I want the huge population of Nigeria to become a real asset — Pate

As Minister of Health and Social Welfare, Muhammad Ali Pate is not a newcomer to public service. A former chief executive officer of the National Primary Health Care Development Agency, he was Minister of State in the Goodluck Jonathan administration. Before 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.

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, with the Global Director for the World Bank Group’s program 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 the Big Wind Philanthropy, a private foundation helping leaders across Africa invest in their youth to reap the demographic dividend of their populations.

In academics, he was a visiting professor at Duke University’s Global Health Institute, where he taught comparative health systems for two years

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. 

 

In this exclusive interview with the BusinessDay media team led by Bashir Ibrahim Hassan, General Manager, Northern Operations, Prof. Pate puts the challenges of health delivery in Nigeria in perspective and postulates his response.

He also touches on the inter-ministerial committee that the government has set up to foster a concerted national response to the nation’s myriad health challenges. He elaborates on the thinking behind this approach and the tasks of the committee.

What was your assessment of the health delivery system in the country on your second coming?

I’ve visited more than 100 countries in the world. Every country that you see that has become as great or strong as it may be is built by its 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. 

What is my assessment? When we came in, we took time to listen and speak to the civil servants in the ministry and agencies. We had people’s voices surveyed to understand how Nigerians view the health sector and their experiences. The People’s Voices survey covered 2500 Nigerians who were interviewed by phone. This was conducted by IPSOS, which is a polling company, to understand what their experience is and what their expectations are. We talked to stakeholders, including traditional leaders, civil society organisations, and private sector health workers. We visited four states in the first few months just to understand the context. And let me tell you, I was in Kano and went to Maiduguri, Borno State. I also went to Nasarawa and went to facilities here in the FCT just to get a sense of what the issues are at the federal, state, and local levels. We went to a community in Kano where seasonal chemoprophylaxis against malaria was being conducted. We went with some of our visitors in September, September 12, and 13, 2023, to understand the context. We had a retreat with the leadership of the Ministry of Health. What we realised was that, yes, over the last 10 years, Nigeria’s performance in terms of improving population health outcomes was suboptimal.

Some things have gone well; we’ve been able to complete the work of polio eradication. We introduced new vaccines. There was some progress in reducing child mortality. But still, it was at a much slower pace than what we could have done when you look at us compared to other countries that are near us, like Sierra Leone, Ethiopia, and Kenya. If we benchmark ourselves, I think we do a lot better than these countries, considering population size and rates.

So, when we did the diagnostics of the state of health of Nigerians, we discovered that infectious diseases were still an issue. Maternal and child health issues were there, but we have fast-growing, non-communicable disease burdens—hypertension, diabetes, cancers, etc. And the quality of the infrastructure in many of our facilities was deficient. Human resources issues, the management of human resources, and the training were not adequate, and many who were trained were exiting and leaving the country. The motivation of some who were remaining was sometimes for things that were outside the control of the health sector, insecurity, and the general state of the economy. We looked at the financing situation in the country; many subnational units were 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. We came to an understanding of the broader economic context within which health actually plays, and we then crafted an agenda.

Based on your assessment, what is your own vision of where the nation should go and how do you plan to achieve this vision?

My vision is that the huge population of Nigeria becomes a real asset that is productive, prosperous, peaceful, and harnesses its human capital. So, I see 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. When I say life cycle, from an adolescent girl who becomes a mother, that she’s healthy, and the mother gets taken care of during pregnancy, and she delivers safely and becomes alive, 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 who is engaged and grows into an adult who becomes older and has a dignified age before they exit.

That is how productivity can be harnessed in our economy, and health is a part of that because you have to survive. So, dealing with maternal health, child health, the treatment of malaria, and providing financial protection so that people don’t get into poverty are very vital parts of it. Now, there’s also an economic dimension because developing the human capital accumulation that we say Nigeria needs to grow requires. If kids are malnourished, they will not have the cognitive ability to do well in school, to stay longer in school, and to be productive adults. But at the same time, as we have more productivity, we get wealthier; we know that we’ll invest more in health. There’s an economic side to health as well, not only in terms of just the productivity of the individual; there’s a whole value chain around health that we can unleash to further propel us as a country, and then health becomes a contributor to our gross domestic product.

In many middle-income countries and OECD countries, the average contribution of health is almost nine to 10 percent; here it’s less than 4 percent. So, as you grow as a country, the health part of your growth becomes even larger. And so how do we then use these twins as levers to make health central to Nigeria’s economic development story? The president’s wisdom in creating this position of coordinator for health and social welfare in a way presents his understanding of the centrality of people in the agenda of his administration, alongside the economic angle, which is also important to grow the economy. But health is also very fundamental because of its contribution to human capital and also to social capital. Health is one thing that can in a way heal countries that may be very fragile because health affects everyone. It affects you regardless of your geopolitical zone, your tribe, or your religion; it doesn’t respect borders or infectious diseases. So we can use health to heal and unify the country, and I think that’s the president’s vision. 

So how do you achieve this?

The first 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, whether it’s pharmaceutical or health professional regulation, the standards are kept. The president has launched the health sector renewal investment initiative, and we signed a compact between the federal government, state governments, and development partners in December 2020. That is the first time that such a compact was signed in our system, and that is the first pillar.

The second pillar is to have a laser focus on improving population health outcomes, meaning we use public financing to deliver basic services to all Nigerians through the primary health care system, using the basic health care provision fund as a starting point to expand the supply side and the vulnerable group fund through the NHIA to begin to move towards improving the affordability of health care for the poorest Nigerians. But at the same time, look at our tertiary facilities. So, in 2024, for instance, we will invest in upgrading the infrastructure, equipment, and training of health workers in our facilities so that we retain many of those who may be considering moving out because their environment gets better, including things like power. We have started introducing new vaccines, including human papillomavirus vaccines, which we just launched in 15 states successfully. It’s preventing cancer in young women down the pipe. We’ve been working with an entity developing a public-private partnership that will expand the infrastructure, starting with teaching hospitals. In the 2024 appropriation, we have put in resources. No matter what you say, if you don’t allocate resources, it’s only a story.

Indeed, in 2024, the Health Insurance Authority will begin to move towards implementing mandatory health insurance, trying to refine the basic care package and also mobilise resources because, when you don’t spend enough, the bottom line is that we have about $13 that we spend per person. What can you buy with it? So, you cannot pay for a bicycle and expect to ride a Mercedes. Quality health care is not cheap. You have to invest in it. For a very long time, Nigeria has not invested as much, but this year we saw the President take deliberate action to increase the budget allocation in the federal government for health.

The third pillar is to unlock the healthcare value chain. As a country, 75 percent of our generic pharmaceuticals that are not patented are imported; 99 percent of our medical devices are imported; and 100 percent of our vaccines are imported. This is not new; we have been on this path for some time; we’ve just positioned ourselves as consumers of everybody else’s products from different countries, some of whom were very similar to us. So, what we’re saying in this administration is that there’s a value chain in health, whether it’s in the products, whether it’s diagnostic kits, whether it’s generic pharmaceuticals, whether it’s even biological vaccines, whether it’s medical devices, whether it’s health technology, whether it’s logistics and services, whether it’s hospitals, laboratory services—this is a value chain. Let’s develop that value chain, and that’s why the President approved an initiative to unlock the healthcare value chain, and he appointed a world-class expert to be the national coordinator and asked me to chair the initiative, which is a cross-ministerial initiative with the Ministry of Trade and Industry, finance, regulators, and standard organisation, NAFDAC. We’ve been moving forward in that arena so that over time we will reduce the import of generic pharmaceuticals and manufacture 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 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 African market with more than a billion people, to which we 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. 

Over time, as we have begun to move in this direction, you will see more private providers expanding, mobilising the resources, and hopefully retaining some of those, particularly with the naira devaluation. So that’s the third pillar of our agenda.

That is a very exciting one because we can then begin to see how health would be a better contributor to Nigeria’s GDP, not only in the productivity of the individual but also as an economic sector. If you look at even the wealthier economies, like the United States, health is the second largest share of the US GDP after the defence. It’s a large employer of labour in the OECD countries on average, and health is a major part of what they do. Even in countries like India, where we go for medical tourism, health is a contributor to their GDP. So the trade in health services is an area in which we are also developing cross-ministerial efforts in this administration. Then the final pillar is that of the health security angle, and people say, Oh, well, what’s health security? Well, we saw COVID, where an infectious disease starting from Wuhan in China rapidly reached more than 200 countries all over the world and grounded the economies of the world; even those who are not infected by COVID were affected by it because of its economic impact.

Give us an idea of the funding you need to effectively implement this vision, vis-à-vis the annual allocations to the health sector over the last several years.

In addition to the federal government allocations, in playing a leadership role, we also have to activate the sub-national units to complement the federal government. Development partners, in December, announced $3 billion over the next three years, collectively, in their resource commitment. So, we’re mobilising, and the federal government itself increased its own contribution.

 

Minister, what is the ideal percentage of our national budget that should go into health?

You’re asking for an ideal, but what I’m saying to you is that we’re being realistic, given our fiscal constraints as a country. With what we have and the increment that we have had in 2024, let’s make good use of it, because in the past, resources have been expanded, but not all of those resources were efficiently and qualitatively spent. You can have resources in health deployed incorrectly. So, use what you have well first.

What it means is that public health is linked to economic security, national security, and global security. So, waiting for a crisis to occur and then going begging for products is not going to serve us well. We need to take proactive steps to have surveillance systems to be ready to stamp out outbreaks when they occur before they spread, to be ready to protect our borders if infectious diseases are coming from elsewhere, and to have the reserves to be able to deal with the fallout of major outbreaks and to produce some of the items here. Can you believe that for masks, we had to import them from somewhere else? A mask that is personal protective equipment from outside, come on. We have all these nice textiles that we wear. Our dress is among the best in the world. But the most important ones are those we have to import. So, by domesticating our production capacities, at least when a crisis occurs, we can be able to attend to the needs of our country as well. So that’s the logic behind the health security pillar.

But there are cross-cutting enablers for all of these four pillars. One is data and digital transformation, and of course, the Ministry of the Digital Economy is an enabler for this effort. And in the ministry here, we’ve also put together a group, now thinking about how we can first get good-quality data to guide our decisions and track our progress. But how do we also use digital transformation to be more efficient in managing our facilities? So electronic medical record systems develop robust words, that are interoperable, and that allow us to track the productivity of our healthcare system.

Indeed, we are adopting the sector-wide approach that the President approved to do. Our partners have keyed into that so that there’s less fragmentation, and then the third element is reorienting the talent within the sector and the culture within the sector. One that is citizen-centred because, at the end of the day, if we don’t do that and focus on only our professional calling—doctors, pharmacists, nurses, etc.—we will go into industrial disharmony, which is so unnecessary. What if we put the Nigerian at the centre and organised ourselves to support us in doing what is right for Nigerians? All of us would get the professional fulfilment that we need. And that requires a cultural reorientation that is service-oriented. As a health sector, nobody goes into the health sector to fight wars; nobody goes into the sector just primarily to make money. Anybody who is a health professional has an intrinsic motivation to support other people to save lives. So, that is the primary focus, so let’s begin to reorient ourselves in that direction. It’s this construct that has sort of been developed with a multi-stakeholder consultation process and an orientation that says, Look, to fix this issue, we need to have a consensus as a country that health is important. It’s not just the president alone or the Ministry of Health alone. So, we have a steering committee involving the ministries of agriculture, environment, and water resources.

 

Could you give us a sense of what this committee will bring to the table?

We just had the mission two weeks ago, in fact, the steering committee, and what we’re discussing is the issue of fruit hunting or fruit bats in Makurdi. I get that fruit bats are being hunted in parts of our country for food because they are a delicacy. There is research that showed that some of those food bats have antibodies to some viruses that have pandemic potential, like the coronavirus virus, like in this study, which was published, but Nepal virus, coronavirus, influenza viruses, and Ebola viruses, antibodies were found in those bats, which means that those bats had been exposed to those viruses, and now humans are interacting with these bats and the fluids of those parts. 

Potentially, you could have a spillover into the human population instead of waiting for something like that. Even before it happened, 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 percent of the new infections in humans come 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 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 with antibiotics. There are lots of antibiotics being used in animal husbandry, aquaculture, and fisheries to improve productivity in the agricultural sector. However antibiotic resistance can develop in infectious agents in the animal sector, and humans can get exposed to infectious agents that are now resistant to antibiotics, and they can cause diseases that can lead to death. So, we need to look at the One Health construct, which is why, in November, we initiated the One Health steering committee that includes a veterinary doctor, medical doctors, and engineers, among others, to create synergies across sectors. That way, we can prevent spillovers and enhance health security; instead of a silo approach, each one does their thing in their corner.

The initiative of a multisectoral approach to meeting the nation’s health challenges is brilliant, but when will Nigerians start feeling the impact?

We’ve put in five to six months of this administration building block, 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. 

There is going to be an executive order, I think, in four to six weeks. We’ll get back to the president. He assigned the Attorney General to work with us. To be precise, for the local manufacturers in the pharmaceutical sector, what would be most helpful would be to reduce tariffs on the import of equipment for manufacturing. Some pay between five and 25 percent of the tariff on manufacturing equipment on raw materials, which are necessary to produce here. So, if those are reduced, they can get those items. Some have to do with the ease of clearings at customs so that they don’t bring products and incur huge amounts of demurrage just by waiting; others have to streamline the regulatory processes and the efficiency of NAFDAC in granting approvals for those things that need imports to manufacture. Some are saying that they will even come and manufacture vaccines in our country. We welcome them because there is the technological transfer aspect of it that will come along with the market, and we think that it will grow over time.

On the financing of health, 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.

So, before you leave this office, I will show you our week-by-week plan, and it is not just that we are starting but that we have done it. You will see our track record of execution. This year is a year of execution for us, and we are on our path, I would like Nigerians to just be patient. What has deteriorated for many years cannot be fixed in 3, 4, or 6 months.

By the end of this quarter, we will channel resources to 8,000 primary healthcare centres through direct facility financing funded by the BHCPF. The money is approved and available. We’re just making sure the integrity of the judicial systems at the sub-national level is good so that we don’t transfer resources that don’t translate into improvements in services, because it’s not just about spending the money. We are painstakingly working through NPHCDA and NHIA, making sure that when we make those resources available, they translate into improvements in services.

 

How do you plan to work effectively with states in realising your vision?

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. Many people are complicit in seeing and just looking the other way. It’s not just the federal government, states, or even the primary health care centres in the 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 and report back. We’re also exploring how we can have youth who 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. And I believe that if Nigerians will just tarry a while, they will see a different direction that will lead this country to a path that will make Nigeria prosperous, an end to the difficulties of today, the President has said again and again. He understands it. But these difficulties are the results of successive steps that we collectively I’m not saying just one government or the other, or one level of government; all of us, including the civil space, who watched and acceded to some of those missteps that were happening are somewhere closely involved.

What challenges do you foresee generally and how do you deal with them?

It’s going to be very challenging. If it were easy, it would have been done before. And I know 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 go up to it and correct ourselves. As a demonstration of our intent, before we leave this office, I will show you, week-by-week, our execution plan

What are you doing specifically to address the wide spread of malaria in the country?

Before I tell you specifically, I just need to correct this perception, which is very prevalent. Yes, malaria taxes our economy. So, I’m not undervaluing the fact that we have a high burden of malaria in Nigeria that affects our economy, people’s lives, and their productivity. It costs money to get tested and to be treated. But there is a very prevalent misconception, even among the elite. Roughly 50 to 60 percent of fevers during the peak of the season are malaria. Less than 40 percent are other causes of fever that are treated as malaria but are not malaria. Some are viral ailments that cause people to have fever but are not malaria. And because we’re using rapid diagnostic tests, sometimes those rapid diagnostic tests are not very sensitive or specific enough. So, you can have false positives. The true gold standard of malaria diagnosis is a blood smear, which some facilities have and many don’t. So, malaria is a deadly infectious disease. And I think before we generalise and overtreat, it would be good each time, folks, to be sure that it is malaria before you call it, so that’s one. 

On what we are doing to address it, I mentioned expanding the primary health care system, including the training of the health workers, so they can diagnose it better. In addition, the commodities that are going to be procured are intended to treat them better. And from the malaria programme side, some of our partners are delivering bed nets to protect populations, but the right types of bed nets are being used by people to prevent it from happening because it’s also a partly preventable disease.

Beyond bed nets, what about even eradicating malaria completely?

It is possible, but it will take time. Nigeria has had a malaria programme for 78 years—since 1948. Yet, we have 30 percent of the world’s burden of malaria in terms of numbers in a large country. And in the last 20 years, at least 600 million bed nets have been distributed in Nigeria. This is textile material; those bed nets were not manufactured in Nigeria. It’s about $2 to $3 a piece, mostly manufactured in Far East Asia. We’re just consuming them. Why are we not producing them here? I’m telling you, and you can come to me at the end of March to see that we have the largest bed net manufacturer in Lagos now exploring partnerships with local manufacturers here. So that these nets are appropriate for the insecticide sensitivity that we have in Nigeria, we should produce them here so that they are also locally produced.

And our partners, whether the US President’s Malaria Initiative or the Global Fund, have been very generous in financing these bed nets. I think without those interventions, it could be even higher. You see, in the health sector, unlike other sectors, our success is not as visible as in other sectors because our success is in preventing badness from happening. 

If what the federal government is doing is complemented with the same energy commitment as the sub-national governments, our partners in the private sector, and the generality of Nigerians, there are a lot of positives that Nigeria can achieve. But consensus has to be built. You in the media can help build that consensus positively, emphasising what is possible and even where the deficits are and how we can improve them.

How concerned are you with the shortage of health workers in Nigeria?

It’s an issue of concern to all ministers of health in developing countries like ours, and it is a global issue. There is at least a shortage of 10 million health workers already all over the world. This is according to the World Health Organisation. The wealthier countries have older people, and health requires human resources. The ploy is to draw those human resources to them. So, they entice them with resources to come and work in those countries. And you cannot prevent individuals from choosing for themselves or their families to migrate—just as engineers, university lecturers, and other professionals, including journalists, are also “Japaing.” So, it’s not limited to health. Even the banks are suffering from it.

In health, I have to say that the framing of the conversation focuses on those who are leaving without appreciating those who are staying. For those who are leaving, some 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.”

For those who opt to stay, we hope that the direction that we’re taking will make it meaningful for them to want to stay and serve in this country, including the infrastructural upgrades that we’re making, the conditions of service, and the growth that we see in the health sector; that if they leave just because the labour that they will offer somewhere else is needed, when they may want to come, the country will have moved on because this country will grow and will be better. So, they might as well stay and be part of building that new Nigeria. 

In practical policy terms, we are about to finalise 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 do not train them. So, we’re asking those countries to consider investing in pre-service for everyone that you take from us to help us train more. And this managed migration policy.

What could you beat your chest and say, in the last six months, you have achieved?

We did not pay attention to this idea of 100 days because it was not original. There was a US president who set an agenda for what he would do in 100 days, and everybody made it almost a standard. When something has not been done for a very long time, you have to be very thoughtful and methodical in organising the things that you want to do. You don’t just go on the fly. Just because you want to make some points. 

Transformation takes effort. It’s hard work. This year is the year of execution, and very soon you’ll hear of groundbreaking 10 health infrastructure projects, some of which are diagnostics and cancer centre infrastructure projects in six geopolitical zones for which procurements have taken place; the sites have been identified and the resources have been identified. Those don’t happen just overnight because you can make mistakes. Those have happened, and this government will be groundbreaking. These efforts have floundered for more than two years. 

This year, we will refurbish and expand the infrastructure of many of our primary health care centres and mobilise the resources for the training of frontline health workers. The training manuals take time to be developed to build consensus around them. The printing has just been completed, and the training will commence so that we will be reporting on the numbers that have been trained. Vaccines are being delivered, including the successful launch of the human papillomavirus vaccine and the second phase that is going to come in a few months. 

Investors are coming to invest in our health sector. It takes time to engage them enough to fully believe in what you’re trying to do. And to be able to do that, we’ve expanded the quotas for the training of healthcare workers, nurses, midwives, and maybe MDCN, and for medical students, that is already done. 

So many of those policy actions that we have taken, some on the regulatory side, are streamlining the finances. Now, to procure infrastructure, you just don’t come overnight and say, “Oh, I want this to be done.” It requires work to be done. Diphtheria, when we came in August, was in all 14 states of this country. Within two weeks, we set up a task force, and that outbreak has been contained. People are no longer talking about it, but they don’t see the connection with the work that we are doing.

We set up a task force led by the NCDC to respond to the diphtheria outbreak from August to September. We provided resources, and we asked the states to provide complementary resources, and that’s going on. We’re not measuring success on short-term achievements as dictated by the 100-Day Movement. Transformation doesn’t take place in 100 days, especially if things have not been done in 10 years. If I tell you that we’re solving all these problems in 100 days, then I’m not being truthful to you. 

With over 216 million Nigerians, we have only three percent under the NHIS coverage. What are you doing to address this?

We have 15 million Nigerians covered; that’s 7 percent. That’s low. But that is after 30 years. Nigeria’s journey on health insurance has taken almost 20 years, and we’re still at 7 percent. That’s not good enough, but there’s now an act that has made it mandatory, and we have a leader appointed by the President to lead NHIA. We’re engaging with health maintenance organisations and state health insurance authorities in Lagos on the roadmap to accelerate enrollment and, using technology, innovative ways to mobilise resources, which is prospective but has to be done. When I mentioned to you the consideration of using telcos to allow airtime to be used for paying health insurance premiums that can unlock more Nigerians to be enrolled, that will mobilise financing that can pay for health care using insurance mechanisms. Those are the kinds of things that we’re looking for to accelerate Nigeria’s progress towards getting universal health coverage. 

In the next three years, in the next four years, what legacy would you be pleased to have left behind you?

In three years, if President Tinubu’s administration is judged to have shifted the curve and the population health of Nigerians has measurably increased, I would be very satisfied that we have done our job well.