Tejuoso: For Human Capital Development, Address Malnutrition, Brain Drain

Lanre Tejuoso

Senator Lanre Tejuoso is the Chairman, Senate Committee on Health. In this interview with Martins Ifijeh during the just concluded 2019 IMF/World Bank Spring Meeting in Washington DC, he spoke on the need for government to prioritise human capital develpment, address malnutrition and improve healthcare of Nigerians. He also addressed the implementation of the BHCPF, school feeding programme and other sundry issues. Excerpts:

How can we address issues around human capital development in Nigeria?
There are different areas of human capital development, but let me first of all talk about my own profession, which is medicine. You can see that all our medical doctors are leaving because they are looking for greener pastures.

Our salary system cannot be compared to what obtains in other countries. The difference in salary structure is too much. Meanwhile, the medical profession is needed like oxygen in the country. There must be a way to address the salary structure in Nigeria so that our doctors and other healthcare workers will be encouraged to stay.

Even the nurses and other healthcare professionals are leaving. Many countries, including those in Europe know the need of healthcare, so they have reduced the stringent measures for our doctors and nurses to come into their countries. In the United Kingdom now, they are doing everything to have our nurses and other healthcare professionals work with them. Meanwhile, we are doing nothing to keep them in Nigeria.
Another area of human capital development we need to address is malnutrition. Today, we have about 11 million stunted children. Meaning that in about 15 years time, these children will be around 25 years old, and they will be the ones manning the civil service and other areas of the economy. But their brains will not be developed enough to cope with what their age mates have to offer. This in turn will tell on the economy of the nation as well as their individual lives. Stunting is an irreversible damage because it cannot be corrected.

Meanwhile, if we know that there is no correction, then why don’t we just stop stunting from increasing? Look at the 2.5 million children that are malnourished in the country. Once you miss the first two years in a child’s life, the brain is permanently retired and that child becomes stunted. So there is nothing you can do again after the first two years. Even if we have forgotten these 11 million children, what about the 2.5 million who urgently need interventions?

To treat one already malnourished child takes about N50,000 per year. So let’s say two years will cost N100,000. Do you know we have to import these treatments? The United Nations Children’s Fund (UNICEF) is supporting us, but they are catering for 500,000 children. So we still have about two million malnourished children to sought for. Two million times N100,000 is the amount needed. This means we must set our priorities right during healthcare budgeting. We can’t talk about human capital development when we are not talking about the future of our children.

Before you came on board as Chairman, Senate Committee on Health, there was no budget to address malnutrition. But few years ago, it was included in the budget. How far has this gone in addressing malnutrition?
Yes. About N600 million was put into the budget, but around N350 million was released.

How many children will that treat?
The way forward is for us to re-prioritise in a very strict way. There are some things now that we need to cancel. For example, we are doing school feeding, which is good, but those children have passed the age, their brian is already formed. If we are going to feed them in the school, let us feed the ones whose brains still have the window period to develop optimally.

The school feeding programme is a laudable project but we must go to the basic, which is addressing malnutrition in children below two years. Those children under the school feeding programme will survive whether you feed them or not in school because they have passed that window stage. But a child of one year and six months that cannot get the food needed to develop the brain should be targeted.
You know this thing starts when the child in his or her mother’s womb. From onset, the mother should take the ideal food for the development of the fetus. That is why Bill Gates Foundation launched a programme to that effect. He saw the emergency and he said the first 1000 days should be addressed, which means that nine months plus two years. So we first of all focus on feeding the mother and the baby with correct nutrients for the baby to develop.

That is why we say it is very important that we develop our primary health centres for antenantal care, as this would be a channel to educate the parents on the importance of feeding in pregnancy. There are certain medicines they are supposed to be taking during pregnancy, for instance iron and folic acids.

The baby must have all these to assist the development of the brain because that is the engine of the baby and of anybody. Once you don’t have the brain you are gone. So the brain is crucial for development.

So are you proposing that the incoming government re-channel the school feeding programme for children below two years old?
Yes. I am letting the government know that the school feeding program is fantastic, but it should be targeted at giving the child well balanced maintenance. I will also encourage poor families to send their children to school. But then if the already stunted children are the ones targeted in schools, there is a likelihood they won’t learn well at the same level with their counterparts who are well nourished, because their learning process will be slow and retarded.

What effort is Nigeria taking as some development partners are winding down their interventions in the country?
Our aim is for Nigeria to have a recipient-focused investment. You know World Bank and other development partners are always talking every year on how to increase their support for us. So we are saying they should now refocus on how they will make us self sustainable. For instance, GAVI has given us a two-year notice that they are going to withdraw their support in about eight years time in the provision of vaccines. Meanwhile, Nigeria is not prepared to supply its own vaccines itself.

Aren’t they withdrawing because government says Nigeria’s economy has improved?
Yes, but we don’t have any vaccine production plant in Nigeria. While we are receiving all these supports, we are also encouraging them to help us in establishing our own vaccine factory. Companies benefiting from the purchase of vaccines into Nigeria should be able to talk to World Bank and other partners to fund such productions. They must have a vision of coming to set up a plant. We have investors in Nigeria who only require technical partnership.

Apart from the vaccine issue, we can also locally provide treatment for addressing malnutrition. These malnourished children can only be fed with the replacement therapy (RETF). Meanwhile, we are finding it difficult to manufacture RETF in Nigeria because 25 per cent of the content is soecika groundnut. Though we have groundnut in Nigeria, the World Health Organisation said the specfic content of our own is not good enough, so we have to import groundnut again to do it.

But why can’t we develop our own agricultural process with the support of international communities. They have been supporting anyway, now they should help us to have plants that manufactures RETF. It will save us a lot of foreign exchange. If organisations are winding down support for instance on vaccines and other areas, we should be able to say we are ready to produce these things ourselves.

But Nigeria has Bio-Vaccine; an organisation trying to start a vaccine production company in Yaba. Can’t that be a replacement?
If GAVI for instance had left when they proposed to leave, would we have had any replacement? At first, they told us they would leave in two years time, we pleaded for them to extend it to another eight years. Vaccine is a life saving product for Nigeria, and as such, we should have it manufactured in our country.

There are so many organisations that want to do corporate social responsibilities but they want these products (for instance, vaccines) for immediate disbursement, which means they won’t have to wait for three months to get them imported into the country. They will rather go and buy indomie or whatever is on ground. So we have a lot of Nigerians that are ready to invest.

We must concentrate our efforts into getting genuine technical partnership. This way, people will be encouraged to invest. Vaccines, nutrition therapies, and related products are technical and sensitive products. You can’t just wake up and say you want to start producing RETF because the conditions are very strict.

While you were presenting at the Palladium in Washington DC, you mentioned that the implementtion of the BHCPF is still very much on paper, and that it is not running the way you and your colleagues expected it to run. Can you expatiate on that?
Its very simple. We appropriated money a year ago for 2018 and the money is still intact. It is better with full implementation so that that money budgeted is utilised as planned within the time frame. The struggle last year was to convince all my mates to make sure that the money was enmarked. Now, to defend it for this new year, they will tell you why should they put in another money when that of last year was not used.

So what then happens to the BHCPF earmarked for last year?
The thing is, it will be transfered to the next year so that it doesn’t go back to the treasury. The way we made the policy is such that the money is supposed to be into a basket. It is a minimum contribution in Nigeria to a basket. Now Bill Gates too is giving us money to put in that basket. So that is the idea. Our own contribution is to help our technicians. Its our own contribution as a country. That is why immediately the World Bank saw our effort, they gave us 20 million dollars to put and every year it is billed to increase once they see that we are serious about funding BHCPF.