Ibrahim Wada is a renowned Nigerian obstetrician and gynecologist with specialty in fertility and sick cell management. Founder/CEO of the Nisa Premier-Garki Hospital Group, he was a former deputy chief medical director of the National Hospital Abuja. In 2007, Dr Wada pioneered PPP in the healthcare sector with the Garki General Hospital Abuja. In this interview with Obinna Nwachukwu and Godsgift Onyedifu, he gave reasons behind that decision and other vital issues. Excerpts:
For the first time in history, the federal government in May 2007 concessioned a hospital, Garki General Hospital Abuja to you under a PPP arrangement. As at that time, the hospital was almost written off but today it has become a centre of excellence. What informed your choice of the hospital among others offered for sale at the time?
The idea of the PPP that we took on was because I knew that having worked in both the public and the private sectors of our health industry and with almost 50 years of doing the same thing by the government running public hospitals have not led us anywhere. When this opportunity came, we put everything we had, our minds and efforts to see if it would work. Because I knew that as a nation we cannot continue to operate as we all was well with our healthcare system. Almost every day we witness industrial strikes, epileptic power supply, utility default and other issues. More importantly, we had key hospitals in this part of the world that ought to do very well but were constrained by factors. The UCH Ibadan, LUTH Lagos; were hospitals that started on a very high note. The Garki General hospital Abuja started on a very high note too; left in government hands; it seemed the only way was down. So when the opportunity of turning around the almost dead government hospital came up we decided to give it a shot. So it was that mind-set with which we took over and we never wavered a day despite the odds.
The key issue is that public private- partnership is a marriage of two parties, both public and private, for the interest of the public. Unfortunately, it’s taking too long for government to seize that opportunity and treat it as a necessity. And that’s why I can tell you that everything that had been achieved in Garki was because we made a sacrifice. We had a goal and we have achieved a lot since we took over including doing fantastic things like heart surgery, kidney transplant, which is unheard of, even in many of our teaching hospitals. We focused on them, invested in them, and proved a point. But carrying on this kind of effort at prices the public can afford needed government support and participation. Somehow, we muscled our way through to be where we are today. We never looked at a profit as the bottom line. I had to insist on that, the truth is that the concessionaire, the private party has not left with one naira profit from that Garki hospital, because against the mind-set that we had, we will not allow life to be wasted just because we want to get money from the practice.
So, each success we made is a factor of mindset, capacity and ability and sense of sacrifice. What we want to get out of it is that our sweat of over 15 years is understood by governments all over the country, so that they can duplicate what has happened in Garki for the good of Nigerians. And also that it is not just private, it’s not like building a bridge with your engineers and leaving it, this is a life-dependent thing, and that government’s presence must be heavier in health PPPs than it is with any other kind of PPP, which is a cash and carry kind of business. So, I must tell you, I’m very grateful to God for the opportunity to have done what we did in Garki, and I salute my team of Nigerians who stood by me most of them understood what direction we were going, they believed in it, and they continue to make that sacrifice, and I don’t think that will be the end of PPPs. I want it to be the birth of several PPPs in the country.
Drawing from experience what would be your advice to government on how to handle several moribund infrastructures in the country?
Honestly, we don’t have a choice but to devise a very efficient method of managing our resources. Nothing supports that kind of situation than a public-private arrangement whereby meagre resources as we have proven in Garki can lead to great achievements. The old ways have not worked, our demand outstrips supply and our pockets are relatively weak. We cannot afford to keep on managing unproductive ventures. Therefore, efficiency is the only way. What is my experience?
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Yes, we must make provision for people in society who cannot access certain services, but saying that the price might be too much for the public is not a reason for not going that way. That statement scares the public and I am telling you that it does not mean we should do things the way we have been doing it, because we don’t have any good results from it. What should be the role of government like other civilised governments is to have a model to help those who cannot afford it.
In Garki, for example, we are the ones supporting the poor, and that’s why I told you that we have not been able to take a penny out of it and there are documents for anybody who is interested in knowing that. I am not saying it is not profitable, it is. But, can you take the money out and not shake the system? So, a model that allows people to access healthcare or PPP government projects is welcome. In the case of health care, it’s health insurance. I salute the National Assembly for saying every Nigerian must be covered now. So, you don’t have to use your personal money to access healthcare. No matter what, it’s a very civilized move and it will help us. Other PPPs like concessioning airports and roads are equally beneficial to us because the private sector has more efficiency, more value for money. I have a major public sector working background, when you get to a public hospital and you are asked to buy card for N100 and in a private hospital, the same card is sold 5times more expensive. But you forgot that with the N100 you paid, government pays salaries from your taxes, oil revenue and everything for that hospital. So, if government were to take their hands off, it would not be N100, it might even be N1000 because of inefficiencies of public sector. Many people are not able to understand that. I believe in public- private partnership. I’ve experienced it for 14 years in healthcare. I am even more convinced now that we need this as a country than I was 14 years ago. The gaps are so easy to block and to make it beneficial to all, so that we can be counted among the nations that have taken health care insurance serious.
You were the Deputy Chief Medical Director of the national hospital Abuja, what do you think are the major challenges facing the hospital? I say this because there have been several complaints from the public about poor service delivery.
I have been away from the national hospital for almost seven years and things have changed. I know they suffer funding challenge. They also suffer quality of personnel because in terms of employment there are many influences that come in, so, it’s not everybody that is a round peg in a round hole, nor is it everybody that wants to maximize what he or she wants to do. And strikes don’t help to. But, like I said, this can’t be about them, all the ills of public health care in the national hospital are the same as in any other hospital. In public hospitals, the funds don’t come as expected. So, “if it doesn’t come, we wait when it comes we do it”. That kind of stop gap cannot help.
And there is an inter-professional rivalry and I think that also is everywhere in the country and in the world at large because the natural human instinct feels it is more important than others. But, this is like a turning wheel and everybody has his/her place to make it turn; it’s called accountability. So whether it’s public or private, what is driving the wheel is accountability, and everybody feeling relevant to the success of the organization. So, I feel that PPP solves it. There is no nurse-doctor quarrel, there’s no lab-pharmacist quarrel, there’s no strikes. Fourteen years of running this project and not one hour strike, are we magicians? Of course, we are not
But despite the merits of PPP labour leaders kick against its implementation…
(Cuts in) …It is the same thing, they perpetrate the old ways that have not yielded new results, if you like pour billions, pour a lot of water into a cup that has holes, what would you get? Have they experienced PPP? What are they protecting? Is it not the underprivileged in the society? Once you are insured, you can access health care. And their aim is, “don’t do PPP unless you can protect the public.” So, in their hours of need, they can access healthcare. The labour might also want to protect jobs, excuse me, 90% of government income goes to payment of salaries, are we colonialists or what? Are we not expected to develop by ourselves, or must we keep on borrowing money to survive? So, if there are jobs, excellent! But, it cannot be employment for employment sake, unless you become a socialist republic. Rather, the economy is virgin, there are so many areas that need attention. For instance, we are still importing food. So, if all of us are wearing white collar, and get paid salaries each month, at what point then shall we rise and say we must work and produce? Or go into the sectors of the economy that are weak and build it up?
The growth in population will lead to catastrophe, if something is not done now to free money from salaries, and invest in things that will give jobs. It is unheard of that 80 to 90% of our earnings as a country are used to pay salaries. I’m so sorry, I don’t intend to make any political statement, but private sector is lean management, and it expands. The way we have expanded Garki hospital we have employed more people and it is alive by the grace of God. So, that can happen to different sectors of the country. I don’t know any other reason why any group of people would not want to study it, test it, question it and modify it. So, as it is today, in Garki, we have some of the best workers and we take good care of them and we also guarantee access to healthcare for those who cannot afford certain levels, and if you solve that, then I don’t see anything wrong with PPP.
How can Nigeria tackle the problem of brain drain? Do you think government is doing enough to stop the migration?
Thank you so much for this question, I want to start this by saying we have one life, we don’t have a second chance in life. So, each person has a duty to maximize that life, whether it’s professional, economic, environmental or whatever. I want to say that a lot more can be done to boost the home stay of our professionals, especially the medical professionals. And that involves not just investment by government, but how to utilize, maximize, in an efficient and accountable manner, those resources. Once that is done, there can be growth. So doctors want to get trained. A doctor graduates with the hope of becoming a gynecologist or say a brain surgeon, but, ask yourself, what are the opportunities in this country compared to the volume that is needed? Generally, career, economy, security, all sorts come to mind in deciding where to work. And these are all interwoven with efficiency. I think the foundation of it is, “whatever you have use it efficiently” so you don’t waste it. And then, all these pillars will go. Can we stop it (brain drain)? The answer to me is yes, but not overnight. It must be a program that expands opportunity first, expands the economy of doctors because they work. They are not office people that sign document, they are guardians of life and must be on the duty post, and they must train to keep on getting in tune with modern realities.
What about the equipment they will need? For example, the way power supply in this country turns on and off is not friendly to many advanced medical equipment. That needs to be solved and government needs resources, and efficiency. I’m not talking of corruption or anything here, efficiency and accountability, to make sure that those people meet what the country demands of them, not just investment but utilization of that investment.
So, I feel that if we get our health insurance right, more money will come into health, if we improve on public private partnership, or at best coexist within government locations things will improve. It’s not all of us that government must cater for, those who can take care of themselves in the same controlled environment should be allowed to do so. It happens in England and America, the quality of what they’re both getting technically are the same , but one is more comfortable than the other. Those are the principles we must embrace, if our doctors can economically survive and plan for the future, like any other doctor anywhere in the world, fine. I want to stop at this point by just pointing out one thing, it is a market force that is driving the world economy of doctors. It is not nationality, what do I mean, UK doctors go to Australia, Australian doctors go to America, others go to Canada, etc., the issue is to ensure that as many people as possible either stay home or attract other people from elsewhere, so that when yours go, people from other places can come to replace them, that’s accepted. So, it’s not something you can decree to stop doctors from moving you have to provide for career, economic advancement, protection and all sorts.
Some of your colleagues are moving to other countries in the name of looking for the greener pastures, why haven’t you joined them?
I had a mission. I’m one of the luckiest Nigerians in terms of medical training. I started in Jos University Teaching hospital, went straight to Cambridge, with the help of God. I was able to push through the UK system to a good height and good knowledge. I learnt how to make infertile couples have their children against all odds. The question then was: do I go home to help, because I had seen many people crying, or do I stay to look after my own self and my family? And I looked at the day that I would be buried and chose the other. It’s not about me, it’s about what I’ve done by the time they’re going to put me in the ground. It is the same thing that’s holding me here, I’ve had enough reasons to abandon ship, but I stayed steadfast because, these contributions may not be recognized so well during my time, but I pray that even if I’m not here, someday, people will remember that a guy came, who was not just about himself. And we need more of these people.
Unfortunately, if you are not as exposed as I am, maybe all you will think of is yourself and the more you do that, the less open you will be. I trained doctors in making sure my brain is transferred to as many people as I can. I care for my patients and I explain to the depth of my mind what the options are. These are ideals that I have worked for. I am not rich and I’m not poor doing those ideals. Anytime I want to leave I look at what I’m doing and see that it is working. It has been progress, progress, progress and protection from the Almighty against the big odds. I interact with my colleagues all over the world, they also appreciate how I have fought and stood here. And there are other words about it that I don’t think it’s for the press but I will say it. Nigeria, on the world scene is a small pond, America and Britain is a huge pond. So, the question a man must ask is, “do I want to be a very small fish in a big pond, which is what we are when we travel; or do I want to try to be a big fish in this small pond?”, My answer is the second one, and you can see that once you choose that, any knock that comes in you try to get your way through. We don’t want a scenario where we say “NISA is about making money”
NISA premier is known more for fertility management. Why did you choose that particular line of medicine?
When I was training as a gynaecologist in Jos my boss was interested in fertility management and we were receiving patients from everywhere. There was a clear roadblock of what we could do. This was in the early 80s. We operate on them, give them drugs and your back is to the wall their backs is to the wall too, there is nothing you can do beyond that. At that time, the idea of in-vitro fertilization was coming, and truly, I was making efforts to go to the UK and was praying to learn what I can do to help those whose backs are to the wall. And I can tell you that the opportunity fell on my laps, as if my prayers were being answered.
When I came home, it was that sense of responsibility that actually brought me, to come and help those whose backs are to the wall, who can’t have their children. That was why we chose fertility. My head was full of international fertility knowledge. I was going to train other people in other countries. But, why would I ignore Nigeria when I had seen the people suffering in Jos. So it’s an emotional thing, that’s why I said I was a man on a mission, rather than any other consideration. So, we made our name first in fertility, after the birth of baby Hannatu who is actually a first class graduate now and we’re very proud of that. All other things followed after that. We have taken the fertility journey to almost its zenith, there’s nothing that can be done in infertility anywhere in the world that we cannot do under my watch. After training people selflessly, sending them abroad for all sorts of education, I am confident to say that we attacked sickle cell disease using fertility treatment. So, both of you are ‘AS’ man and woman, you don’t have to be afraid of ‘SS’ children anymore, and this is a home-grown technology. So, this is one of the ways to end childlessness, and you can even choose the kind of child you want without being depressed.
