Dr. Jeremie Zoungrana, who joined the Bill and Melinda Gates Foundation as Director, Nigeria office in January 2021, is a health sociologist and program management specialist who brings more than two decades of leadership and experience managing complex, large-scale family planning; reproductive health; maternal, newborn and child health; HIV; and community health projects across both the public and private sectors in sub-Saharan Africa. In this interview with Chiemelie Ezeobi and other select journalists, Zoungrana, while reaffirming the foundation’s commitment to support Nigeria to meet its development priority, also touched on COVID-19 pandemic, vaccine misinformation and hesitancy mandatory vaccination, challenge of insecurity on Immunisation, among other things
What do you stand for?
The Bill and Melinda Gates Foundation through our many partners helped to build back better and is sustaining essential delivery service, life-saving services to those who need them most. Together we have saved gains on routine immunisation, Primary healthcare services, maternal/newborn/child health, financial services for poor and agriculture. We also made a strong commitment to support Nigeria, to meet the minimum, the human capital development goal. Just last month, we had a Memorandum of Understanding review with six states and all of them are on track. We were able to review our collaborative effort to deliver primary healthcare services for the people.
At the Bill and Melinda Gates Foundation, we believe that all lives have equal value. We envision a world where every person has the opportunity to live a healthy and active life. In Nigeria, since 2010, working across health, agriculture, financial development, nutrition and more recently, on gender, all within the goal of supporting the country to advance its progress in achieving the sustainable development goal and ensuring health and productive life for all. At the foundation, I have to say that we have four main goals. One of them is to ensure more children and young people survive and thrive. The second one is to empower the poorest, especially women and girls, to transform their lives. The third one is combating infectious diseases that particularly affect the poorest, and the last one is to inspire people to take action to change the world.
The Gates Foundation doesn’t make a product or provide a service, we don’t do work in the field. Hence, what we do is deploy the funding that you know should be a catalytic way, our voice to advocate for what matters most and area of key concern; our convening power, mobilising other partners to support big efforts or big area, and also the expertise of our staff. By combining all of them, we hope it will act as the catalyst and spur positive actions to bring a big change in a systematic way.
I assumed office as the Nigeria Country Director since January 2021, and since then, I have met with several partners like I am doing right now with you this morning, to reaffirm the foundation’s commitment to support Nigeria to meet its development priority. We know that this effort requires support from the government, the private sector, the public, community, non-profit, individuals and of course, the media. We need all hands on deck, and I am happy that this morning the media has remained as usual, a trusted and reliable partner to work with through the years.
The Bill and Melinda Gates Foundation commits huge amount of resources to a wide range of projects across Africa, and Nigeria in particular. What is your assessment of Nigerian public and private authorities’ commitment to these goals? Do you think there are areas they can improve, and what sort of improvement would you suggest for them?
Yes, we know the foundation committed a lot of money across… talking about the level of commitment of Nigeria public health as well as area of improvement. So, I have to say that in that area, when the foundation wants to make investment, or use any of our assets as I mentioned, it has been always in partnership with the government and we assess the commitment before engaging together because whatever we do, we have to do it with the government. And we saw it through different programme that become a priority for the federal government. We saw it through the polio virus eradication where we saw high commitment from different actors, down from the community level, and we are seeing it with the primary healthcare systems transformative endeavour. In the context of Nigeria, everything in the health sector as well as the productive sector remains priority and we are working together with the government to make sure that we accelerate progress on these areas to ensure that people are healthy, but also, they can contribute to a productive life.
What new programmes, if any, do you have in mind for sub-Saharan Africa and Nigeria in particular?
Of course, it is not because I am a new director that everything should be new, so, I am here to ensure that we have continuity on our commitment. That remains on top, and I will not talk about new programme because our priority remains the same and we need to make sure that we fulfil them efficiently before moving to a new thing. But, of course, as we continue to implement and collaborate with different partners and the government, we need to make sure that we bring innovative approaches to accelerate progress. We also need to ensure that we tackle the most important issues that are critical to development. In the context of Nigeria, I think we remain committed to what we want to do, and we want to make sure that we accelerate progress because in the health sector for example, there is a need to really accelerate on maternal mortality reduction, strengthening routine immunisation so that we don’t get the polio virus coming back, reducing childhood mortality. Also, on the agriculture sector, we need to support small-holders to have more productivity, financial inclusion. So, there are a lot of tools and technologies that lead to development and these are areas we want to focus, of course with the ownership and collaboration with different partners.
Over the last 12 months, security in Nigeria has worsened, going by the numbers, and of course indices- kidnappings and killings nationwide. How does this affect the Gates Foundation’s immunisation programme here in Nigeria?
Before COVID, security has been a big issue and a big concern for all of us including the foundation. It is clear that the security issue is not without negative impact on access to services, including service provision across the country. During our MoU review with states, we have many governors who attested that there are a lot of challenges with security and these impact to key essential services like immunisation. I think a lot of innovation have been developed together with partners to improve access in different ways. New points of services are being created for those who cannot have access and help is being proposed for some people to have some information, outreach activities are being developed. This is mainly for the internally displaced people, and also people who are in areas of difficult access. I know that other interventions are aligned to mitigate the consequence, which is also part of our area of concern, and we are working closely with states to make sure that essential services are made available.
What is the foundation’s position on mandatory COVID-19 vaccination?
We don’t have a position on what is happening at the state level, but what I can tell you is that vaccine has been a proven intervention to really bend the curve in terms of infection and it is evidence based. What we need currently is to ensure that the country get enough doses for people to be vaccinated. Of course, a lot of behaviour awareness communication has been on that for people to get the vaccine to protect themselves against the COVID-19 pandemic. Of course, vaccine hesitancy is a clear concern and many people are coming with different solutions to address it. I do believe that if we continue to emphasise on sensitising people and also clearing rumour on everything around vaccine, we’ll get people coming to take the vaccine without being obliged to take it. I think it is a way that people are using, many efforts are being done to sensitise and educate people on the importance of the vaccine for them.
There are a lot of misinformation in the public space already, even before the pandemic, like cholera and other diseases, but the COVID-19 pandemic actually made misinformation worse. Is the foundation willing to fund projects to tackle misinformation in Nigeria?
The foundation is already working with different partners and entities to address miscommunication. As you know, miscommunication is a big barrier and feed negatively, any effort that can boost development. And you right, the foundation is also considering helping, supporting any project that contributes to fighting against miscommunication. As you can see, we have a communication team and this team is really following at different levels to address miscommunication and support any project in that area, as they are already supporting some of them at the country level and also at the regional level.
There has been a lot of emphasis on COVID-19, but also, I know that the Bill Gates Foundation does a lot of work in the area of Agriculture. What has been the effect of the insecurity on Agriculture and food security? In what areas will the foundation be coming in, in that regard?
I think if we have to really develop on the COVID impact across every single sector, of course, agriculture is one of the main activities for many population has been greatly affected. When you don’t feel safe, you cannot even initiate any intervention. You have to move, and when you move to a safer place, you do not have land to continue your activity. Consequently, you will see a reduced level of productivity and of course many people put in poverty and they do not have access to food. So, this is a cycle with consequences that are glaring, but you know that even though in Nigeria, we don’t have a big programme on food security, except through the nutrition and the productivity projects that we are supporting, we know that globally, the foundation is working with global leaders like World Food Programme, FAO, to ensure that every country at least gets the assistance to provide support to the poor, to the displaced people and those who are being affected. Most of these interventions currently are based on humanitarian aspect, the Foundation is not yet at the humanitarian area as we are tackling the development aspect, but we are working in collaboration with other partners to be sure that they are covering the gap, understanding that responding through providing food to displaced people is just an interim solution, as the long-term and permanent solution is to ensure that we tackle the security issue definitely and that involves a lot of interventions, because it is fuelled by different factors.
Another question on the vaccine-derived polio, which is on the rise. Do you see a situation whereby it could actually dissuade people from getting vaccines and then set Nigeria back on polio, which was eradicated last year?
Of course, if nothing is done, it will be a rare problem of concern, but I am happy to see that state leaders and the NPHCDA is really taking this seriously. I recently attended a meeting with traditional leaders to discuss about this fact because the gain on polio eradication needs to be maintained and it can only be maintained if we continuously support routine immunisation. I am seeing a lot of efforts done at state level and at the ward level for people to really bring back children for routine immunisation. It is clear that Nigeria currently is the biggest country with immunised children and this is something that people are really taking seriously to address and I hope we will succeed.
On COVID-19 hesitancy, we’ve seen that the federal government is already considering the idea of making it compulsory, mainly because a lot of people are not inclined towards taking it, and some states have actually stopped testing for COVID-19…what is the foundation doing in terms of advocacy…?
As far as COVID-19 hesitancy is concerned, this is something that the foundation is fully aware from the beginning, and it has been for many other vaccines. I can tell you polio has been one of them, where for many years, there was a big problem here in Nigeria. With advocacy, and again advocacy is not a magic bullet where you can just start today and tomorrow you will get a result, but it is a long-term effort to be done. The foundation is working, at the federal level, we are supporting different entities and also at the state level, we provided few grants to address the vaccine hesitancy among the health workers and also at the community level.
In addition to us, we know we have many partners who are also making efforts to address this situation. As I mentioned, part of the engagement with traditional and religious leaders was also to help them have a good understanding. I don’t think no one will refuse to take something that he believes is good for him. We need to make effort in communicating and this is where I see communication being a very important tool to address the long-term goal, rather than the short one. So, there are different ways to administer the vaccine, and of course, the best is the sustainable one, convincing people, making them aware of the importance. This is the way to go.
What lessons and experiences are you bringing to your work here in Nigeria and how significantly different is this from your past experiences?
Great! I think it is linked to my past experience. I have to say that as I mentioned, my background, I worked in public health most of the time. I have been with one university for more than 20 years, working in different positions and implementing different programmes in West Africa, Southern Africa and East Africa. I have been working with government, private sector as well as civil society and media. I used to be an implementer, that means you take a programme, you assess the need and then you got to the field, you implement, you get results and then you come back. So, what is different here is I am playing a similar role of director but in the donor side, making decisions to fund someone else to implement the activity or co-fund or collaborate with other partners, is the difference. So, I think wearing this lens of experience through different health sector areas including agriculture and financial services for poor, is a unique opportunity for me to of course apply in Nigeria the lot of innovation happening somewhere else that can be shared here. I am not saying necessarily it will work here, but we can always share. So, this long-term experience implementing can also be applied, providing support, remember that one of our assets is our own staff expertise, sharing experience in building the capacity of other partners is something that I do believe I am bringing here. Also, working with a good team here based on my past experience managing big teams, I think it is something that I am looking forward to sharing with all of them, including the vision too in terms of development, especially in the public health area.
Education is one of the development goals/SDGs and the foundation is also doing a lot of work in that area. Now, a lot of schools are currently closed especially in Northern Nigeria, so many have been shut down due to banditry. Do you foresee an increase in the number of out-of-school children in the coming weeks or months? And if you do, what advise do you have to curtail this impending disaster, so to speak?
I think you are touching a very critical point that is so important in the development world, especially when it is about education that even before COVID or the security issue, access to education has not been effective everywhere, especially in the northern part of this country. Then, we now have security issues as well as COVID, where schools are being closed and many being displaced. I do believe that with expectations, that it will be improved. If it is not improved, if there is no clear action to stop it yet, the anticipation is to see more of this thing happening. I think people are trying to see what the best way will be to address access to school for the majority of children, especially young girls. There are some innovative tools for people to have access online using tablets, but there are some limitations here because some of these people still do not have access to simple telephone or radio and there has been a concern.
The foundation currently does not have a big programme specially on education, but it is a matter of concern and our team is thinking about how we can contribute to addressing some of these issues because they are development priorities as well, if you want the next generation to be part of the development.
