till date, what is the reason for the delay?
It hasn’t been implemented one, mainly from the point of view of funding. The major thing the National Act would do for this country is to provide universal health insurance for basic health for Nigerians. One good thing about it for instance is that, no one knows when accident will occur but you are on the road and you are involved in an accident you don’t have to pay for that care. That law is going to provide funds that if automatically managed well, will make no hospital reject you because that hospital would be reimbursed for treating an accident victim. These are some of the goodies in it. But how is it going to be funded? It is supposed to be funded by a minimum of 1% of the consolidated revenue of the federation. Now forget the name, the name is a misnomer but that’s what the constitution calls it and if you study the Nigerian constitution, first you have the federation account. The federation account is all the money due the whole country. When the Minister of Finance and the Commissioners of Finance meets during FAC they come to share it according to an agreed or legalized principle. They give to the federal government its own share, give to the states and then the local governments but the Constituted Revenue of the Federation (CRF) is the federal government’s share of that money. So, it’s at least one per cent. The President could decide to increase it to 2% but the law says a minimum of 1%. It’s almost similar to the way Basic Education in Nigeria is being funded. In the case of Basic Education it’s being funded with 2% of that Consolidated Revenue of the federation but National Health Act says at least 1%, so it’s more flexible. It could be more than 2% or just at 1% but never less than one per cent. So, that was not provided during this fiscal year, it wasn’t there in the budget of the Federal Government but I don’t know whether it would be there next year but since the president said he was determined to implement the National Health Act it’s a reasonable guess that next year that money would be provided. That could be one aspect of it. I also think there are bills that could be implemented. For instance, there could be committees that would begin to regulate HIV healthcare in Nigeria. I don’t see why that body cannot be set up by the Minister. I think we can begin to set it up because right now we are not regulating health properly in Nigeria. What is the standard of care? That National Health Act even said for you to run any hospital you must have your Certificate of Standards which has to be granted by this committees. So, establishing these committees is very important so we begin to implement it and begin to inspect because right now health professions are being regulated. As a doctor I am regulated by the Medical and Dental Council of Nigeria, nurses are regulated by the Nursing and Midwifery Council of Nigeria, the lab scientist are regulated by the Medical Laboratory Science Council of Nigeria, Pharmacy Council of Nigeria is there to regulate pharmacists and so on and so forth. So, the health professionals are being regulated but the facilities where they work is not being regulated. You can bring together first class doctors, nurses and pharmacists, laboratory scientists and put them in one place but if the system there is not first class their performance will be mediocre. We therefore need such bodies to improve on the qualities of healthcare. You can’t be talking about Universal Health Coverage if the quality is nothing to write home about. I think we can begin to implement those aspects of the national health act that is not really dependent on having that kind of extra money and that’s my view on it.
Do you think we are doing enough in the area of research and drug development?
Well, no country is doing enough but the question is if we are doing even half as much as other countries are doing? The answer is No, and the reason is that we are not funding research. Why it’s so difficult for politicians to appreciate research and the need for it to be funded is because sometimes it takes time. It’s not like where you set a target, you cannot set a target for a scientist that by the end of 12 months he should have invented something. It’s not possible. Just provide the fund and the research goes on and sometimes some research may take up to 30 years before we begin to see results. But then again without research there’s no progress. So, why this country is not also making progress is mainly because we’ve not been doing research and so many times we just borrowed what other countries have decided for their people and try to adapt it in our country and it doesn’t work out because there are things that are in Nigeria that are not in these countries and vice versa. So, any kind of research must also be part of operations. We are not doing enough but since we’ve agreed that we need to fund research let’s begin to do so. Listening to the current Minister of Science and Technology as well as President Buhari there’s hope that, well it is possible that this administration may actually bring funds for research. But some research are ongoing even though they are not enough. We have another problem as far as research is concerned in Nigeria. You can have result from research but if you don’t connect it to the industry, it’s not useful. So again we’ve not been able to update as it were research findings even though they are not enough. The ones that have been done in Nigeria some other countries have come, stolen them and implemented them and we have reported products of those research.
You look fit and energetic, can you share some of your secrets with us?
My life is so simple. I have only three answers when you ask me a question. If I know the answer I give you the answer, if you are expecting either a yes or no, I will say yes if I am sure of what I am saying and if I am also sure it’s a No I will also say No. The ones I don’t know I say give me time. So, it makes my life very easy, you don’t need to think of any trick. Why people have problem is because they are always thinking of how they can outsmart others in some illicit ways and that requires a lot of hard-work and that further reduces their age. When you are doing things in a more straight forward way you will be relaxed and look healthy. I try to exercise and try to control my weight. It’s not easy but I try to control it.