Umar Abubakar: Sokoto is Fighting for Every Breath

Ex Secretary General/Registrar/CEO of the Nursing/Midwifery Council of Nigeria (NMCN) and Commissioner of Health, Sokoto State, Dr. Faruk Umar Abubakar tells Louis Achi the state’s health sector was in Intensive Care Unit, ICU, in 2023, before the current government and shares insights into what the administration of Governor Ahmad Aliyu is doing in line with its 9 Point Smart Agenda to reposition the sector

You are not a medical doctor, though a crucial stakeholder and professional in the sector. How did the Nigerian Medical Association (NMA) react to your appointment?

The appointment of all commissioners is political, except that of the Attorney General and Commissioner of Justice, which the constitution lists the qualifications the candidate must have – specific number of years at the bar, etc. So, every other position is at the discretion of the governor and he is at liberty to appoint anyone that he believes would add value to his administration.

I am aware of that issue, but in my own case, my appointment was welcomed by the entire professionals in the health sector. And I want to believe it’s because they know my antecedents. Having been around for the last 35 years, I have established a very good working relationship with all the professional bodies and have utmost respect for every profession in the healthcare delivery system.

So, I wasn’t surprised they celebrated my appointment and have ever been very supportive. In return, I have been fair and respectful in my relationship with them. Take the issue of the new National Minimum Wage, I engaged with the governor and thankfully he agreed with me that they deserved to be better remunerated.

I am very proud to announce that today the Sokoto State Government pays better than the federal government, such that those who had wanted to leave have withdrawn their letters of resignation. The various professional bodies wrote the governor thanking him for approving a salary package that matches that of the federal government.

So being a commissioner is about protecting and advancing the interests of your constituency and ensuring that they have the necessary working tools and a working environment that is conducive – which is what the governor has been doing since 2023. A doctor needs medical scientists, nurses, cleaners, pharmacists, etc., to function effectively.

You retired as Registrar/CEO of the Nursing and Midwifery Council of Nigeria. Against this background, how difficult was it for you to hit the ground running?

Having been in the health sector in the last 35 years, I would say yes, it wasn’t really difficult. Luckily, I started from the very scratch as a nurse, and I have worked in hospitals and interacted with all professionals in the healthcare system. So, I have a good understanding of the issues.

As an administrator, I understand the issues that must be addressed so that we can deliver quality healthcare to our people. I am lucky to have a governor who truly believes in delivering quality healthcare to the people. He has, for instance, approved my memo for the State Specialist Hospital to run internship programmes for radiography and medical doctors.

We have applied to the Medical and Dental Council for the necessary accreditation. Sokoto State has more than 100 medical doctors who have graduated and they need a specialist hospital for their programmes. So, this initiative would solve a big problem for us. Just as we have about 270 medical students on the payroll of the state government.

They have been placed on Level 07, which is about N82,000 monthly. It’s the same with pharmacy students, medical lab scientists, etc. So, we are solving the problem of inadequate personnel and at the same time making life easier for the students and their families. We stand to benefit in many other ways because, being indigenes, they understand the culture of the people.

On admission they get scholarships, but once they start their clinical practice they are transferred to the Ministry of Health and the ministry will in turn transfer their documents to the Civil Service Commission, which would process and send their details to the Ministry of Finance for implementation. His Excellency has also paid the registration fees of all our foreign trained doctors. This has helped address the shortage of medical personnel.

From the needs assessment you carried out on assumption of office, what did you find out?

From the needs assessment I ordered and visitation of all the general hospitals in the 23 local governments I noticed inadequate manpower at the grassroots, a gap that was unacceptable. I equally found a health system that was on its knees due to the neglect by the Aminu Tambuwal administration. Infrastructure at the hospitals was practically nonexistent with obsolete equipment, decayed and uninhabitable wards.

Even the mattresses were torn into pieces and the beds broken. The first thing that we did was to urgently provide critical equipment and mattresses. We have equally procured nine ultrasound machines that will be distributed to the general hospitals – 3 for each senatorial district. Same with X ray machines, one for each geographical zone, so that investigations can be carried out at that level.

Our people don’t have to travel to Sokoto for such investigations. To date we have also procured about 240 beds, 240 mattresses, and 240 stands. I want to assure the people of Sokoto State that the governor has just started because he is more than determined to change the story. Governor Ahmad Aliyu means business when he says that health is a critical component of his 9 Point SMART Agenda.

The other benefit of my needs assessment is that it enabled me to come up with a strategic framework that would give us the direction to address the problems at the primary healthcare, the secondary and tertiary levels. So, very important is infrastructural development. We are going to tackle 10 general hospitals in the first instance and we have sent requests to the Ministry of Works to carry out an assessment to enable me make my submission to His Excellency.

I have visited the specialist and orthopedic hospitals. I must say that I was scandalized that the entire maternity ward was without light. How can doctors operate without power? The governor has since approved the installation of solar power. We now have 24 hour light at the labour room, in the postnatal ward, and in the prenatal ward.

We have also acquired incubators for premature babies. There is also 24 hour power. We have embarked on a comprehensive rehabilitation of the wards. We have provided functional toilet facilities for families and visitors – the era of open defecation is past. We sank boreholes, with overhead tanks to ensure availability of water 2/4/7. Even though the hospital is almost 100 years old, we can make it functional.

To help in the general cleanliness of the hospital, I engaged the services of prisoners. We are working on the drainage system. The environment and general sanitation of the hospital has greatly improved. I know His Excellency is planning on building a new world class facility. The other thing I am working on is the attitude to work of our personnel.

I have had series of meetings with them on the need to be diligent and caring in their work. They have no reason to be lackadaisical – especially as the government is prompt in payment of their salaries and allowances. I will no longer accept negligence of duty, where workers abandon their duty posts and leave patients unattended to. The abandoned amenity ward is receiving attention, same with the new theatre. It’s a shame that the equipment has been stolen. I intend to get the hospital functioning at full capacity.

How many hospitals and healthcare centers does Sokoto State have?

We have about 824 primary healthcare centres, health posts and clinics across the 23 local government areas. In each of the 240 wards, we have a primary health centre; health posts and clinics in villages – that is what gives us the 824 facilities across the state. Presently, we have about 21 hospitals, meaning at least one general hospital in each LGA. We have two in Tambuwal. It’s only Dange Shuni and Wamakko LGAs that presently do not have general hospitals.

These were abandoned by the Aminu Tambuwal administration?

Yes, but the government is working assiduously hard to ensure that we have a general hospital in these two local government areas – Dange Shuni and Wamakko. The Aliyu Magatakarda Wamakko administration in 2013 awarded the contract for the construction of the hospitals but it was unfortunately abandoned by the Aminu Tambuwal administration.

Meanwhile we’re making efforts to ensure that all our general hospitals are renovated. We started with 10 hospitals. For the rest of the hospitals, His Excellency, the Deputy Governor, who is also the Commissioner of Works, has constituted three committees – one for each of the senatorial districts to assess the hospitals.

So, we are awaiting the reports from the Ministry of Works. I am grateful to the governor for his unprecedented investment in the health sector. I can tell you that today, Sokoto is fighting for every breath and we are succeeding.

What is the funding situation in the sector?

Accountability is key, especially under Governor Ahmad Aliyu Sokoto, who constantly reminds you that it’s the people’s money. So, the judicious use of the limited resources is important, and planning. You might have all the money, but without a strategic framework you can squander the resources.

Money is important, but planning and prioritization are crucial. In my ministry, I have in a systematic way addressed fundamental issues, one at a time. We ensure we have a detailed report of whatever we want to do and that has helped us in achieving results. I will give you an example.

Recently the governor sent me a text message: “Honorable Commissioner, do you have an outbreak?” I replied that indeed there were some issues of an outbreak of hepatitis in the prison and that it had been resolved. He replied that I should investigate further. Eventually we discovered that there was an outbreak of measles.

I quickly deployed our epidemiologists to the following villages: Sayyinna, Jabo, Salla, Alassan and Barkeji – all in Tambuwal Local Government Area. We established that 20 children were affected and that three had unfortunately died. We then moved in the team with the necessary drugs and had a camp erected to isolate the children that were affected because we didn’t want it to spread. So, the issue is not always about money even though money is important.

It’s essentially about planning. This is our approach in tackling every issue. We engage in sensitization and advocacy and that has helped us contain any outbreaks of diseases.

Any other major challenges that are hindrances to healthcare delivery and what policies have you introduced to overcome such hurdles?

The attitude of the healthcare providers and the people themselves is a big issue. Patients, for instance, believe that everything must be provided to them free. They also only go to hospital when a problem has reached an advanced stage – most times beyond the capacity of the hospital in their area. They prefer being treated by chemists who are solely interested in making money.

We are working with the Pharmacy Council of Nigeria to sanitize the system. We appreciate that, being close to the people, they offer services, but they should keep to their boundaries. For instance, they shouldn’t be injecting. They should encourage people to use the hospital after administering first-aid treatment. The other major challenge is the state of the hospitals.

Many people deserted the hospitals because of the infrastructural decay. With what we have put in place, people are coming back in droves to our facilities. I have insisted that they operate antenatal clinics from once a week to at least three times.

Which do you favour – preventative or curative medicine?

Well, we are taking them simultaneously.

Against the background of poor health status indices flowing from poor health literacy, informed by cultural and religious triggers and lack of education, what’s the way forward in getting folks to embrace immunization?

I will shock you with the statistics of our immunization campaigns. Our strategy was to work with the traditional institutions; the religious leaders and I must thank the Sultan of Sokoto for his leadership in the various sensitization campaigns. The Sultan convened a meeting with over 82 district heads and some selected religious leaders on the need for them to embrace and propagate the benefits of immunization.

We made it abundantly clear that the children in question are our children, and that if they are not healthy, they can’t be future leaders of tomorrow because they will have critical health challenges. As a result, the last round of immunization was near perfect.

The number of rejections that were recorded was minimal. We noticed that the rejection rate came down from 4,000 to 1,000. We have not given up on those who refused because every child is important to us.