Despite the daily decline in COVID-19 figures, the Minister of state for Health, Senator Adeleke Mamora, has harped on the need for extra caution, just as he shared his thought on Nigeria’s health sector outlook post COVID-19 pandemic. In this interview with Omolabake Fasogbon, he also delved into sundry issues like the need for continuous routine polio immunisation if Nigeria must sustain her polio-free status; and the progress so far made on the National Health Research Committee that was set up May 2020, as well as the need for innovations in Primary Health Care. Excerpts:
It is six months since Nigeria had the index case of COVID-19. How would you access management of the pandemic since then?
Nigeria has not fared badly considering what the virus met on ground. It came unexpectedly and devastated lives and livelihood in the same manner it did globally. People have been saying that Nigeria has a weak health system but do we also realise that countries with the best health facilities bowed to the force of COVID-19? We are really grateful so far, moreover, President Muhammadu Buhari has been quite supportive since the outbreak of the disease. We’ve had the Presidential Task Force Committee who no doubt has been up and doing. COVID-19 has come as a blessing in disguise as we have also drawn the support from several bodies both within and outside the country. We have enjoyed support from advanced countries and various bodies like World Health Organisation (WHO), European Union (EU) and the African Centres for Disease Control and Prevention (Africa CDC). We have also been privileged to get help from nongovernmental organisation like Dangote Foundation, The Coalition against COVID-19 (CACOVID), Bill and Melinda Gates Foundation, amongst others.
Can you tell us how the funds donated by these bodies were utilised?
There are so many things a lot of people don’t understand about the interventions that come in during this pandemic. Let me clarify that the bulk of the interventions were in the form of materials and not in cash contrary to what many people believed. We have received donations like isolation centres, ventilators, Personal Protective Equipment (PPEs) molecular laboratories, extraction kits, nose masks, building and capacity building. Essentially, when donors give out these items, they usually say we are donating items worth a particular amount of money but people seem to give attention to the money figure alone. That is however not to say that we have not received assistance in cash but the bulk has been in kind. For accountability purpose, we have printed the details of how these funds were spent on the website for everyone to access.
COVID-19 curve is no doubt leveling off in Nigeria. Would you attribute this development to adherence to safety protocol or low testing capacity?
As much as Nigeria is doing a lot to increase testing capacity, we have not reached our destination yet. Yes, we are doing a lot in terms of advocacy, risk communication and non- pharmaceutical intervention; we can also say to some extent that people are observing the COVID-19 precautions. Having said that, we say that it is not yet time go to town and start jubilating, the reduction in figures only call for greater caution because there is always a tendency for resurgence. We need to learn from what is happening in other countries where the measures were relaxed but later had resurgence. This is why we are very careful about full reopening of schools. No country, as far as COVID-19 is concerned, can say it is uhuru. It is not at all.
Government seems to be relaxed in terms of response to Lassa fever despite the fact that the disease is still much around. Is it that you are taking some measures underground that the public don’t know of?
One of the challenges that COVID-I9 has brought on us is the tendency to downplay other routine services and programmes. But, from day one, we have given a clear instruction to our centres, institutions and practitioners not to neglect other routine services. In the case of Lassa fever, the disease thrives towards the peak of the dry season and we are in the rainy season presently. Notwithstanding, the advocacy on precautions still continue. While the federal Ministry of health is not relenting, we have always encouraged respective states especially the high burden areas to be on the alert.
In May this year, you inaugurated the National Health Research Committee, what can you say have been the committee’s achievement so far?
They have been working in collaboration with several bodies and institutions. We anticipate major breakthroughs with respect to drugs and vaccine to defeat COVID-19. Presently, we have close to 250 vaccine candidates that are being interrogated to be able to establish their efficacy against COVID-19. Let me state here that their scope of research is beyond COVID-19 and you should understand that research result does not come so fast as there is no magic in research. But so far, we have been able to establish the genomics sequence of COVID-19, which is we have been able to discover that the virus discovered here is same as the one that originated in Wuhan, China. This was established by the National Institute of Medical Research in collaboration with other agencies. We have also been able to establish that as a survivor of COVID-19, you are likely to have an infection from another mutant virus that is not exactly COVID-19 but may have a wilder effect. The committee is up and doing and we must appreciate them. Research is endless.
More health workers have tested positive for COVID-19 in Nigeria than in any other country in Africa except South Africa. The common reason given for this is inadequate supply of PPEs. What is the ministry doing in this wise?
The basic thing is to make sure that our health workers have adequate supply of PPEs, which we have not underperformed in this area. However, one thing is to provide PPEs and another thing is effective use of them. Once PPEs are not properly used, then the possibility to contract the virus is high. This is why we are taking our time to train and retrain medical professionals on the use of PPEs and several other areas this period. We will not relent on this training and we will continue to ensure adequate supply of the PPEs. Don’t forget also that we have made provisions for isolation room in our health facilities. Health workers are mandated to stay here after a work shift for a particular period before they go home and reunite with their family. This is also to prevent them from spreading the virus just in case they are positive.
What are you doing to address brain drain in the sector as we know some health workers are thinking of leaving the country at any slightest opportunity
We are definitely aware of this and we are not folding our hands either. The complaints generally have been about condition of service, emolument, working environment, equipment and infrastructure, amongst others. But like I tell you that, things are and will continue to improve, we therefore see no reason for this flight. Take for instance, the federal government has started paying for doctors’ residency training which comes at a huge cost. We also recently started paying the hazard allowance
But the payment for hazard allowance has not being implemented in all hospitals
Well, we can talk about some shortfalls in some areas which are not entirely the fault of government. We can only rely on the figure given to us by those doing the computation at the centre. We approached those doing the computation to compile names of worthy workers and send to us only to discover some errors. We are reviewing the situation and it will definitely be sorted out.
Nigeria health budgetary allocation of four percent is far behind the 15 per cent benchmark agreed upon in the Abuja Declaration of 2001. With COVID-19 realities, should we look forward to a new era in health financing?
Let me quickly say here that it is not all the time that what happened in the health sector is determined absolutely by the health sector. Health performance is also shaped by activities in other sectors. Having every other sector like power, water, e.t.c in shape will reduce the cost and burden on the health sector. Notwithstanding, we cannot pretend about the fact that budgetary allocation is not important because there is also personnel cost other than equipment or infrastructure. This is one of our priorities and again we have made the health insurance scheme compulsory so that we can have a bigger net of people covered by the plan.
One of the promises of the present administration is to make primary health centres work for 24 hours daily. This is not yet the case. Why is it so?
This is one of our major projects but before we can make this happen, we should be talking of fully functional health centres where virtually everything is intact. Fully functional in terms of accessibility, infrastructure, constant electricity supply preferably renewable energy, water supply, human resources, electronic record system to capture patients data, essential service and essential drugs as well as staff quarters for health workers, amongst others. These are all what we are aiming to achieve. This administration is aiming at not less than one primary health centre in each of the political wards. We have almost close to 30,000 health centres and we are working on upgrading them to taste. This is why we are also inviting private partners who want to be involved in this mega change.
What major trends should Nigeria look forward to in the health sector post COVID-19?
COVID-19 like I said earlier is a blessing in disguise. It has given us the opportunity to see to other routine cases. It has also imbibed in us the attitude of preparedness. Recently, I was at Federal Medical Centre, Ebute-metta, Lagos to inaugurate the newly built state-of- the -arts accident and emergency unit , you can imagine that we are doing this even during the pandemic. Certainly, we expect nothing less than improvement all round. Our vision is to ensure that every state has at least a 100- bed infectious hospital, fully furnished intensive care units, appropriate and motivated human resource, well equipped and expanded health facilities that are better equipped.
We are aware that you have been talking to traditional medical practitioners to come up with their solutions for COVID-19. Should we expect a breakthrough soon?
Yes, we recently had an online engagement with traditional and herbal practitioners where we asked them to come forward with their COVID-19 solutions. We hosted about 21 of them online and we are planning to have another session with some other groups. But you know, these things do not come so fast like that, we have to work the way of science by subjecting whatever solution they bring to interrogation. For instance, when Madagascar came up with COVID organic, in the wisdom of President Buhari, we were able to subject the drug to test which at the end of the day we discovered that it only has some activities against cough, it does not have curative property for COVID. Likewise, we are asking herbal practitioners to come forward with their solution which we will then subject whatever they bring to due process. First of all, NAFDAC will test for safety after which we will test the efficacy and then check for the side effects. We will also check whether the therapeutic advantage outweighs the side effect, we will also look for volunteers who will present themselves for testing of the drugs and off course, such persons will sign an undertaking that they have willingly submitted themselves. We also have a duty to protect their intellectual property that is where the legal aspect come in. All these are what we convey to them during the engagement .We let them understand all the processes so that they don’t feel that they do not matter or being marginalized.
Some people still believe COVID-19 is a hoax. What word do you have for people like this?
It is unfortunate that some people still think COVID-19 is a scam. As government, we have a duty to keep educating our people to do the right thing and engage them with risk communication. We will continue to do this. But for those who still feel it is not real, I would implore them to first of all learn to take responsibility for their health. I say that nurturing this belief will be unfair on the frontline workers who are sacrificing their lives. It is like making mockery of their huge sacrifice and we appeal to people in this category to face the reality. People are dying! We see and we know them. Some survivors have even come out to share their experience. I mean how else or what else do they need to be convinced? if they still don’t believe with all these, then I say good luck to them.