Charity Usifoh-Chenge is a healthcare professional, who is passionate about health systems that work, especially in developing countries.
She has evolved in three major dimensions as a public health specialist, health systems strategist and founder of a social enterprise.
She is co-founder and lead volunteer at the Centre for Health Systems Support (CHESIDS), Founder of ‘The Next Hundred’ initiative, serves on boards of several non-profit boards and a member of a leading global development organisation.
Charity is a global public health leader who is board director, G4 Alliance and Committee Chair, G4 Alliance awards. She completed her medical training at the College of Medicine, University of Lagos.
She holds a master’s in public health (MPH) from the same institution and holds an MSc in Health Policy, Planning and Financing from the London School of Economics (LSE) and the London School of Hygiene & Tropical Medicine (LSHTM), both of the University of London. She is a doctoral candidate (DrPH) in Public Health Leadership at the Gillings School of Global Public Health of the University of North Carolina (UNC) at Chapel Hill, USA, where she has also been invited to serve on the DrPH evaluation advisory committee.
As a recognised one, who in your own words is a global health leader?
Being referred to as a global health leader means that both my training and background are beyond just the local context. I can engage in discussions that have a global nature. If I’m engaging, for example, in discussing the pandemic, my perspectives, my contributions would be beyond Nigeria. I can engage in global dialogue, I can engage with stakeholders who are global in nature beyond the Nigerian Federal Ministry of Health or Nigerian stakeholders. I understand health at a global level, beyond local, beyond my village, my country, my state. I engage at a global level. That’s the way I see it. So, it’s about the who, the when, the what. It’s about the players, the actors. It’s about the issues, the communities and the kinds of discourse. They’re not limited to a local community or national community. That’s what I mean.
Do you find that to be a huge responsibility or something exciting for you, or a little bit of both?
I think it’s a mix of everything. It’s a calling. It’s a mission. It’s focusing on the mission and recognising that the work I do as a public health leader is not limited to local boundaries. Someone is infected in Nigeria, gets on a plane, lands in another country and is harbouring an infection that could be transmitted. That’s not a local issue, it becomes a global problem. So, it’s a good thing, it’s exciting because it compels you to think beyond just where you are at that time, but rather project your thoughts into what can be when disease agents or infectious agents or health systems are weak. It is both exciting and also a responsibility, but for me, the way I look at it is that it’s a mission that I’m committed to, and a mission I’m willing to deliver at whichever level I am working, whether it’s local, sub-national, national, or international.
Who inspired you along the way on your journey in the health space?
A couple of brilliant, powerful and strong women. Charity Osibo, Professor Adenike Grange, Bola Oyedejo, Laura Homick and Catherine Johnson. These are women who have, at different times, nudged me when I’m at crossroads, influenced decisions, influenced decision making around my professional and personal life, and some of them have actually handheld me to job opportunities, written references, shared feedback in so many different ways. They have been a personal board of mentors.
What’s your take on continuous education, knowing you are undergoing another doctorate programme, tell us about this extra feather
Before I answer that, let’s talk about my PhD. I think it’s more popular to call it PhD, but for my background and expert area, it’s a DRPH – Doctor of Public Health. It’s a unique doctorate for public health folks, and so over time, you might want to get used to saying DRPH, but people won’t understand so, one can just say doctorate. That’s one, then two, the other one, I will be conferred in May next year, it’s in the works. On my view on continuous education, I see it as a structured classroom or preferably a lifelong learning. The difference is that it doesn’t have to be a certifiable venture or learning, and I think that’s important because not everyone may be privileged to have access to the kind of learning I have benefited from, and that shouldn’t discourage them from seeking lifelong learning, and access could mean funds, it could mean even the information to know that this is available. For me, lifelong learning is key, and that’s because we must (and the term ‘must’ is deliberate) always seek to be a better version of ourselves, period. You know, at the point where we feel we know it all, when we think there is nothing else to learn, it means that is the end. This shouldn’t be because there must be something driving you to stay. The reason why my lifelong learning appears to be continuous education is because of my field. It also means a lot with how far you can go in my field.
In an age where information is only a click away, as a health professional, how do you think we can best embrace this without suffering from information overload?
There are multiple ways to look at it and honestly, discussing this is a topic on its own. This is like four topics that can take four different weeks. But, in summary, for public health, social media is a great communication tool. It’s a great health promotion tool. It’s a great myth-dispelling tool. It’s a great information dissemination tool, but it has its trade-offs. I mean, releasing something about COVID, for example, in one second could reach the other end of the world within two minutes. So, it’s great. However, what you need to solve is misinformation because the same tool can be used in the hand of propagandists, those who run propaganda, who are into conspiracy theories. I think it’s important that once you mount a campaign, a health promotion campaign, you need to think of the entire value chain that message is going to go through and begin to be proactive on how to address the trade, the fallout, and the unintended consequences of using that same tool. It’s just like Adora, (my friend) asked me when we were discussing this whole project at the beginning. She said, have I thought of the fact that the same visibility I seek professionally could also mean people beginning to know things I prefer to have kept private? It’s that unintended consequence. You need to think about using the tool to promote health. Also, the same tool can be used to propagate incorrect information, inappropriate information. That’s one. And then, two, I think that the world learnt from the lockdown and the use of digital platforms that we can do so much without coming together in person. We can reduce cost in a way that is efficient, and this is really meaningful.
What is your take on female empowerment?
What it means to me is equipping and supporting women
to be the best that they can be, though a lot of leadership positions in various sectors is headed by men. This is not okay because the world is not made of only one gender. So, it’s a bad thing. It’s a bad thing because if the world was populated by only men, then it would be okay, but the world is populated by men and women, so why should you have only men leading? It’s not for lack of skills or anything, but sometimes it’s the barriers, some are intentional barriers, some are unconsciously intentional or intentionally unconscious barriers. Some are because women just don’t have access to opportunities you should have access to, and some of it again is about the life cycle of a woman, and the expectations of societies, particularly if the woman is raised or lives or was born into a patriarchal society. There are just expectations and it is why you will hear words like ‘she is being ambitious.’ Her passion to excel is questioned. They ask her questions like ‘why would you be aspiring for XYZ? Isn’t this enough for you?’ For me, female empowerment means that you’re offering equitable opportunities to women to achieve the best that they can be and that they deserve to be.
Share with us some of the memorable moments of being a clinician, good and bad. Do you miss it?
I read medicine. So, the default, essentially, is that you’re going to end up with a stethoscope around your neck and you’re going to be seeing sick people. That is the default expectation, right? And anything you don’t do immediately following that line, you’re a disappointment for a while until you prove that the path you’re on is also worthwhile, right? So, you finish medical school, house job, you started practising medicine, right? From even your rotations, clinical rotations, however, from all of that, my best memory was seeing sick people smile because they are healed, it’s very fulfilling. If you see a family, including the sick person just smile, it brings joy to my heart. Like you see someone transform from pain and suffering to relief. It’s miraculous. It’s wonderful. That’s one. Again, from helplessness to full functionalities, such a transformation. Also, I really enjoyed my posting, talking of clinical posting in the neonatal, that is, in the newborn unit. Because these children were fresh and purely innocent. They had no opinions. They couldn’t even express their pain in words. You just saw their full innocence, like 120% innocence, and it was just pure. It was so pure and I enjoyed all of that but, I think my worst experiences, which actually hastened my transition away from clinical medicine, was just driven by the poor management of our health system in Nigeria. You would have to carry products in your pockets, particularly if you’re in government facility, because if you were depending on going to the store or the whatever for consumables, and the family came in a state requiring emergency treatment, you didn’t have supplies in your pockets, you were almost carrying the blame of the entire government.
What strategies do you think government should take on healthcare and what should people know about health being beyond just going to the hospital?
Government needs to communicate it first by providing the right funding. You cannot promote what you are not giving. Government is not delivering, healthcare is a human right, and the government is not, well, let me not say “they are not” but they can do a much better job of helping people to access the care they need when they need them, without catastrophic expenses. We can do so much. When you start doing that, then you can talk more about people seeking proper health behaviour. It’s like saying, ‘Oh, seek healthcare, seek healthcare’ I go and seek healthcare and there’s no medicine there, there are no healthcare workers. This whole chicken and egg thing, do we put the chicken first? Do we put the doctors first? We are not yet at a place where we can boldly say, ‘Go to any healthcare facilities in Nigeria, you will get the care’ we’re not there yet.
How can people change their behaviour to healthcare?
Let me look at it from two ways. The first way is to recognise that health has a supply side and a demand side, right? So, when you talk of health systems, supply side, are the drugs there? Are the facilities equipped? Do they have healthcare workers? Which means even if I’m sick, I am good at seeking health care. Will I go there and find drugs? Will I go there and find a health facility? Will I go there and there’s running water? Will I go there and there’s power? That’s the supply side, right? Will I recognise that my symptoms and my records are being kept in the way that ensures continuity in my care? That’s a supply side matter. Now, on the demand side, who does this cost about health seeking behaviour? Some people believe that some particular things should be done in a particular way. cultures around the world and in Nigeria, where if a woman is giving birth at home, she’s seen as a “champion.”
Whether there’s a risk or no risk, she’s told she is a champion if she gives birth naturally, but if she seeks care in the hospital, she is seen as a weak woman. To be very honest, I lean away from using the term “natural delivery” because sometimes, it becomes stigmatising.
I just say vaginal delivery, CS, they’re all in my opinion, natural. You see what I’m meant to say? Because when we use the term natural, we almost perpetrate stigmatising women who don’t have a vaginal delivery.
She has given birth and that is what matters. It’s just the way she gave birth that is different. Honestly, societies or cultures who engage in this needs to change. How do you say a woman who doesn’t deliver through vaginal delivery is not strong? Do you know that some of these places where the practice is so strong and the repercussions are so deep, a woman may be facing a risk? She might be bleeding, and as a medical professional, you’re telling her to go for a Caesarean Section, and she says, “No, my people will say that I’m not strong” meanwhile, she’s bleeding, her blood pressure is high among so many other issues. These are the challenges around the demand side. Another part of the demand side apart from the social constructs is financing. This is the reason why the health insurance, (as you see, many of the other countries are far ahead of us) is important because what health insurance does is to make people pay a small amount.
How important is it to have public health leaders become health diplomats?
In the healthcare system, there are different stakeholders, including manufacturers. If nothing at all, what the African continent has learnt, and there’s a solid intentional movement towards addressing this, is that we can’t be manufacturing all the lifesaving products elsewhere.
We need to establish our own vaccine manufacturing platforms and centres here, and that agenda is gaining traction. It is clear. Because we can’t hold ourselves bound or subject ourselves to handouts from elsewhere, right? Especially in an era of crisis.
Having said that, public health leaders need to begin to hold more competences around diplomacy, because part of those who were involved in the conversations about where the vaccine should go to, during the pandemic, it was a negotiation. You have to have those skills, those skills don’t drop during a clinical class, or a class where you’re learning about cardiology, or the liver or the heart or the skeleton, it is a skill that is honed, and many times it needs to be honed intentionally.
So, political leaders need to acquire more skills around health diplomacy and management of multi stakeholders that health has become. There is politics in health as you see in many other places. Let me give you an example in the US. During COVID, health was highly politicised, the more you could leverage what you were doing around COVID to up your political game, the better you had a stronger political footing, period.
If you go and replay what goes from that era, watch the utterances from Trump as a president, watch the utterances from those who were leading the response to the pandemic. Watch, listen to the utterances of CDC that was supposed to be a leading agency. You know, this is CDC that was known for full technical competence, but they didn’t have the best diplomatic competence or political competence. This is all documented, you can Google it. So, they lost a lot of reputation that they are trying to build back because at that time, it was more of a political conversation than a technical conversation.We need to get some public health leaders to be health diplomats.
Who are those you define as public health leaders?
First and foremost, you don’t have to have a clinical
background to lead public health, however, there are some skills and some training in public health that you need to have to really have core competencies. Skills or knowledge around technology, for example, disease control, lifesaving intellect, those basic skills. But more importantly, a public health leader, is one who understands a vision that needs to be achieved, a mandate. It could be a vision about strengthening a health system. It could be a vision about controlling an ebola, an outbreak at the time.
My point is that, the leader could also be situational or a leader in a steady state or an emergency state. I want you to think about the leader in a broader horizon. It could also be a leader who doesn’t necessarily have positional authority. That person may not be called “head of…” or “director of…” but at that point in time, or that period in time, they are responsible for understanding a vision that needs to be delivered, for sharing that vision with a team, for identifying the team that needs to deliver this vision, for identifying the resources, assets or whatever, including people, that they need to deliver the vision, and for managing the performance and the results of delivering that vision.
They also need to be able to mobilise resources to fund the vision and also to manage multiple stakeholders to fund the vision. They gain that vision of a public health nature.
That’s a public health leader.
