Pate: Investment, Basic HealthcareFund Key to Nigeria’s Growth, Development

Muhammad Ali Pate is a Professor at Global Health Institute, Duke University, North Carolina, United States. He was Senior Leadership Fellow at Harvard University and a member of the World Economic Forum (WEF), Davos Switzerland. Between 2008 and 2013, he served as Executive Director, National Primary Health Care Development Agency and later became Nigeria’s former Minister of state for Health. In this interview with Martins Ifijeh, he spoke on the need to invest in healthcare, among others. Excerpts:

Recently, Ondo State University of Medical Sciences established a department of public health in your name, what strategic role do you think the institution will play on public health?
The Ondo State University of Medical Sciences is the first of its kind in West Africa and they established the School of Public Health, and in their generosity decided to name it after me; Mohammed Ali Pate International School of Public Health. That, to me, is a tremendous honour because I am neither from Ondo State nor from the South-west. I am from another part of the country. I served in government a few years back, but on merit, they decided to do that to honour me. That is very remarkable and I appreciate.

Ondo was one of the worst performing states in the country, but really transformed within 10-15 years to be the best performing state. It was the only state that achieved the Millennium Development Goals (MDGs) in Nigeria and was ranked number one by World Bank and by many others in terms of performance, community health care, Primary Health Care, maternal and child care. It is one state that is a positive deviant that is a good example. I am pleased to be associated with the school and we will certainly do our best to contribute in building it to be one of the leading institutions of public health that will influence public health practice and research policy on the continent.

Are you worried over the resurgence of polio virus in Borno two years ago after all efforts, particularly, as it concerns funding and public health?
Ten years ago, Nigeria was almost a barrier in the global polio eradication. You remember there was a World Health Organisation (WHO) resolution that specifically condemned Nigeria because at that time, we had almost 27 states in Nigeria that had polio. Every week there were cases of children paralysed by polio. We were the last in the continent and were exporting virus to other parts of the world. The late President Umaru Musa Yar’adua tackled it and a lot of efforts went into it, we played out role as the National Primary Health Care Development Agency with the Minister of Health. The then President Goodluck Jonathan continued with the effort and he promised that he will not hand-over polio to his successor and he did not because the last Type 3 polio in the whole world was in November 2012, from then there was no remaining Type 3 polio. The only remaining one was Type 1 Wild Polio Virus (WPV). Nigeria was able to interrupt the virus, although the security situation in Borno limited the ability of the programme and those who followed us to be able to reach some children in the security challenge areas.

So that led to some reversal, but was localised to some areas in Borno. So, from where we had 27 states to where we had only one state. I think Nigeria made a remarkable turn around and broke the back of polio in this country, by implication in Africa. Since the reversal two years ago, I know that this government has tried to build on what has been done by the previous administration to continue to improve surveillance, improve the quality of the programme even though the security challenge in Borno have not allowed all the children that needed to be reached, to be reached. However, the last two years there was no child to have been discovered to be paralysed by WPV. I know that over time, an independent certification body will have to verify if it is true. One year from now, Nigeria stands the chance of being considered to have eradicated polio. It has been a tough struggle, but we don’t have to judge the entire country by just one state that has not been completely out of the woods. Still on polio, there is the issue of routine immunisation which is important to even guard against reversal in the future if polio is completely eradicated.

So, how would you rate Nigeria’s performance on immunisation?
In the last few years, Nigeria has been able to introduce new vaccines. If we raised immunisation to a certain level, children in Nigeria should not have widespread measles epidemic because such diseases are vaccine preventable. I am hoping that the resources will be provided and the government will continue to prioritise immunising our children from vaccine preventable diseases because that is the most cost effective public health intervention. If we cannot immunise our children against simple diseases, whatever we do, the most complicated things will be difficult.

To what extent can Primary Health Care be used to fast track Universal Health Coverage?
I think we, as Africans, are very fortunate to have Dr. Tedrus as the Director General of the WHO at this time, and we have to reciprocate his presence with national leadership to make as much progress in improving and ensure that our population get the health care they need as a matter of right. It is not just a choice and it should be for everyone. But it will take time. Primary health care is the foundation for achieving universal access to healthcare- the basic one and even the most sophisticated ones. The building block for it will include not only the infrastructure in terms of availability but the people- human resources. When we were in government a few years back, the Midwives Services Scheme (MSS), the Community Health Workers, the Village Health Workers and the communities were important elements of that.

How then should challenges relating to primary health care be tackled?
The primary health care system has to be people-centred. It should be designed for the people, taking into account their voices and what their needs are and ensuring that they have a say in holding people accountable at the front lines. UHC will not happen by just rhetoric. We have to invest in it. Now that we have the basic health services funds, if it is released and used, it will take much more than that, but it will be making a contribution in Nigeria’s progress to UHC. It is a key to our healthcare growth.

In what critical area should health insurance be approached?
Formalising the health insurance programme such that wider pool is brought to bear to finance health service will reduce the risk for families, individuals from catastrophic health expenditure and that is an avenue that will grow the private sector and even help the public sector. There should be health sector regulation and standard setting to ensure that there is minimum standard that ought to be provided by practitioners and providers. We have to also attend to the quality of healthcare itself. UHC will not be achieved by just expanding access. Access alone may not improve the health of the people; we also have to attend to the quality of care. This is paramount for our leaders to pay attention to, because healthcare affects everyone. If you sample people’s opinion, almost everybody gets affected by the issues of health and yet our political leaders have not paid the needed attention, in terms of faster progress. Other countries have done it and we can do it. As we move on the UHC agenda and building the PHC, we also have to ensure that the core capacities in the public health system are built and also promote research so that we can understand within our localities the pattern of disease to know if there are things that are out of the realm. So, the Ondo state University of Medical Sciences and department of public health that has been established is to build a generation of visionary leaders that are going to be innovating, that will generate evidence and also influence both policies and practice and public health in Nigeria and also in Africa.

How do you think global institutions like Duke University can intervene in setting up a template that will assist Nigeria in addressing public health challenges?

You see, there is global solidarity but there is also national responsibility. Global universities-Duke and many others partner universities in Nigeria mostly on research and training. All of that will make sense if you have focused leadership in-country that is responsible to the people. No one can come from outside Nigeria and care for the health and well-being of Nigerians more than the elected or appointed representatives of the Nigerian people. They have to stand up first. That requires transparency and competence so that the institutions can have the partner they consider reliable and work with. Its two sides, no one will just come from outside and build our institutions for us. Now, with the school of public health in Ondo, what we are sensing is that there is a lot of willingness from many external partners to see how they can help to grow the school because they feel they have a partner.