An estimated 2,000 children die every day from malnutrition in Nigeria, and 11 million are stunted, according to the Chairman, Senate Committee on Health,Â Senator Lanre Tejuoso,Â
In an interview withÂ Martins Ifijeh,Â the lawmakerÂ said Nigeria accounts for 14 percent of undernourished children in the world – a share topped only by India, whose population is more than seven times larger. While Nigeria plans to provide a school-feeding program for children to tackle malnutrition, he believes more is needed, citing in particular a need to improve care for pregnant women and children during the first 1000 days of life.
The wide-range interviewÂ also touched on other topics, includingÂ President Muhammadu Buhariâ€™s health, and the need for increase in health budgeting.Â Excerpts:
What are your thoughts on the high level of malnutrition in Nigeria?
Nigeria is contributing 14 per cent of the total number of malnourished children under five years to the entire world. We are second only to India, which contributes 20 per cent. Malnutrition in Nigeria is not just something happening today, but came to major highlight because of the establishment of the Internally Displaced Persons (IDP) camps as a result of the Boko Haram devastation.Due to the nature of the camps, it was easy to know the number and percentage of malnourished children in the region.
On a larger scale, we have over 11 million stunted Nigerian children. This means these children will not be able to develop the organs in their body to the optimal level. By the time they are 30 or 40 years old, their brain and other organs wonâ€™t have developed to that level, which means they will not be able to perform effectively in relation to their age. Their contribution to the society in terms of what they can offer and achieve will be very minimal as well.
How will being stunted make children unable to live their full potential as adults?
This means the children would lack the necessary nutrients for proper development in the first one thousand days of life. Day one starts the day the woman gets pregnant, then, up to when the child becomes two years old. That is the time the organs of the body develop fully and optimally. Once this period is lost, it is irreversible.
Giving priority to the first 1,000 days is more important than the school feeding programme the government is talking about. If we concentrate more on that 1,000 days, we would have succeeded in solving a major problem. Of course school feeding programme is good because of the poverty situation in the country, but those children that are already in school would have developed their organs already or are in an irreversible stage of poor development due to malnutrition in their first 1,000 days.
The school feeding programme does not address poor brain or organ development, but will only be useful in maintaining the children, not for development. So if I have 10 naira, I will rather spend five naira on the first 1,000 days of life and then keep five kobo for school feeding.
How can the government support families for first 1,000 days of their children?
First, we have antenatal classes. When the women are pregnant, they often go for antenatal visits. During these classes, there should be necessary support from the government for them to take care of their feeding and that of the baby inside them. When a pregnant woman eats well, it will also tell on the baby inside her. Since any mother that delivers need to continue hospital visits for at least the next one year, the primary health centres should design a way of continuously providing nutrition intervention to them. These women should be able to get all the goodness needed for the development of their children until they clock the first 1,000 days of life or two years old.
There should be a system that works with health facilities and midwives, such that these pregnant women and mothers, especially in rural areas, are given nutrition packs for themselves (if she is a pregnant woman) and for the babies (if she has delivered).
As a policy maker and the Chairman, Senate Committee on Health, what have you done to see that these plans become policies and are implemented?
On our part, we have drawn more attention of the government and stakeholders to nutrition. When we came in, the budget for nutrition interventions in the entire country was two million naira (about $3,273). That is the least budget in the world for nutrition intervention. Yet we have about the highest burden of malnutrition, just second to India. That amount definitely could not take care of nutrition intervention in just one ward in the country. Nigeria has about 9,572 wards.
But in this yearâ€™s budget, we have been able to argue a case for its importance. There is over one billion naira (over $3.3 million) budgeted for nutrition intervention. Although the budget is still not correct because it is focusing only on malnutrition in children, where as nothing is allocated for pregnant women, because the intervention should even start from the womb.
Recently, you mentioned that money spent on nutrition for the first 1,000 days of life was never wasted. Adding that for every naira spent on a childâ€™s early journey yields 17 naira. Could you elaborate on this?
The reason your organisation sent you here to do this interview is because you have the capacity for it. If you were stunted, you wonâ€™t be here. The reason people contribute to their countries is because they are not stunted, which means their brains developed to its optimal capacity. But for a stunted child, by the time he or she grows into an adult age, which is when the country needs them to work in the civil service or in other types of services, such children wonâ€™t be able to to provide services because they havenâ€™t developed to the level required.
Their age might be ideal, but their brain development will be too poor or small for such age. What this simply means is that we wonâ€™t have enough workforce for the country and of course the country will not be able to generate the income it suppose to. But for every naira you spend in making sure a child develops optimally and not stunted, when that child grows up, that investment returns back as 17 naira because he or she will be able to contribute in that measure to him or her self, and the society as well.
We have several people your age in this country, but not all are competent enough to do the job you are doing now. For such people, their brain canâ€™t comprehend it.
Since Nigeria has 11 million stunted children, what would this mean for the country in future?Â
What this means is that while other countries will be enjoying return on investment on early childhood development, Nigeria will be lagging behind because our major workforce will be persons who did not develop optimally during their early childhood yeas. We have 11 million children now that they are going to grow into adult with the brain of children. We wonâ€™t notice the damage now, but in future we will see it.
By that time when Nigerians go to America, everyone will be saying Nigerians are the dullest people, because those persons must have ended up not developing well. Now, Nigerians are glowing all over the world because we were not having stunting issues 10, 15 years ago. We hear reports they are doing well in universities in the U.S., United Kingdom because the youths and adults of now do not have stunting problems then. Their brains are well developed. That is why for instance, you hear six universities abroad begging us to come study with them. But we should fear for a decade or so to come for the generation that will become Nigerian youths and adults. In 20 years to come, God help our country, you will no longer be hearing â€˜Nigerians are sharp and intelligent. What we may be hearing in future is that Nigerians are the dullest peopleâ€™ because the millions of stunted children we have now will be the youths and workforce of tomorrow. Now the world sees an average Nigerian as intelligent, but we will be seen in future as the dullest people in the world if we donâ€™t tackle the burden of stunting we presently have. As Iâ€™m talking now, about 50 per cent of children in the North are stunted. The South-west contributes to19 per cent of stunting in the country.
You have at different occasions raised alarm on our malnutrition issue in the country. What do you intend to achieve?
It is alarming when you hear in Nigeria we are losing up to 2,000 children daily because of malnutrition. It is just like when we say we put 2,000 children in a Boeing 747 and then crash it everyday. That is what is happening now. If these children were dying from such crashes daily, I believe we would have made it a national priority. But what is happening now is more than that. Do you know what it is for 2,000 children to be dying daily? It means we are gradually losing our future. Mind you, that is even for those dying. We have many more who are lucky not to lose their lives, but they end up being stunted.
I just came back from World Bank programme on malnutrition in Nigeria and they intend to support us. I thank God the President of World Bank, Finance Ministers from Nigeria and Indian, among others were present. By the way, Nigeria and India have the largest of malnourished children in the world.
What has Nigeria not done right to warrant this level of stunting in children?
We should take a queue from other countries that have made progress in their health sector. Use Turkey as an example. I have learnt a bit from them. They were like us about 10, 15 years ago, but now the difference is clear.When you invest in healthcare you will get the desired results.
Nigeria called all African countries together and made the Abuja Declaration in 2001, which called on every member country of the African Union to allocate 15 per cent to health from their annual national budget. Countries that do not have resources up to Nigeria are already getting there. They are not just getting there, we are seeing the results. Now they are enjoying medical tourism.
How much are we investing in our healthcare system in this country? The executive should raise the health allocation in the budget so that certain interventions can be done adequately. But often times when the budget comes, you discover percentage for health is very small. And if we try to do anything on it or raise it, they will say we are padding the budget.
As the Chairman, Senate Committee on Health, what have you achieved?
I will say first of all, we have put a lot of attention on the countryâ€™s malnutrition crisis, which has in no small measure contributed to the health situation in the country. We have also commenced and about to conclude the amendment of the National Health Insurance Scheme (NHIS) because without universal health coverage, there is nothing we can achieve.
The plan is this! We want health insurance to become mandatory. If it is only N100 (33 cents) every Nigerian is paying monthly, we will have enough to fund the health sector. Assuming we have just 100 million Nigerians paying N100 (33 cents) each, that is N10 billion ($32.7 million) every month. In a year we will have N120 billion ($329 million), which is a huge amount. That N100 is just equivalent to what we use to buy recharge card everyday.
Even when you see a very poor man who hasnâ€™t eaten, he still finds a way to buy recharge card. The good thing is this amount will be paid not every day, but monthly. That amount alone can be used to develop our primary health centres. With it we can build one PHC in every ward and with your N100 (33 cents) payment for the month, you can go to any health facility with your ticket to get health service.We are very hopeful this NHIS amendment will change our health system for good.
What I also want to achieve is to at the least see that we have two hospitals that will be medical destinations for Nigerians instead of rushing abroad for healthcare.
As a medical doctor, a stakeholder in this government and by virtue of being the Chairman, Senate Committee on Health, what are your thoughts on President Buhariâ€™s health?
On our Presidentâ€™s health, I donâ€™t think I know more than you do. I only know just exactly what you know. Yes, I am a doctor, but Iâ€™m not his personal doctor. All I know is that he went for medical attention abroad and he is back. I cannot say more than what I know. The only thing is that this is a pointer for the need for us to support our quest for a quality healthcare system, such that no Nigerian would have the need to travel outside this country again for healthcare.