Olufemi Onanuga
Dr. Olufemi Onanuga is the Special Adviser to Lagos State governor on Primary Health Care. In this interview with Charles Ajunwa and Martins Ifijeh, he talked about the state’s drive to deliver a total of 75 world class PHCs to Lagosians by May 2018. He also spoke on the newly introduced Coastal Health Services, how the state plans to solve the scarcity of health workers in PHCs, among others
In August last year, the governor signed the release of about N1b for renovation of 20 PHCs in the state. Have these PHCs been delivered now?

Specifically, it wasn’t one billion naira, it was 905 million naira that was approved by His Excellency, Akinwunmi Ambode. We thought we were going to renovate the 20 PHCs, but we realised that there was no point doing renovation all alone, so we decided that we should renovate about 15 PHCs and use the remaining money to purchase medical equipment and furniture for primary healthcare centres.
Graciously, His Excellency has released 70 per cent of that approved amount, and work is seriously ongoing in the designated 15 PHCs. The equipment and furniture have been delivered. So by the time they finish the renovation, they will be equipped and delivered.
When will these 15 PHCs be delivered?
We gave the contractors about six months because we want them to do a good job, so we are looking at May 2018. That means by May, we would have succeeded in delivering 75 world class PHCs to Lagosians.
If you deliver 75 world class PHCs by May, it means Lagos still has about 200 PHCs that require the same transformation. What should we expect before this year end?
That will depend on how much is being budgeted for capital expenditure in terms of renovation and equipping of PHCs. We will look at how funding is coming in and see how many more we can work on before the end of this year. Once the monies are available, we won’t stop renovation and equipping of the PHCs.
We must also get it clear that the 200 remaining are actually functioning. Not that they are not functioning, but we feel we should bring them up to world class level through renovation and purchasing of new medical equipment because those that have been there will somehow be obsolete.
So we will replace old ones with new ones. Although, they are still functioning optimally, people still go there and get health services. We will continue to work on them in stages because we can’t finish them at once. Fund is a limiting factor, there are so many sectors competing for funds.
There are dearths of doctors, nurses and other health workers in the state. What are you doing to ensure there is increased numbers of health workers in PHCs? 
I want to correct that notion. When we talk of health workers, people always place emphasis on doctors alone. Health workers include; doctors, nurses, pharmacists, technicians and all. As much as we are renovating and equipping all the PHCs, we are also looking at times where we are going to employ people.
We have tabled this with the governor, and he graciously approved recruitment and employment of health workers. The governor has recently approved for the recruitment of a minimum of 245 doctors that will be spread across the state. Same for about 400 nurses, about 400 pharmacists, technicians, community health workers and several others, and the process is ongoing.
In August 2017, you hinted of the recruitment, and this is January. Why has the recruitment process slowed down?
When we apply for fund, the governor takes his time to look into it. He has prioritised it, and towards the end of last year, he gave us money for recruitment of our own workers and then we are about to start employing. Not that we have slowed down, we had to prioritise what we want to do. There are many areas looking, begging for funds which is not enough and can’t be enough in anywhere, so that’s what is happening. It can’t slow down because Lagos doesn’t slow down.
When it comes to timeline, when are we expecting more health workers in our PHCs?
In another one to two months, we would have added more hands to our workforce. We are not only concentrating on delivering world class PHCs, but also working on putting adequate personnel in place to offer health services to Lagosians.
In Ondo State, the TBAs are only trained for referral, while in Lagos they are trained to take deliveries. Why are you encouraging TBAs in Lagos, especially considering the fact that most maternal and newborn deaths occur with TBAs?
If you look at it very well, you can’t compare the population of Ondo State to that of Lagos State. In Lagos, people come in from all over and the population here is enormous- Almost 23 million. We realised that the approach of Ondo State will be cumbersome in Lagos State because of the population. And we know we can’t do it alone, that is why we have encouraged to partner with the Traditional Birth Attendants (TBAs). And we thought if we train them and limit their activities to the training, and also monitor them to ensure that the engagement of the TBAs will reduce our maternal and infancy mortality, this will help.
Notwithstanding, we have realised that a lot of TBAs are not coming up. They have refused to register with us. And because they are not trained, those are the ones actually causing the havoc. And measures are being put in place to curtail the activities of such TBAs.
In Lagos State, we have trained at least 1,500 TBAs that have registered with us. We have also ensured that these trained TBAs have standard operative procedures which we give to them and we monitor it. They are also registered with the TBA amnesty board in Lagos State. The governor himself after the training certified them to show that they are competent to do some of these deliveries. Despite that certification, we also encouraged them to as a matter of priority refer complicated cases to PHCs.
I believe that it will work because whether we like it or not, it will be difficult to stop TBAs in Lagos State because the population is massive and many residents believe in TBAs. They are the ones the residents have been using and they get results from them. Like I know for a fact that the majority of the TBAs are in Ikorodu areas, and those that are not registered are being worked on to come register and undergo training. We are even willing to pay their allowances for coming down.
Do you have any idea of how many are yet to register in Lagos State?
We don’t have any idea because they are not coming forward. They stay in their rooms and perform these things and it’s not easy to get all of them. All we do is to continue our education and enlightenment for them to come out. The more they come, the more we train them.
Is there a working relationship between PHCs and TBAs in the various communities? 
Yes. We have a community department in all PHCs where the community health officers liaise with TBAs and community members. There is no way you can do PHC service without community involvement because the community is the key ingredient of PHC. We also go to communities on our own for education, enlightenment, and immunisation, so there is no way you can be successful without community involvement.
Is there a way you encourage community members to use PHCs rather than use TBAs?
Yes, we do public enlightenment and health education. We don’t discourage them not to go to the TBAs but we encourage them more to use the PHCs because we partner with them. We just must tell them that even if you go to the TBAs, they should look carefully to detect it’s a registered one. Part of the ways we encourage them to use PHCs is by providing them with insecticides, mosquito nets, delivery kits, free card, free ante natal, among other ways. But many of them still go to TBAs. So we try to support the TBAs because if we don’t, we will record more deaths because people have cultural belief in these TBAs. That is one of the reasons we are partnering with them.
In terms of maternal and newborn mortality, what has changed since you assumed office?
Maternal and child mortality has drastically reduced compared to when we came on board.
Information available suggest you and your team have stopped monitoring PHCs across the State. Why?
We have not stopped monitoring PHCs, we only slowed down because we realised that there has been a serious compliance. Health workers are now coming to work early, closing when they are supposed to and they are doing their works without anybody monitoring them. Because of that, we realised that the compliance level is very high. We will still continue our monitoring and we will not relent because if we stop, I’m sure things will go bad or worse than when we came in.
What new approach are you bringing to PHC this 2018?

We are doing a lot in the urban setting. But we realised we still have a lot to do in the rural and the riverine areas (coastal areas) of the state. So this year, we have decided to offer them health services. We have more than 800 communities in the riverine areas. We have a programme that we are working on now, which we tagged ‘Coastal Health Service’.  This has been discussed with His Excellency and he has approved it and even approved advance money for the pilot phase.
The pilot study started towards the end of December and we gave it to an expert, Dr. Mabawondu, who is on it for the next three to four months in about 40 communities, including Oriba in Ekpe, Ikorodu area and other riverine areas. He has started on it and has ben briefing us on all the activities. After his assignments, he will provide a document which will serve as a guideline to carry out our duties. We have started in coastal area by making sure we build PHC in Takwa Bay, which is optimally functioning, we have nurses working there but we are still not satisfied with the way it is going on. If we are able to recruit, we will send some people there. We will make sure that those 800 communities have the presence of government in terms of health services.
The pilot study will take that long because  immunisation normally comes up every two weeks, so we go there and also provide health education, environmental sanitation, water sanitation, public enlightenment. On the water they drink, we will either give them boreholes or teach them to boil water. These are the little things we can educate them about because by the time we do that, disease burden will reduce.
Can you highlight some of the successes recorded since you became the Special Adviser to the governor on PHC?
I cannot decide on that, it’s for the people to talk about our successes, from my commitment to them. Part of the campaign promises of the Governor Akinwunmi Ambode, is good and quality healthcare delivery in Lagos State irrespective of ethnicity or religion. And the feelers we are getting are positive. We have improved on what we met on ground in terms of PHC services. The previous administration did well but we are doing better now. We have actually moved forward. Generally, people are happier now. All the complaints we used to get have reduced.
There are still obsolete PHCs that need intervention.
What are your plans to speed up the interventions?
 
I mentioned that the plans are there but we can only be limited by funding. Our plan is that these PHCs will be done in phases every year and we will ensure we improve on the process.
We appreciate journalists for putting us on our toes. It shows we are in this together. You have been correcting our mistakes by calling our attention to what needs to be fixed. The essence why we are here is to serve the people and the governor is very passionate when it comes to the people, he is a blessing to the state. I want to believe that Lagosians are happier and healthier now.