In this interview with SADE OGUNTOLA, Minister of State for Health Dr Tunji Alausa discusses the Federal Government’s plans to reform, revamp, and remobilize more funds into Nigeria’s health sector in a more sustainable manner. Excerpt
NIGERIA needs to increase investment funding in the health sector to curb the emigration of health workers. What is your perspective on this?
We need to increase our spending on health care. We have started very well; the 2024 budget has the most budget for the health sector in almost a decade. When we came in as a government, I and Honourable Minister Prof. Pate, as the superintendent minister of health, had a retreat where we had the leadership in the healthcare sector as well as the ministry of health. We came up with four broad pillars on how to revitalise and rejuvenate our healthcare system.
The four pillars are to improve the governance of the healthcare system by holding our healthcare providers and health facilities accountable for the way we care for and talk to our patients. The second is improving population health outcomes by strengthening our healthcare system, providing more infrastructure, and equipping our hospitals with state-of-the-art equipment. The third pillar is, of course, to unlock the healthcare sector’s value chain, making it a contributor to Nigeria’s economic growth. Currently, it is mostly a consuming part of the economy. Unlocking its value chain will create thousands of decent and well-paying jobs in the pharmaceutical sector and other sectors that support healthcare services.
How do you intend to unlock the value chain precisely?
We’re working very quickly to domesticate the pharmaceutical manufacturing process in the country. For instance, our pharmaceutical law has not been reviewed in decades. We are going to review it to ensure that multinational pharmaceutical companies do not just continue to market their products for decades. We are setting up a law to protect our country that allows them to import, but after about three years, they will have to start manufacturing in the country too.
Is that not already in existence? Has NAFDAC already listed such drugs that, after a few years, they must start to manufacture locally?
I don’t believe that it is a law; it is a policy from NAFDAC. A legislated law is different. In other countries in Africa, Algeria is an example. Any pharmaceutical company that comes in as an importer of pharmaceutical products and medical devices after some years has to start producing in the country. That is what we have lacked as a nation. We are going to work to change that very quickly. This will help protect our pharmaceutical and medical device industries, and a whole lot of industries will spin off from this. That is where we must go to ensure that healthcare becomes a big contributor to Nigeria’s economic growth. That is President Bola Tinubu’s mandate to us, which we intend to ensure through the provision of the right legislative, business, and financial environment to support our industries even as the government regulates in a fair manner, not a predatory manner. We’ve been talking, even with the customs on duties, and have engaged the private sector on how we can help them. But I wish things were much better than how we inherited them. But we are working for President Tinubu to fix Nigeria. The president has told us that the way he wants to revitalise the country is not for the short-term but for the medium- and long-term, where everything we do as a country and as a government is sustainable.
The Coordinating Minister, Professor Pate, talked about the National Health Sector Renewal Initiatives. What does it portend for the common man on Nigeria’s streets?
The National Health Sector Renewal Initiative is an umbrella for a lot of things that we are doing to reform, revamp, remobilize, and bring more money into Nigeria’s health sector. There are several components to it. One big component of that is the swap programme, which is sector-wide programming to prevent duplication of programmes by our development partners and remobilize funds together with them. We have the basic healthcare fund, which is 1% of the consolidated revenue. That is not enough to fund our different gateways, including primary healthcare, national health insurance, and emergency care. Part of the initiative included the retraining of over 120,000 frontline healthcare workers at the PHC level.
Also, President Tinubu has given us approval for the Presidential Health Initiative to mobilise funding to start building infrastructure in the healthcare sector. They will bring the funds. We are building a medical industrialization hub in each of the geopolitical zones where these industries will come; they will begin to manufacture pharmaceuticals, consumables, devices, and a whole lot of other things.
An African Development Bank secondee will be in charge of coordination. That is the main goal of the health sector renewal project. It is an all-encompassing programme that is meant to help revitalise and revamp our healthcare system.
Do you see that working given the energy problem, high exchange rate, and even emigration of human capital, including craftsmen?
People are leaving, but if you agree with me, the president is working so hard and moving to fix a lot of these problems. Obviously, we have a huge infrastructure gap, but we’re working, and the president removed the fuel subsidy that nobody has been able to remove for almost 46 years.
Also, on the exchange rate, the president has a plan to intervene. But I will not talk for the president’s economy team on that; I will talk about what we are doing at the Ministry of Health. But what I can assure you is that we are working as a government in a concerted effort with other agencies. Things will start to get better, and the exchange rate will get better. In our business environment, the messages people give out are not correct. I’ll tell you, our human capital is high; Nigeria is endowed. Look at our country, which has 220 million people, about 51 percent of them below 50 years of age.
Now, we have youths who are very highly educated and who want to do well. We have one of the best health-trained people in the world. We have to produce more and leverage our population. By the time we increase the number of people, Nigeria will be a place where it will be easier to manufacture and do business. In a lot of places, the cost of manpower is huge. Take the health sector, for instance. On average, personnel take about 50% of the budget. Let’s fast forward: if you have a healthcare business in the UK, 50 percent of your running capital is personnel.
Now, in Nigeria, the pay to personnel will probably be about 5 percent of what you will pay them in the UK. The government is working to make energy better, but even if you are generating your own energy, the cost of that is not up to 10 percent. Look at what you have saved on both manpower and energy, so let’s be fair. Let’s look at things in a more encompassing way. The cost of doing business in Nigeria is not high because manpower is cheap and labour is cheap. That is the highest chunk of any operating cost. Of course, there’s peace in the land.
Let’s give our government some time. President Tinubu has said it over and over that Nigerians should be patient and that this country will get better. He is a man of his word.
Nigerians are faced with a high cost of drugs, especially prescription drugs. How best can the government intervene?
It is a thing that borders on the President; we need to bring down the prices of pharmaceuticals. The president told us that the high cost of drugs is not acceptable to him, and we have to bring it down. And the President has asked for quick things that he can give executive orders on to ensure succour and bring down the high prices of drugs. Alongside the trade and investment minister, we are coming up with immediate intervention as well as medium- and long-term plans to ensure this problem will never happen again.
And we are also engaging the pharmaceutical multinational companies; the Honourable Minister, Prof. Pate, just came back from a trip to Brussels, where he met almost nine multinational pharmaceutical companies. They reviewed their coming back, including that they can import but for a certain period before they domesticate manufacturing in the country.
Kidney and kidney dysfunction is a big problem in Nigeria, particularly because dialysis is expensive and there are no organs for transplantation. As a nephrologist, how best can Nigeria help?
Kidney disease is a chronic disease, but unfortunately, it is a bit expensive to treat anywhere in the world. Our health insurance does not also cover chronic dialysis, which is what a person with a failed kidney will require. The national health insurance currently covers only six dialysis sessions, but we have set up a committee, working with the Nigerian Association of Nephrologists and the Nigerian Association of Transplant Nephrologists, to have a national kidney programme for the country. Also, we are working on a kidney fund to support some free dialysis and a transplant programme where some kidney transplants can be supported for some Nigerians.
The other part is the building of an organ donor system, which is not in existence today but has actually encouraged the illegal organ trade. This will prevent the illegal organ trade from becoming a much bigger problem. Of course, our equipping of hospitals will improve access to kidney care for Nigerians.
Currently, there is a disparity in pay among the consultants in teaching hospitals across Nigeria, creating apathy towards the training of medical students. How best can the situation be resolved?
We have had multiple meetings with Medical and Dental Consultants of Nigeria (MDCAN) on this. It happened historically when there were lots of labour issues and the coming up of different salary scales, like CONMESS and CONHESS. It is not only among academic consultants and the other clinical consultants at the hospital; other groups of people are also complaining of salary disparities. President Tinubu inaugurated the salary and wage review committee a few days ago to look into all of these in order to ensure that there is no disparity in the pay of federal government employees in the future.
Does it mean that despite the number of people on leave of absence, the payroll of these institutions remains the same?
No, they don’t pay them; what is left of the budget for personnel is returned to the government at the end of the year. But we need to get anybody who is not working out so that another person can take their job. The government has done it so well; they have come up with a non-regular allowance to hire locums. This fund is substantial, so if they have a shortfall because a doctor has left, they should hire another doctor as a locum, apply for a waiver, and once the waiver comes, move that doctor into the primary job. The government has a clean process for this; they are not doing that. They have clogged up the establishment roll with people who have been gone for months and years. That is what is happening. It is not the government’s fault at all; the government is doing its bit.
At the 60th celebration of the Department of Paediatrics, the HOD declared that the department has only one senior registrar, with others being in the consultant cadre. This is contrary to the usual hierarchy in a teaching hospital. How best can this be resolved?
Part of the problem is the human resource for health, which has gone for so long without aggressive solutions. And once we came in as a government, we increased enrollment in schools to train different cadres of health workers. For instance, admission to medical school is increased from 5000 to 10,000. Also, we are working on improving our health infrastructure and equipping our hospitals to create a better work environment. Certainly, over time, our healthcare system will become a much better place to work. Likewise, President Tinubu is working on improving the welfare package for our healthcare workers and also for Nigerian workers at large.
The reason we have some of these shortages is because of the way the waiver process at these hospitals has been managed. The hospitals have not followed the due process regarding the way things should be done. I’ll tell you, if there are 20 consultants and just one registrar, they could have asked for a waiver. What happened in the past, and that is what we are telling the hospitals, is that employees cannot just come to take a leave of absence and then go abroad to work. They remain on the hospital’s establishment roll, and it will show when waivers are requested for employment. So such waivers will not be granted.
Now, what we are mandating our CMDs and medical directors to do is that such people requesting leave of absence should rather resign. If they want to come back, they can reapply. They cannot be working in the UK or the USA and then blocking a replacement for their job. We need to put an immediate stop to it. That is a big part of the problem in teaching hospitals. In fairness, the head of service office had been relatively quick in getting these waivers approved, but they looked at what was on the establishment roll and approved them based on the shortfall.