When he was announced as Minister of Health and Social Welfare at the inception of the present administration, the consensus among the broad spectrum of stakeholders was that Muhammad Ali Pate was the best thing to have happened to the nation’s health sector in a long time.
Indeed, it was, for him, a veritable homecoming—not only to public service but to the self-same ministry he has now fully taken charge of in an enlarged capacity, considering his designation as Coordinating Minister of Health and Social Welfare. This presents him with arguably the largest ministerial portfolio on offer in the Tinubu administration. But what is the vision that he nurtures that can deliver on his mission? “My vision is that the huge population of Nigeria becomes really an asset that is productive, that is prosperous, that is peaceful, and that harnesses their human capital.”
To whom much is given, much is expected. How prepared is Pate for his gargantuan responsibilities? On practically every score, the man is up for it.
A former chief executive officer of the National Primary Health Care Development Agency, he was Minister of State in the Goodluck Jonathan administration. Prior to that, he was to be the Chief Executive Officer of the world’s largest global health fund, the Global Vaccine Alliance, which, with about $21 billion, covered more than 100 countries through the pandemic period from its base in Geneva, Switzerland.
In academics, he was an assistant professor at Duke University’s Global Health Institute, where he taught comparative health systems for a two-year period.
In addition to the United States, international development work has taken him to the East Asian Pacific, South Pacific, East Asia, and East and Southern Africa.
He lists outcomes to include a reduction in child mortality and maternal mortality as key to the demographic transition to a change in the structure of the population, “such that we have less dependency, more productivity, and more investments in human capital. “And then kids have a successful transition across the life cycle to adulthood,” he adds. “When I say life cycle, I mean from an adolescent girl to when she becomes a mother, that she’s healthy.
His priority is to improve the governance of the sector in the federal system “to manifest what we call the National Health System.
And during pregnancy, the mother gets taken care of and she delivers safely, her child survives, that child is immunised, taken care of for malaria or other infectious diseases, grows into early childhood, gets developed in the educational sector, goes into the educational system, and translates into a healthy youth, free of substance abuse, mental health, and becomes a productive adult that is engaged. And then grows into an adult that becomes older and has a dignified ageing before they exit.”
He didn’t construct this vision until he had undertaken an assessment of the health delivery system in the country on his second visit. Of course, he has a global perspective to draw upon, having visited more than 100 countries in the world. He posits: “Every country that you see, that has become as great as it may be or strong as it may be, is built by its own people. Development comes from inside, not from outside.
And so, while we have experiences, learning, and networks, fundamentally, it is the leadership of a country—in our case, the president—who sets the pace for transforming the path that we take as a country towards one that is prosperous and inclusive—that works for all of us as Nigerians, and I’m so honoured to join him.”
His assessment consisted of taking the time to listen, to speak to the civil servants in the ministry and agencies, and then conducting a people’s voices survey to understand how Nigerians view the health sector and their experiences. This covered 2,500 Nigerians who were interviewed by phone by IPSOS, a polling company, on their experiences and their expectations.
It also included interactions with stakeholders, such as traditional leaders, civil society organisations, and private sector health workers, in four sample states: Kano, Borno, Nasarawa, and the FCT, “to get a sense of what the issues are at the federal, state, and local levels. The assessment informed him that, over the last 10 years, Nigeria’s performance in terms of improving population health outcomes has been suboptimal.
It has enabled him to introduce new ideas covering vaccination to reduce child mortality in order to attain a faster pace of vaccine administration and keep pace with such countries as Sierra Leone, Ethiopia, and Kenya. Now, he boasts, “If we benchmark ourselves, I think we do a lot better than these countries considering population size and rates.”
However, he’s concerned that infectious diseases are still an issue, noting: “Maternal and child health issues were there, but we have fast-growing, non-communicable disease burdens—hypertension, diabetes, cancers, etc.
He’s therefore giving attention to improving the quality of the infrastructure in numerous facilities while also tackling deficiencies relating to human resources, inadequacies in training, and the mass emigration of many that were trained to other countries.
These challenges underscore the need to look beyond the health sector to factors that fuel the nation’s health-related challenges: insecurity, the general state of the economy, financing, etc. On financing, he notes that “many subnational units were really stressed in terms of their fiscal space, and the federal government spending on health was not necessarily the most efficient at the time when we analysed it.”
His priority is to improve the governance of the sector in the federal system “to manifest what we call the National Health System. This refers to how the Federal Ministry of Health and Social Welfare interfaces with the composite state ministries of health in the respective states that we have in the country and the Federal Capital Territory and works with the local governments in tandem with our development partners, who contribute to the health efforts in this country with their finance and technical support; the private sector; and civil society towards responding to the needs of our citizens. We must strengthen the regulatory framework for health so that all standards are met, whether they are pharmaceutical or health professional regulations.”
Under the government’s health sector renewal investment initiative, the ministry signed a compact with state governments and development partners in December 2020 to increase health financing.
The second area of emphasis is on improving population health outcomes through the use of public financing to deliver basic services through the primary health care system, targeting vulnerable groups through the NHIA.
At the same time, attention will be given to tertiary facilities. In 2024, for instance, there will be investment in upgrading the infrastructure, equipment, and training of health workers in our facilities to retain many of those who may be considering moving out because their environment gets better, including things like power.
The President approved an initiative to unlock the healthcare value chain, which will enable collaboration among ministries of trade and industry, finance, and regulators, such as the Standards Organisation of Nigeria (SON) and NAFDAC. Says the minister: “We’ve been moving forward in that arena so that, over time, we will reduce the importation of generic pharmaceuticals and be manufacturing more here. We will unlock the space so that diagnostics can be manufactured here.
There is no need for test strips that you have to import from far away. And believe me already, I can tell you three entities that are indicating interest in coming and manufacturing here, because if they succeed here, we’ve got a large demand. And we also have access to the African market. So, we’re also going to be ratifying the African Medicines Agency treaty and being part of this one Africa market, to which more than a billion people can contribute.
So, there’s a value chain in that space. The private sector can contribute to service delivery; with the $1 billion to $2 billion that we spend every year on outbound medical tourism, the elites will fly out to Dubai and other places for medical care. Because the private health providers have not been enabled to provide the service at the quality that is expected.”
The inter-ministerial committee on health is bringing together resources to tackle the challenges to public health from various sources. For example, it undertook a mission to address the issue of fruit hunting and the spectre of wiping out bats that are antibodies to some viruses that have pandemic potential, like coronavirus. “We had a joint risk assessment with the Ministry of Agriculture’s Chief Veterinary Officer because animal health is also very key to protecting human health, considering that 70% of the new infections in humans are coming from animals, as revealed by zoonosis in the last several years.
So, effective animal health surveillance is critical to human health. We therefore need to do research to understand the epidemiology of animal infections so that human health is protected. So, the One Health construct is to enable us to coordinate antimicrobial resistance antibiotics.”
One area in which he calls for restraint is the pressure on public institutions to indicate progress. He’s not sold on the 100-Day Syndrome, believing that it takes time for health outcomes to manifest.
“We’ve put in five to six months of this administration’s building blocks, and this year we’re saying it is a year of execution. And by the end of the year, we will have matrices that will show what has been done. And in just a short time between putting these plans in place, we’re seeing the results of some of the ideas. Take, for example, the healthcare value chain. We have three major manufacturers that are already expressing interest in establishing themselves in Nigeria.
They haven’t been here since. There’s never been anyone. In December, we launched a factory in Lagos to manufacture in-vitro diagnostics. Yes, individual diagnostics have never been manufactured in Nigeria. We’ve been importing them for years, and we’ve accepted that as normal. In December, one opened up. A second one is coming to start building a plant. A third one from Morocco came and said, “We’re interested.”
We have pharmaceutical factories. I was in Lagos, and we met with industry players. They have the capabilities, and the local manufacturers said they would be investing more. These don’t get into the news because it’s good news. What gets in the news is the exit.
So, it is a very difficult business environment. But when the game was good, many stayed. When the going gets tough, those who are not with us will exit. Those who will stick with Nigeria in the long run will stay, and when daylight emerges, they will enjoy the benefits. We will know who our genuine and fair-weather friends are. In health, we have focused, and we’ll unlock the market potential of the sector. And we’re getting very positive encouragement from the local manufacturers, who are facing difficulties but are not giving up. In the long run, there will be winners in Nigeria.
He’s looking forward to an imminent executive order to support local manufacturing of pharmaceuticals and a reduction of tariffs on the import of equipment for manufacturing. The minister is also in discussion with mobile telephone operators on health financing. “Can we allow the 15 million Nigerians who are currently insured to use airtime to pay for health insurance? We have more than 100 million lines in Nigeria that can be used to accelerate Nigeria’s coverage of health insurance.”
He believes in close coordination with states in realising the vision of his ministry, underscored by a commitment to accountability. “This is in the realm of social accountability. All of us, Nigerians, have to be very vigilant to flag issues of diversion of resources. Because when resources are not used for the intended purpose, this oftentimes results from collusion. There are many people who are complicit in seeing things and just looking the other way.
It’s not just the federal government, states, or even the primary health care centres, even in communities. So, through NPHCDA, we’re going to be recruiting folks to help with the financial management at the local government levels so that the facilities that receive those funds can use them and report back. We’re also exploring how we can have youth that will be paid to be on the social accountability track to ensure that, at the end of the day, we make things more transparent. This will reduce the incentive for anyone to misbehave.”
He’s encouraged that “The President is very committed and, in his team, we’re all committed to ensuring that we deliver. One of the challenges is changing people’s mindsets. The Minister of Information has been saying, again and again, that the government will be very transparent and that the citizenry should not expect perfection, which is only in the hands of God. But we will try. And if we succeed, you’ll see, and when we falter or make mistakes, we’ll own up to them and correct ourselves. As a demonstration of our intent, before we leave this office, I will show you, week-by-week, our execution plan.”
Is he not concerned about the shortage of health workers in Nigeria? He is, but the solution he proffers is that you cannot prevent individual health workers from choosing for themselves or their families to migrate. Just as engineers, university lecturers, and other professions, including journalists, are also ‘Japaing’, the emphasis should not only be on those who are leaving. “We should also appreciate those who are staying.
We have 46,000 doctors in Nigeria today who are registered and licensed. Every year, we lose 2000–3000, according to MDCN. So, we first have to appreciate those who are staying. I saw one of them in Lagos. I asked him, “You are a consultant, and many of your colleagues are leaving. What are you still doing here?” He said, “See, I want to serve my country.”
He says the government is finalising a policy of managing migration, “whereby we will produce more, and we will ask the recipient countries to also invest in the training because they’re taking where they did not sow. We have universities that train medical doctors and nurses, and they move into countries that did not train them. So, we’re asking those countries to consider investing in pre-service for every one that you take from us to help us train more. And this will manage the migration policy.”
He’s very pleased with what his ministry has achieved in the last six months, despite his aversion to this time frame, saying, “This idea of 100 days, we did not pay attention to it because it was not original. Transformation takes effort. It’s hard work. This year is the year of execution, and very soon you’ll hear of the groundbreaking of 10 health infrastructure projects, some of which are diagnostics and cancer centres, infrastructure projects in six geopolitical zones for which procurements have taken place; the sites have been identified and the resources have been identified. These don’t happen just overnight because you can make mistakes. These have happened, and this government will be groundbreaking. These efforts have floundered for more than two years.
The achievements include:
· Refurbishing and expansion of the infrastructure of many of our primary health care centres
· Development of the resources for the training of frontline health workers, including building consensus around and printing of material
· Delivery of vaccines, including launching of the human papillomavirus vaccine and the second phase that is going to come in a few months’ time.
He also points at investors coming to invest in our health sector and the timely response to the outbreak of diphtheria in August to September of 2023.
In the next three years, what legacy would he have left behind? “In three years, if President Tinubu’s administration is judged to be one that has shifted the curve and the population health of Nigerians has measurably increased, I would be very satisfied that we have done our job well,” he quips.
After his undergraduate medical degree at Ahmadu Bello University in Nigeria, from which he graduated in 1990, he became a Julio Frenk Professor of Public Health Leadership fellow at the Harvard Chan School of Public Health in Boston, Massachusetts. In 2019, he was appointed Global Director for the World Bank Group’s programme for health nutrition and population Global Practice as director of its Global Financing Facility in Washington, DC. Before then, he had served as CEO of Big Wind Philanthropy, a private foundation helping leaders across Africa invest in their youth to reap the demographic dividend of their populations.
