Professor Muhammad Ali Pate is a global public health expert and former health minister. In this interview, he talks about infectious disease preparedness and response, local vaccine production, financing and health policies, among others.
As a global public health expert who is familiar with Nigeria’s primary healthcare system, what is your take on the country’s healthcare policies?
Over the past few decades, Nigeria has put in place, on paper, very strong policies, legal frameworks, regulations and programs.
These range from the health reforms and the National Health Policy in 2004 led by the then Minister of Health Prof. Eyitayo Lambo, which 10 years later led to the promulgation of the National Health Law (2014), creating the Fund for Provision of Basic Health Care (BHCPF ), to the National Strategic Health Development Plan led by the late Minister, Prof. Babatunde Osotimehin in 2009, to the State Health Investment Program (NSHIP) Results-based financing in 2009, the One Roof Primary Health Care policy in 2010, Midwives Service Scheme, Saving One Million Lives (SOML Initiative), creation of the Presidential Task Force on PHC and Polio Eradication, EOCs at national and state level, and many other initiatives.
Some of these policies and initiatives have been successful and have endured to this day many years after their development.
The EOC mechanism created for polio became so vital in the fight against Ebola. The PTF created for the first time for polio has today become the anchor in the fight against COVID-19.
Our challenge in Nigeria is not so much policy at the sectoral level, but has to do with the implementation and enforcement of norms and standards.
If the health sector policies are faithfully implemented, with all the integrity that is required of all the actors, the results would be much better than they are today.
Like the rest of the world and Africa, Nigeria is affected by the COVID-19 pandemic. What is your assessment of their efforts to deal with the pandemic?
COVID-19 has clearly shown why investing in the health sector is not a luxury or an option. Public health security is vital to economic and national security.
While the devastating health impact of the pandemic in terms of loss of life in Nigeria has fortunately been relatively less than in other countries, the economic impact has affected almost everyone. The federal and state governments and the private sector have demonstrated a collaborative approach that is commendable.
But it is necessary to continue to engage citizens in ways that earn their trust to respect and comply with public health measures when necessary.
Public officials themselves can do better by being more transparent with the public, to dispel the perception that the response to COVID-19 was mired in corrupt tendencies in some government agencies.
Africa as a region has yet to adopt a common approach to dealing with pandemics, as we have seen in its handling of COVID-19, Ebola and other threats.
The misallocation of the budget to the health sector is a matter of concern in the country. Where is the exit?
The issue of health financing is very important for any country. Not only the level of public financing available through the budget, but also what the financing buys, that is, the quality of spending.
For adequate funding to be available, the government must be able to collect tax revenue, which at the moment, Nigeria is among the lowest collectors relative to the size of our economy, due to leakage, exemptions and perhaps also corruption.
While these are not in the domain of the health sector, they affect the total resources available to the government to adequately finance health, education, and other critical areas. To fix it, Nigeria must grow its economy, and then raise more of the additional revenue to deploy in people-oriented sectors like health.
When our leaders go to Europe or the United Arab Emirates for medical tourism, they are taking the easy way out. Those countries collected more of their public revenue and invested that revenue in health.
You can’t spend to buy a bike and expect to ride a Mercedes car. To finance healthcare, the government must either collect revenue or not let revenue be drained by corruption or willful non-compliance.
In terms of what is allocated to health, Nigeria spends slightly more than other African countries on health, but achieves worse population health outcomes compared to countries such as Ghana, Ethiopia, and Rwanda.
The most cost-effective interventions for the health of the population are essential services for all, primary health care services: immunization, treatment of basic conditions such as diarrhoea, malaria, pneumonia, care for pregnant women, newborns, children and adolescents, nutrition, sanitation and hygiene, as well as preventive care for non-communicable diseases such as hypertension and diabetes.
Unfortunately, in some cases, the allocated funds end up funding redundant human resources, or major construction and supplies due to contracts and associated bonuses. Therefore, we must closely monitor the quality of health spending and reduce waste to stretch limited health budgets for more health.
In the face of emerging and re-emerging infectious diseases, do you think Nigeria and other African countries are prepared?
In the last 25 years, there has been a rising wave of emerging and re-emerging infectious diseases globally. Partly because as the human population expands along with urbanization, we are encroaching on the natural ecology and finding infectious agents in animal populations.
The interface of humans, animals, and ecology continues, so we should expect to see new zoonotic diseases periodically.
To deal with this situation, we need to do more to avoid spillover effects in the first place and have adequate prevention and preparedness measures in place.
This implies cooperation between the human and animal health sectors, requires developing laboratory capacities, human resources and health infrastructure. It requires engaging citizens and communities through channels they trust.
These are the investments in public health security that our governments should prioritize at the country and regional levels. The richest countries are protecting themselves, and when the chips are down, we will find that we are on our own unless we invest in our healthcare systems and public health.
There is a strong case for local vaccine production in Africa. How can Nigeria build capacity and lead the way?
There is an economic value chain in health, which includes the manufacture of pharmaceuticals for local diseases and biologics such as vaccines.
But in order to successfully manufacture, the enabling environment must be in place, such as proper regulation, ease of doing business, quality human resources, patient capital, and strong intellectual property protection laws.
Without a strong National Agency for Food and Drug Administration and Control (NAFDAC), and all those enablers, including investment in science and technology, my view is that we could miss an important opportunity to accelerate medical industrialization in Nigeria and its attendant economic benefits.
It is no coincidence that India is where it is in pharmaceutical and vaccine production, or that the major manufacturers are in just a few countries. With Nigeria’s estimated population of 212 million, we have the demand base and medical industrialization can become a reality, with the right government leadership.
Where is the exit?
The way out is to invest appropriately and prudently in public health systems to ensure basic health care for all Nigerians, including the poorest and most vulnerable, and to regulate and mobilize private sector capacities and capital to develop private sector facilities of world class for those. willing to pay the premium.