In his quest to deliver on the promise of igniting renewed hope among Nigerians, President Bola Ahmed Tinubu is investing faith in a new generation of Nigerians with impeccable academic credentials and hands-on professional skills.
Dr Muyi Aina, the Executive Director and Chief Executive Officer (CEO) of the National Primary Health Care Development Agency (NPHCDA) over the past year, ticks both boxes. A public health professional and management consultant with over 20 years of experience in healthcare and management consulting, he was a faculty member at the University of Maryland School of Medicine (Baltimore, USA) between 2004 and 2006 and was actively involved in the design and implementation of the multi-country HIV/AIDS care and treatment programs that provided access to HIV services for 700,000 persons in Nigeria and seven other countries in Africa, as well as Guyana and Haiti. And, then, he has been involved in health management consulting, having, in 2010, founded Solina Group, a management and healthcare consulting firm, after a spell as an engagement manager at McKinsey & Company.
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However, despite his vast experience in the conduct of operations research into models of delivery of HIV treatment at scale and credit for some 27 publications with about 7,000 reads and 350 citations in the course obtaining medical studies at the University of Ilorin and Harvard University and a doctorate degree from Johns Hopkins University, he has been jolted by challenges in Nigeria’s public health delivery system.
“One of the things I have learnt is that supporting a system from the outside is different from when you’re inside,” he admits. “A lot of details are different in terms of how things work, as well as the resources and also the leverage and flexibility that you have.”
When the 50-year-old health management expert from Egbe in Yagba West LGA, Kogi State, surveyed the country’s health horizon, the grim picture he saw was of a system unable to meet the basic requirements of people. “For example, we have over 30,000 primary healthcare centres across the country, but how many of you will walk in there when you fall sick?”
“The blueprint, he says, addresses reducing maternal mortality and child mortality, decreasing stunting and malnutrition, improving the quality of our primary health care centres, increasing health insurance, strengthening local production of commodities for health care, and improving immunisation coverage.”
He has decided to confront the challenges head-on. He’s enthused by the commitment of Mr President to improve the system, noting, “The President is truly committed to this. If I didn’t believe that, I would not be part of the government. I had a job that I was doing before this that paid well. The president had set an agenda for the health sector. He wants to remove the label on Nigeria as the capital of maternal mortality during his time as President of Nigeria. He wants to crash maternal mortality and reduce unnecessary infant and under-five deaths in Nigeria. To stop women from dying, we have to identify the issues and what is killing them the most and tackle them head-on. The question was how and why colleagues and equally competent people who have worn the same shoes may have fallen short of the objectives they set for themselves, and what we need to do to increase the chances of succeeding in this role.”
To give effect to the President’s commitment, Dr Aina says the Coordinating Minister for Health and Social Welfare, Prof. Muhammad Ali Pate, led the articulation of a blueprint for the health sector “that focuses on saving lives and reducing pain for Nigerians.”
The blueprint, he says, addresses reducing maternal mortality and child mortality, decreasing stunting and malnutrition, improving the quality of our primary health care centres, increasing health insurance, strengthening local production of commodities for health care, and improving immunisation coverage.
The blueprint provides a framework for working with the states and other stakeholders, including civil society, international donors, and bilateral organisations, in the process removing the frictions and mutual distrust that have bedevilled the provision of basic health services.
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He’s pleased with the outcomes of his team’s efforts so far. “When we decided to revitalise primary health centres and started the process of resource mobilisation, a number of states went ahead of us, using their own resources,” he notes. “As of today, about 239 PHCs have already been fixed, either repaired or built from scratch by states themselves. The federal government has commenced the process of revitalising another 350 PHCs. We have mobilised substantial resources and will revitalise another 2,500 to 3,000 across the states. It was World Bank financing for the federal government and the states.
“We gave states a framework because, unfortunately, needs are not evenly distributed. If we say one per ward, one per tribe, one per state, but in reality, people’s needs are quite different. And if I assume the same need for you that I assume for me, chances are one of us is not well served. So, we are moving away to a more equitable distribution of things.”
On how the public can support his agency, he pleads: “We ask that Nigerians give us a little bit of time, to ask us questions, challenge us, but to understand that it takes time to repair a system that has been damaged over many years. You don’t just turn it around overnight.”
The academic that he is, he has also engineered the clarification of issues in health care delivery. He says, “First, we have defined what a functional primary health centre is. We have mobilised the resources. We have actually started the revitalisation. Like I said, as of the last count, about 239 PHCs have been completed, and we are now working on about double that number. Contractors are there now, but I won’t count them until we are done so they are not abandoned at any stage. So, I will count when it’s done. There are about 200 additional PHCs that we’re using global fund resources to revitalise. So that journey has started.”
He has also put emphasis on human resource capacity development to address a systemic weakness, noting: “Many of these health workers have never been trained since they joined the service. Some who have been trained in the past have not been trained in 15 years. We have trained over about 42,000 as of the last count.” In the process, the agency has worked with the Federal Ministry of Health to revise the Basic Healthcare Provision Guidelines in collaboration with the other pathways, including the NPHCDA, the National Health Insurance Authority, the National Centre for Disease Control, and the National Emergency Medical Transport Programme, to great effect.
The agency has also forged collaboration with other government agencies to achieve common objectives of transparency and accountability. For example, it involved the Office of the Auditor-General of the Federation to conduct an audit when this became necessary to address specific issues and remedy them. This, he says, was because “We have accountability mechanisms now that did not exist before; one of them is digitising the entire process of disbursing the money. We are limiting what they can spend the money on. A health facility cannot withdraw more than 10 percent of the money but can transfer it digitally. If you transfer, we can look at the bank statement and know what it was used for. That’s easier to track. We have also established something called the Performance and Financial Management Officers (PFMOs) program, which is in alignment with President Bola Ahmed Tinubu’s social accountability officers. It will be deployed by the local government to also monitor. When the states give us their reports, we have these external mechanisms to check. We have established a partnership with the Independent Corrupt Practices and Other Related Offences Commission (ICPC). I had a conversation with the Director General, State Security Service (SSS) yesterday to get them involved in this process. “We are rolling out a dashboard for people to identify which PHCs are near them. I think we will roll it out before the next two weeks as part of the Basic Health Care Provision 2.0.”
Dr Aina has also led NPHCDA to become more proactive in responding to issues of floods and disease outbreaks in Borno, Yobe, and Adamawa. The agency has secured resources to support the 10 most affected states for maternal mortality, having identified about 150 LGAs to intervene in, where it will recruit and retrain midwives with full commitment from state governments.
The federal government has disbursed over N100 billion under the Basic Healthcare Provision.
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Fund (BHCPF). How well are states accessing the funds that are available for them to help in the work that they are supposed to do? Dr Aina says the agency is removing some of the barriers faced by states that revolve around accountability requirements. “We need to spend the money in ways that ensure value for money. Many times, the problem is not even that the money is being stolen or anything; it is the capacity at that level to account for the money. Transparency is not always there, so typically when a state is unable to access, it’s two things: either there is a counterpart payment requirement that the state has not paid, or they have collected a first tranche and have not been able to retire it to be able to get a subsequent tranche.”
The National Agency for Food and Drug Administration and Control (NAFDAC) has reviewed and determined it fit and safe for Nigeria. The World Health Organisation has recommended it and specifies how to use it.
Happily married with children, Dr Aina pleads with Nigerians to exercise patience as the government makes difficult choices so they can reap the full benefits of the reform in the health and other sectors, noting: “One of the fundamental principles of reversing your fortunes and starting to improve your economy is to start to live within your means. A lot of the reforms that are going on really target that. It’s important that Nigerians are patient for good reasons, but a little bit of patience and a little bit of engagement. Engagement in that when we have programs, they should please participate. When we provide services, they should take advantage of them; they should trust that the government is not out to do damage when offering health intervention. There will always be false information out there; there will always be misinformation, especially in the era of social media, but Nigerians need to understand that the government cares about them.”
In Dr Aina’s exceptional drive and passion to reform the basic health care provision in the country through revitalisation of infrastructure and addressing the dearth of human resources for health, a combination of support from the President, the minister (his boss and mentor), and the public on offer will ensure that PHC delivers quality health to the citizenry towards making Nigeria a healthier country.
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