National Policy to curb brain drain in Nigeria’s health sector underway – Pate, Minister of Health and Social Welfare

Muhammad Pate is a Nigerian physician and politician and the current Minister of Health and Social Welfare, appointed in 2023. He is also a professor of the Practice of Public Health Leadership in the Department of Global Health and Population at Harvard University. Prior to his appointment, Pate served as the Global Director for Health, Nutrition, and Population and director of the Global Financing Facility for Women, Children, and Adolescents (GFF) at the World Bank Group. He led the bank’s $18 billion COVID-19 global health response. Before joining the World Bank, Pate headed Nigeria’s National Primary Health Care Development Agency (NPHCDA). In 2011, he was appointed Minister of State for Health by former President Goodluck Jonathan but resigned in July 2013 to take up the position of Professor at Duke University’s Global Health Institute in the US, in addition to a role as Senior Adviser to the Bill and Melinda Gates Foundation in Washington, DC. He also participated in a university-wide Africa initiative. Born on September 6, 1968, Pate hails from Bauchi State and attended Ahmadu Bello University (ABU), where he studied medicine. He is certified by the American Board as a medical doctor in both internal medicine and infectious diseases, with an MBA from Duke University, USA. He also bagged a Master’s certificate in Health System Management from the London School of Hygiene and Tropical Medicine in the United Kingdom (UK). In October 2022, Pate was conferred with Commander of the Order of the Niger (CON). In this interview with a BusinessDay team comprising John Osadolor, Onyinye Nwachukwu, Tony Ailemen, and Godsgift Onyedinefu, he spoke extensively on the government’s efforts at rebuilding Nigeria’s dilapidated health sector, especially a critical policy to deal with the mass emigration of the country’s health professionals.

Can you talk us through the implementation of your health sector reform plans and programmes since your appointment?

When this administration started in 2023 and His Excellency appointed us, we took time to understand the Nigerian health landscape and the issues facing the health of our citizens. We did a people survey with 2,500 Nigerians to ask them about their experiences and expectations. We looked at the burden of disease and saw that Nigeria’s health was challenged. The president’s renewed Hope Agenda placed health and the well-being of the people at the centre of it. Health, because it’s a right and without health, you can’t do much. It’s a basis for the human capital that Nigeria has and needs to accumulate in order to achieve that prosperity that the president has foreseen. We discovered that the health outcomes in Nigeria were relatively lower compared to countries at similar levels of development, who spend sometimes less than us. So there was a performance gap. The fact that many Nigerians are paying for health care out-of-pocket was challenging for them; the cost of pharmaceuticals was challenging, and there were disease outbreaks like diphtheria, which were in 14 states by August last year. So in consultation with various stakeholders, state governments, local governments, development partners, and civil society, we articulated an agenda to fit with the president’s vision. And in that agenda, we set the goal to save lives, reduce physical and financial pain, produce health, and to do so for all Nigerians. We set the goal to produce health because we also needed to focus on prevention because hypertension, diabetes, stroke, and cardiovascular diseases were becoming the fastest-growing segment of Nigeria’s burden of diseases. By preventing them, you’re producing a stock of health. And to do it for all Nigerians means to walk towards universality.

We articulated a four-point agenda. One is on how the sector is governed so that we do it collectively. The federal government is not the only entity responsible for the health of Nigerians, it has agencies and the state governments, local governments are complementary partners. There are large private sector actors that are also part of the health ecosystem; civil society development partners are all part of this national health system, but they have all been working in separate ways. So governance was important. There were regulators of professional groups; there were also issues of transparency, accountability, and responding to the needs of citizens. That was the first pillar. The second pillar was to do things that will improve the population’s health outcomes, focussing on primary health care, frontline health workers, essential commodities, vaccines, hospitals that provide emergency operative care, federal hospitals, cancer care facilities, and expanding health insurance so that people can afford the care that is being provided because even if there’s good quality care, if it cannot be afforded, it won’t serve.

The third pillar was to unlock the value chain to produce some of the things that we need—whether generics, devices, vaccines, or whether they are other services by the private sector to help the healthcare market function better.
The fourth pillar is to do better in health security, to deal with outbreaks like diphtheria, which was prevalent when we came, and to organise it in a sector-wide manner.

This was the direction that we took, and you would recall that in December 2023, we signed a sector-wide compact in the banquet hall, Aso Villa, where Mr President, for the first time, witnessed a signing between the Federal Ministry of Health and all 36 states of the Federation as well as the 17 development partners. We mobilised additional resources to complement what the federal government was providing with external resources to support us to accelerate progress and improve the health and well-being of Nigerians.

There are various tangible steps that we have achieved in this journey, and I will lay them out for you pillar by pillar. In the governance pillar, the compact itself has accountability measures that we have put in there. We have started the quarterly performance review with all the states on how they are doing in terms of improvement, in terms of maternal and child health, immunisation, and other services at the front line in an inclusive way. We have strengthened the regulatory bodies—NAFDAC, the Pharmaceutical Council, the Blood Service Commission, the Midwifery Council of Nigeria, and the Medical and Dental Council of Nigeria—so that we will have strong regulators that actually play the function of appropriate regulation. We had forums of citizen and civil society engagement in trying to improve the governance and to be transparent in how we even disburse the basic health care provision fund—the flow of funds that is going through the federal government to the state and local governments.

On the second pillar, we have had two cycles of disbursements to 8,800 primary healthcare facilities in the 36 states of the Federation. We did this publicly. These funds are direct facility financing that reach all those primary health care centres to deliver services for Nigerians such as antenatal care, maternal care, and immunisation. We continued to provide immunisation for Nigerian children. We launched the human papillomavirus (HPV) vaccine, which is to deal with cervical cancer, in October. The first phase in 15 states reached almost 80% of the targeted children, and by the second phase, which was done in May in 21 states, we had 93 percent coverage for the children targeted for that HPV vaccine, which means that in the future, many of these young children who are vaccinated will be protected from the virus that causes cervical cancer. That’s a big achievement. We announced that we will retrain 120,000 frontline health workers by 2027. As of today, we have retrained about 10,000 health workers in eight states, and about 8,000 will be trained again in another seven states very soon. The retraining is underway through the National Primary Health Care; this is very tangible, which will improve the quality of services that are being offered.

We doubled the quota for schools of health technology, schools of nursing, and schools of pharmacy, and also encouraged medical schools so that we double the health workers that are being trained because we know we’re losing many health workers. In our efforts to improve maternal mortality, we’ve mobilised resources now to provide comprehensive emergency obstetric care in about 700 facilities. That has not started, but we will start because we’ve mobilised the resources for it. We have expanded the vulnerable groups fund through the basic health care provision fund, which has now covered 2 million additional Nigerians to have access to affordable health care services. NHIA can tell you who we’ve added. That is a significant uptick if you know that Nigeria, for a long time, had stagnated between 15 and 16 million people.

On the hospital side, you recall the president approved the refurbishment and infrastructure equipment for cancer care in six geopolitical zones. Those have been provided in our 2024 budget; we have signed the agreement with NSIA; the procurement process is underway so that those cancer centres will be built and opened in 12 to 18 months so that Nigeria for the first time will have a robust cancer treatment infrastructure. NSIA has also developed a program for eight diagnostic centres and two oncology centres. The groundbreaking was to happen tomorrow for ten of them simultaneously, except for this crisis (protest) that slowed us down. In the 2024 budget, we put resources to revamp the physical infrastructure, the hostels, equipment in federal facilities, teaching hospitals, federal medical centres, and specialist hospitals. As of May/June, we had almost 179 distinct pieces of equipment and almost 230 distinct projects that had been done in federal hospitals all over Nigeria. On health insurance again, we’re discussing reforming the health insurance authority because we inherited an institution that has not delivered to the expectations of Nigerians. So we are repositioning it with the support of the president to expand health insurance. The reforms are currently being designed, and the president has mandated us to work with the Attorney General to execute on them. That is on pillar two of our agenda.

On pillar three, the president announced in October an initiative to unlock the healthcare value chain; we have constructed that. There were policy, regulatory, and financing measures that we were trying to bring together to manufacture. When you’re trying to manufacture to reduce the cost of pharmaceuticals, it isn’t going to happen overnight. What we have not done for decades, we can’t just wake up overnight and do. We still import 75 percent of our generics and almost 99 percent of our devices. We’re very dependent on what people bring in, so to change it, it’s not going to be overnight. Through the Presidential Initiative on Healthcare Value Chain (PVAC), we are very grateful the president signed an executive order very recently to reduce tariffs on raw materials, machinery for the production of active pharmaceutical ingredients, long-lasting nets, test kits, and reagents that can be manufactured here. It also allowed us to do market shaping like volume guarantees to allow us to mobilise the demand here and channel it to our pharmaceutical companies. The framework for the implementation of that executive order has just been developed; an advanced draft is available because it requires different parts of government, from customs to NAFDAC to SON to the Ministry of Finance and the Ministry of Industry to ourselves, working together to make it happen. It has to be governed well, so that we monitor the progress on execution.

We have developed at least 40 investment cases for different aspects of the healthcare value chain. There is a company in Lagos that has already started producing test kits for the first time—in fact, the first in Africa. There is an AMA diagnostic centre in Kaduna that Ngozi Okonjo-Iweala followed me to. They are going to produce test kits and generics. We also have a company from Brazil that has announced that they are going to spend $240 million to produce generic pharmaceuticals. They have licensed many of their products already, and I was told that they are going to start building their plant in January 2025. There is also a company that is building its plant here in Gudu, Abuja, to produce test kits, and they want to also start producing vaccines.

The African Vaccine Manufacturers Alliance met in Paris eight weeks ago, and we had four Nigerian vaccine manufacturers that accompanied me: There was the BVNL, which is May and Baker, that has a technical partnership with Serum Institute for fill and finish; there was Ash Biomedical in Gudu, which is now building their own plant; there was Innovative Biotech, which is in Nassarawa; they are going to do a different type of vaccine; they are trying that vaccine in South Africa and ultimately raising the resources to have their plant; there’s AfriVax, which is Lagos-based, which is going to also establish their own plant starting from fill and finish. But you know vaccine production is not something you just wake up to; it’s not like cooking food. You have to ensure they are well regulated, safe, and effective. You don’t rush into it. We already have four that have cropped up, and we connected them with the African Manufacturers Alliance so that they get the incentives for various milestones if they are able to produce.

At the same time, there are various entities aiming to produce medical textiles. We have one of the largest manufacturers of bed nets interested in coming up with a plant in Lagos. There are also public-private partnerships that FEC approved to expand the capacities in our hospital four weeks ago. There are others who are trying to manufacture IV fluids and other medical products, all as part of stimulating the industry to produce things. It will take some time, but that is a path that we have to take ultimately. We are now embarking on an effort to procure medical commodities that can be provided at subsidised prices to reduce the difficulty Nigerians are facing. That’s on the third pillar.

The fourth pillar is on health security, which is preventing and dealing with infectious disease outbreaks. You recall we had a diphtheria outbreak in 14 states; we created a task force that controlled that outbreak. In February, we had an initial outbreak of meningitis in Yobe and a few states. We rapidly acted within three weeks. We were the first country to have the pentavalent meningococcal vaccine in the world, which was deployed, and that outbreak was contained. Then we had a cholera outbreak from early this year, which got severe in Lagos. We had an emergency operation centre, we put a cabinet committee, and we mobilised resources through NCDC. The epidemic has gone down in many of the states because, working together with water resources, environment, agriculture, education, aviation, and information, we rallied around under the direction of the president. It’s too early to say we’ve won given the flooding, the practice of open defecation, and poor sanitation that allow this infection to continue. We feel confident that we’ve turned the corner, but we don’t want to declare victory yet. We’ve mobilised cholera vaccines through Gavi; we’re expecting that we should receive them in a couple of weeks. But even without the vaccines, we’re able to handle it.

We have set up one health steering committee that is multi-sectoral because many infectious diseases come from animal health, like Ebola, which is coming from the wilderness, even coronaviruses. So we need to collaborate. The one health steering committee, which has myself as chair and includes ministers of agriculture and environment, has met twice. We discovered that there were some bats somewhere in Benue that had some antibodies to some pathogenic organisms that we assessed and put measures to ensure that there is no spillover for pandemic. We’ve put up an application for the pandemic fund both for Nigeria but also in the context of the region, and we are successful. We have also got the president to approve a site for the regional collaborating centre for the Africa Centre for Disease Control here in Nigeria to anchor Western and Central Africa as part of the African Centre for Disease Control, because what we do also affects other countries.

Overall, we have created a sector-wide approach; the idea is that it’s not just a federal or state health system. You cannot have some 774 health systems in Nigeria, so the sector-wide approach takes the view that we have a national health system comprising all of us but rowing in the same direction led by the president. And we now have a governance framework around it; we have technical working groups with our development partners. We have mobilised resources, a coordination office in partnership with the states, and are working with all the commissioners of health, the state health insurance authorities, and the state primary health care agencies so that we are all pulling in the same direction.

Now there are certain strands that don’t fit into this neat bucket, and I will tell you, one is malnutrition, which is a big issue. When we discovered that there are Nigerian children suffering from acute malnutrition, we set up a ministerial task force more than 10 weeks ago. We rallied together and raised resources to channel to 1,200 primary health care centres. In collaboration with the minister of finance, we raised $30 million through a project of the World Bank to buy ready-to-use therapeutic foods. We raised through Kirk humanitarian donations of multiple micronutrient supplements. An initial 1.3 million doses in Nigeria, which I believe came through UNICEF. Each pregnant woman who gets one of those 1.3 million doses will take those multiple micronutrient supplements for at least six months. That will spotify their body but also help their babies because we need to protect the most vulnerable, the unborn children and the mothers. We also activated a different set of partners under the leadership of the Vice President to accelerate Nigeria’s progress in dealing with malnutrition.

Secondly, malaria as a major issue, we convened on May 3rd, a rethinking malaria effort here in Nigeria, where we discussed with all stakeholders, funders, technical partners, and ourselves and agreed on measures to revamp Nigeria’s malaria elimination effort. We were able to identify certain things that we needed to do to recalibrate our plan and tailor our efforts at the subnational level so that what you do in Bayelsa is going to be different from what you do in Zamfara because they’re different geographies. There are procurements of antimalarials that are underway; some of them are being delivered for use by our frontline health workers, who were trained to be able to test with rapid diagnostic kits and deploy bed nets. I was supposed to be in Gombe last Saturday to distribute bed nets, but this unfortunate protest stopped us. Jigawa was to do the same, but this protest stopped us.

We are in the process of revamping the procurement of nets that will be bought from folks that are going to manufacture here and deploy seasonal malaria chemoprophylaxis, meaning you give kids anti-malaria twice a year. That’s very effective, as well as intermittent presumptive therapy for pregnant women. We looked at the issue of malaria vaccines. These are new vaccines that have been approved by NAFDAC and approved globally. But vaccines are not the magic bullet; they have to be built on the back of certain very simple, cost-effective interventions. They are the bed nets, the seasonal chemoprophylaxis, and the intermittent presumptive therapy, which we had previously not optimised. Then you use vaccines to get the maximum benefit in terms of prevention. But the vaccines are also expensive; they are more expensive than some of the simpler vaccines that we have not yet fully utilised. For instance, the measles vaccine is less than a dollar per dose, but there were many children in the past that had not been reached by these vaccines. Imagine with the HPV vaccine that we deployed, we had to do a lot of mobilisation and preparation because some misguided elements will come and discourage people from receiving freely given vaccines. So when you mobilise malaria vaccines that are expensive, and then some misguided elements who think they are educated but have absolutely no clue will go to the media and discourage people from taking the vaccines. But these vaccines are not free; somebody paid for them. You could end up wasting them, so you have to deploy these vaccines in a systematic way, with preparation that includes mobilising communities, training the health workers to know how to administer them, when to administer them, and all of that.

We have secured some doses of this R21 malaria vaccine, which will be deployed in Bayelsa and Kebbi states. We will start with those states to see how the rollout goes, and then, in parallel, identify where the money is going to come from. Is it only the federal government, or are states going to contribute? Will private sector individuals also pay? If you have vaccines, are you going to give them to only the people in Abuja? What about other Nigerians elsewhere? An estimated $250 million will be required; where is that going to come from, and who is going to pay for it? This is the hard work that is being done so that we introduce such new vaccines in a systematic way while optimising the most basic interventions, bed nets. Just bed nets can prevent malaria, but some people are not even using them. I went to Kano and saw parents administering two doses of this seasonal prophylaxis, they told me their children don’t get malaria because of this prevention. They are protected by this very simple intervention. So there are some cost-effective interventions that we also have to deliver. But even as you are delivering them, when you come with the newer tools, those so-called anti-vaxxers, half-educated folks, tell people that taking the vaccines will harm them. They don’t know the implications of what they are doing. There are not enough of these vaccines; they cost money, and yet they discourage people from taking them.

So we have to prepare so that when we provide them, it’s optional. If you want your child to have the disease, don’t take the vaccines. But if you want to follow, then you take. That’s the only way; we cannot force people to take what they don’t want to. We know the struggle we had before we could educate people to take the HPV vaccine. People have to help themselves. Local governments have to help themselves. States have to help us to work under the leadership of the President. The federal government by itself cannot do it alone. And I thank some of the state governors who have contributed significantly, especially in the area of primary health care. They need to sustain it, even with local government autonomy, so that we work hand in hand in a collaborative or cooperative federalism to serve Nigerian citizens.

 “There were regulators of professional groups; there were also issues of transparency, accountability, and responding to the needs of citizens.”

On malaria and other vaccines, how much awareness is going out there for people to understand that these interventions are for their good and benefit?

Through the program on immunisation that is hosted at the NPHCDA, we are enlightening key stakeholders. NPHCDA, in collaboration with UNICEF, is educating folks on the value of vaccines. Vaccines are one of the most effective public health instruments that we have. And there are many of them, about 17.

The diphtheria vaccine has been available for decades. It’s very cheap; it costs 20-30 cents a dose. But there were children in Nigeria who, as of 2023, were not immunised against diphtheria; that’s why we had the outbreak. 99 percent of the children who had diphtheria were not vaccinated. Even with the vaccine being safe and effective, their parents didn’t bring them up to be vaccinated. So when you now talk about a more expensive vaccine, where is the resource going to come from? The delivery mechanism has to be fixed; that’s why we want to fix the primary health care system; that’s why we’re retraining our frontline health workers, organising our supply chain mechanism, and collaborating between federal government, states, and local government. The responsibility for delivering primary health care is not the federal government. But we are ultimately pushing everybody to work with us so that we can deliver on those. The awareness through traditional leaders and religious leaders for the value of vaccines has been very much underway through NPHCDA.

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We want members of the media, educated people, to be enlightened, because sometimes you have half-educated pseudo-scientists who copy some misinformation somewhere and start spreading it through WhatsApp. Social media has made it easy to spread misinformation. But social media has allowed everybody to be an expert. And this is not the first time. Polio vaccine costs 20 cents, but we were the last country to eliminate polio virus in Africa because some people decided that polio vaccine is harmful to their children, and they rejected it. We had to put in a lot of intense effort to educate them. But by then, thousands of Nigerian children had been paralysed by the wild polio virus. Now that we have eliminated the wild polio virus, it’s impossible for you to see a Nigerian child less than eight years of age paralysed by the wild poliovirus in Nigeria, thanks to the polio vaccine. But the damage that those actors who are still with us have done, they don’t see it. Vaccines by themselves are useless unless people take them. It’s when a vaccine gets into a child that they work.

The president’s vision is not just tactical; it’s about rebuilding Nigeria block by block. What we are doing in the health sector is to rebuild this country’s health system block by block. There are other pneumococcal diseases, bacterial diseases, haemophilus influenzae, diphtheria, back, measles, and yellow fever. These are vaccine-preventable diseases that we have to also prevent, and we have to finance them, and all the financing comes from the federal government. So how can states join us in co-financing this? How do the local governments do it? Because health is the responsibility of all levels of government. If everybody does what the federal government is trying to do, I believe that you will see changes.

There are other aspects, which are the non-communicable diseases. Every day you hear someone slump and die because we have a fast-growing rate of non-communicable diseases: hypertension, diabetes, cardiovascular diseases, strokes, and cancer. Because when you go up the ladder, you start eating high cholesterol, highly processed foods, high-salt diets, and not the kinds of food that our parents ate. You don’t exercise because of too much stress, smoking, excessive alcohol consumption, and also environmental exposure to heavy metals and plastics in the environment. They contribute to the rise of this non-communicable disease. So there’s a lot of prevention that has to happen. And some of it is in the health sector, some is in the water sector, in the environment, in transportation, and some on the regulatory side. The whole government has to contribute to preventing some of those diseases.

At the National Council on Health in November in Ekiti State, we passed a resolution on National Health Promotion Day. We need to have a day to promote health. We think of health as a net; you can also produce health; if you exercise, you’re building a stock of healthiness. If you don’t take drugs or excess alcohol, you’re preventing badness that could happen to you. That is promotion of health; you have a stock of health so that when something happens, it will be less severe than it could be. Many people are on dialysis, and it’s a sad circumstance, and the president two weeks ago approved in council 7,887 dialysis sets to be distributed to seven teaching hospitals in Nigeria to bring relief to those who are suffering from dialysis. But dialysis is not something that just happens; it starts with hypertension, diabetes, and other conditions and progresses over time. So if you know your hypertension is getting out of control and you treat it, then you can reduce the progression. And if you have hypertension and diabetes, the better you control it, the less likely it will progress to be complicated. So there has to be awareness. From our side, as part of the efforts to revive the primary healthcare system, we’re trying to embed this aspect of non-communicable diseases as well.

In the ministry, we have some resources for poor procurement of certain commodities so that people can, in these times of difficulty, control their condition so that it doesn’t progress. Because of expensive drugs, somebody who has hypertension may choose to take a one-month medication in two months in order to reduce cost. But the implication is that their blood pressure will not be under control. What I’m saying is that the health of our population is key to the vibrant, prosperous future that we have. But to make our population healthy, it takes more than President Tinubu’s administration. It takes all levels of government. It also takes individuals, households, and families taking action as a population, not just individuals. All the reforms we are pursuing are leading towards improvement in the health of our population. We are beginning to see early signs that there is progress being made. But it will take time for the full import of it to manifest itself. But we have no option but to rebuild this country block by block.

On biodiversity and phytomedicines, NIPRD has been doing some research on phytomedicines, plant-based medicines. There are things that we had, like Moringa, which is grown here. And many years ago, they developed something called NYBRISAN for sickle cell disease. We want to accelerate the commercialisation of some of the work that has been done on the value chain. But to do that, our regulators have to also be equal to the task. NAFDAC, in particular, had reached level three. We want to get them to a higher level, but it’s not easy to maintain that level of regulatory capacity when the resources needed are limited. But it’s so important for industrialization.

We have also tried to address the open drug markets. If you recall, a few months ago, I was in Kano to close the open drug markets and to open the coordinated wholesale warehouse, where distribution of counterfeit and substandard medicines was prevalent. Counterfeit and substandard medicines are now reduced to almost 10–11 percent from a much higher number. Nigerians, not President Tinubu, take fake medicine and sell it to another Nigerian because they want to make money, and they will print fake labels. So the closure of the open drug market and the coordinated warehouse is to ensure that Nigerians get high-quality products. We found that there were people who had produced fake things. You take anti-malaria and you still die, or you take antihypertensive and it doesn’t get better because some wicked Nigerian has decided to allow counterfeit and substandard products in the market. We’ve written to all the state governors to try to help us close the open drug market. There’s no open drug market in Abuja. There is one in Aba, one in Lagos, and we’ve closed one in Kano. We wrote to the states to see how they can also close that, because that is key to the safety of our population but also to industrialization. If we don’t address them, you can invest to produce a good product for 10 Naira, somebody will produce a substandard and sell it 5 Naira under the same brand and it takes away your market. So how can you industrialise? That’s why we’re putting pressure on NAFDAC, and NAFDAC is being squeezed because it’s not easy due to the financial and human resource requirements to be able to do that. But we’re pushing along.

What exactly is the government doing as regards the required regulation on vaccine manufacturing? And how long more are Nigerians going to wait to begin to see appreciable outcomes?

First, producing vaccines is called biologicals. They are one level above just chemicals and pharmaceuticals in terms of the molecules. Paracetamol is a chemical. Biologicals have to do with living things that produce protein that gets into the body. They’re higher level. For 20 to 40 years, we have not produced vaccines in this country. We don’t produce 70 percent of our generics; the basic chemical antibiotics talk less of branded pharmaceuticals. The industrial base that we have has become limited because there are lots of imports.

We became open to all kinds of contractors bringing things to our markets, so our ability to produce vaccines atrophied. In the 80s, we had a lab that produced a yellow fever vaccine. At the same time that Fiocruz produced it in Brazil. We opened up our markets to importers and contractors. They asked for technology transfer, and now they are producing almost all their vaccines in Brazil. We are still dependent on people who bring them to us. So how do you change it? It’s a chain. Before you produce a plane, you produce a bicycle, because if a plane crashes, it crashes with lots of people. So you have to be very thoughtful, and it has to be rooted in good scientific capability.

We undertook a roadmap to expand the healthcare value chain, including that of vaccines, but not limited to vaccines. So the generic pharmaceuticals first, which are low-hanging, then medical consumables such as IV fluids. The scientific capacity, research capacity, and development capacity in the country were atrophied, so we put up a governance system with my colleague, the Minister of State, an ethics framework that is strong, a health research committee, and now, through PVAC, expanding a partnership to have clinical research units in our hospital so that we can be able to test. There is a scientific method to know what works and what doesn’t work. That method requires people who know what questions to ask, what methods to apply, how to measure, and how to analyse the results. We are now partnering with a group called Purpose Africa, through PVAC and through many of our hospitals, to build that. Even for research on things like Lassa fever, which has a vaccine under development and ongoing clinical trials, first you have to be sure it’s safe. They do the animal studies to be sure that the animals are okay, then they give them to healthy volunteers. Then they check the markers to be sure that it reproduces the result.

The next step is to give it to a wider population and compare those who receive it versus those who don’t to determine if it’s safe and effective. But the regulator has to be able to independently assess and confirm that it is safe. That’s what NAFDAC is to do. NAFDAC has developed some capabilities that have been benchmarked by WHO and assessed as level three. It’s one of the only three or four maturity level three national regulators in Africa. We want them to go to level four, which is called the World Listed Authority, so that they have robust systems, procedures, and people so that when they say that something is safe, people know that it is safe. For water and food, they can say it’s safe, and we agree it’s safe because it’s just water and drink. But for pharmaceuticals, the standard is higher. For vaccines, it’s even higher. That’s why NAFDAC needs the resources and people that have the intellectual ability. For a long time, people have gone into regulatory bodies because they’re looking for a job, but they don’t have what it takes to mix skills. They have to have expertise to be able to know what is good and what is not. We are working with NAFDAC to build those capabilities, to have the systems and procedures.

For the clinical research capability, we are now building a bioequivalence lab in Lagos. When you bring Panadol from India to NAFDAC, it checks the chemical. But how do you know it acts like Panadol in Nigerians? There is what they call a bioequivalence test. That lab had not existed. This administration is working to establish that. Those are the regulatory functions that we are trying to fix, which have not been done, because we know where we want to take this country and what the president wants us to do. So that’s on the regulatory side.

On the issue of how long to wait, we waited at least 24 years for certain things, 1999 to 2023, then God brought us President Bola Tinubu. I think we can say 24 months at least to put block by block is reasonable. Within a year, under the president’s leadership, I think we have done things that had not been done for a very long time. The relief will come in the medium term, and in the short term, there are measures that are being deployed as we speak for relief because we have resources in our budget to reduce the pain and suffering of Nigerians.

A week ago, we unleashed what we call medical palliatives in Gwarimpa Hospital. We delivered mama kits, bed nets, and some of the 1.3 million multiple micronutrient supplements that were donated from Kirk Humanitarian. These have been distributed as we speak. So the relief that this government is causing is already underway. It may not be enough relative to the cumulative needs that ease life basically. The Permanent Secretary is working with us now on emergency anti-snake venom due to flooding. Water floods the holes of snakes in some places, and it’s affecting farmers. We are mobilising to provide relief for them. Without that relief, things could have been worse.

Health is a different sector—how do you assess the health sector? Oftentimes you assess us on some of the things that we’ve done. But my success is in the badness that we prevent, that you don’t see because it hasn’t happened. When the meningitis outbreak that happened in Yobe started, I was having sleepless nights. We had 1,200 cases and a few deaths. We quickly went to action, got the vaccine, and did ring vaccination. If we didn’t do that, we could have had 30,000-440,000 cases with thousands of deaths. But that was nipped. When diphtheria came, we had a task force that quickly rallied around and killed it. A few weeks ago, there were few cases of suspected yellow fever in Bayelsa. We quickly acted and stopped it from happening. This year, there were hundreds of thousands of cholera cases all over the world. We had a few thousands in Nigeria, mostly Lagos. But we acted quickly and stamped it. Given our population and state of hygiene, we could have had hundreds of thousands of cholera cases. But we stopped it. There is no way you can take credit for that because it is bad that it hasn’t happened. But what you see is 10 to 15 cases, and everybody freaks.

If you look at what this President is doing, it’s not just accidental that he placed the health and well-being of citizens at the centre of his administration. Without health, what does prosperity mean? As a journalist, if you are not healthy, how are you going to work? Who will go to school? How will children learn? How will traders trade? With COVID-19, everything stopped; the whole world stopped because of a health issue. The health crisis caused the world 5.5 percent of its GDP. Till today, we’re suffering from the consequences of a health crisis. So these efforts we are putting in are not accidental. It may not be short-term; it may not be also sexy politically because everybody wants a contract here and there, but it’s a very serious issue. The president has asked us to be systematic and thorough in how we build it block by block.

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Are there talks to bring back some of those pharmaceutical companies that left the country?

I told them last August when they said they were leaving that every one of those multinationals that walked away from Nigeria at our time of need, one day they will look back and regret it. We are 220 million people. This difficult patch that we’re going through will pass. In five years’ time, our years of plenty will come back, and we will have an economy that will grow, and we will have the people who will need drugs, surgery, and other things, and we’ll have a market. The reason they came was because they could make a profit, not because they liked us. So when we ran into difficulty, they scampered away because they were not producing anything. So we are using that as an opportunity to help our local manufacturers. We also have others who think differently—companies from France, Brazil, China, and the US interested in coming to Nigeria. For instance, the indigenous cancer corps says they’ve got $1.75 million and they want to help build equipment for cancer. There are many fair-weather companies; when things are good, they come, and when there’s difficulty, they scamper away.

God-willing with this president, we will build Nigerian companies that will be playing in the medical industrialisation space, and they will endure. Those folks that have gone will now have to go somewhere else. Let them go somewhere else.

Talk us through efforts to address brain drain in the health sector?

The ministry has developed a national policy on health workforce migration. We took a progressive view on migration. You can’t stop people from travelling; they have their rights to move. Teachers leave, bankers leave, journalists leave, health workers leave, and tourists leave. Everybody leaves because everybody has a right to leave. We look around the world; how have other countries dealt with this? There is a global shortage of the health workforce—an 18 million health workforce deficit. In a few years’ time, 50 million workers will be needed. Many of these northern countries are ageing; we are young. Healthcare needs people, and they have more money, so they will extract people. If you close your doors, they will find some other ways to leave. So we decided to have a managed migration policy that acknowledges the people’s right to leave. 67 percent of them leave to go to the UK, some go to Canada, US, and a few to the Middle East for various reasons. If we can produce 10 more, 3 may leave, and 7 will remain. But if we are not producing, we are just losing every day. This is what we have been doing for almost 20 years. There are about 350,000 health workers in Nigeria of different cadres: physicians, doctors, nurses, pharmacists, and lab scientists. About half of the doctors we produce leave every year to the UK and other places.

Let’s appreciate those who are staying because the total number of those who are leaving is a small fraction of those who are here. Let’s improve their working environment. That’s why we are giving meaning to all the infrastructural things, the cancer equipment, and the commodities. Those who go to health don’t go because they want money; they are orientated towards serving other people. So let’s tap into their intrinsic motivation and call to serve. So we reframed the conversation to focus on those who are staying. I have seen extremely qualified professionals who have refused to leave, but for those who leave, let them leave to experience the world, and get training, friends, and networks. When they come back, they are better capable of contributing. But let’s expand the training and let the recipient countries invest in the pre-service training so that they improve the infrastructure with us. That’s what this policy is asking them to do. To work with us so they can expand the infrastructure because if we train them, they go to them. They are reaping where they did not sow. Let them sow a little bit where they are reaping. For those who are here, the proposal is how do we provide relief for them for things like mortgages, car loans, and houses? I trained in the US, and I had a credit card; it was from the American College of Physicians. They just gave it to me because I’m a doctor. When I was going to buy a car, it was easy for me to go to a car dealership with just my appointment letter as a doctor because I have a stable income, and the dealer just gave me a car. We are working on those mechanisms. This policy will allow us to formalise it.

But how do we also train and give them the exposure because sometimes people think of the other side; it’s just curiosity. These are intelligent people; they see it and want to experience it. I just got the feedback that Qatar will take 10 of our people, five from the public and five from private, for training on rehabilitation at the Qatar Rehabilitation Institute. That’s just one example, and it’s from the fallout of the president’s visit. We told Qatar not to recruit them. So, brain drain can be brain gain. And we have to respond to the challenge in a progressive manner. The President in December asked those countries to help invest in training here. And we are going to call on them to do more of that. When the FEC meets next, you will hear more about what the government has put in place. So we have been working very hard in this ministry to address that.

We see that Nigerians are increasingly patronising herbal medicine. What is being done to regulate that sector for safety?

The National Health Research Committee, NIPRD, and NAMA are working to regulate traditional herbal medicines and prevent counterfeit and substandard medicines. Traditional remedies, such as Moringa, are being classified and studied by scientists and pharmaceutical chemists in universities. However, it is crucial to maintain discipline to prevent harm. Traditional practitioners must protect their intellectual property to avoid theft and profit. The Ministry has a department of traditional, complementary, and alternative medicine, working to reposition it. The scientific method, which has been applied to shamans and herbalists 200 years ago, can be applied to herbal medicines, but avoiding it can create room for quackery and shamanism. The Ministry is working to systematise this process and protect the trust relationship between traditional practitioners and the scientific method.

Again, there are lots of issues that cannot be solved in four years or even eight years. I think we are trying the best that we can. We are not yet done; we are just one year in office.