Nigerians would not forget the former Minister of Health, Prof Onyebuchi Chukwu in a hurry. In his time as minister, Nigeria recorded what could be regarded as a feat in disease control by effectively containing the deadly Ebola epidemic which devastated many African countries. In this interview with WILLY EYA, he goes down memory lane in the battle against Ebola and offers tips on how to manage the Monkey pox epidemic in several states of the country.
As the then minister of health, your effort to contain the deadly Ebola virus readily comes to mind since the outbreak of the Monkey pox epidemic spreading in some parts of Nigeria. What extra measures did the administration of former President Goodluck Jonathan take to stop the escalation of that disease?
There were a number of things we did. One, in terms of what we did, for the first time to the best of my knowledge in public health, Nigeria as a country led a campaign and not the World Health Organisation(WHO) or United Nations Centre for Disease Control or United Nations Children’s Emergency Fund(UNICEF). Nigeria through its federal ministry of Health and the Nigerian Centre for Disease Control with other agencies supported us, so we need to begin to have confidence in ourselves. Second thing, I did not know we had Ebola but I knew that if we needed to have a proper public health system, we need to have a focused implementing establishment and not the ministry of Health. I am convinced that ministries are meant for policy formulation, monitoring and evaluation. I believe that implementers should be parastatals on their own so that they would not be bugged down by the civil service bureaucracy. I was the minister that established the Nigerian Centre for Disease Control. Of course I had the support of the Vice President and the President. They gave me all the support I needed. I am happy that today, the centre is dealing with the public health emergencies. Then, thirdly is the leadership. As a minister, I had to show all the initiatives to my boss and if you do not have your boss supporting you, you are not likely to succeed. So I led the coordination of the fight to contain the Ebola virus but my boss gave me all the support I needed. So, there was the issue of leadership and I was on top of the situation; I led by example and I was always in touch everyday. Then the fourth thing was an innovation that I did which was having the emergency operation centre. After the first few days, I noticed that there was a gap and right there in Lagos, I felt that we needed to have an emergency operating unit. But of course, we borrowed from what was already in existence. I shortlisted three people and I interviewed this particular young man and that young man is today the Managing Director of the National Primary Health Care of the ministry. He was the second in command at the Polio emergency operation and he had some training. So we introduced that system and then the fifth thing is that we did not play politics. If you recall, the Federal Government was being led by the Peoples Democratic Party(PDP) but the two main states involved then were of the APC. They were Lagos and Rivers State. But the government then removed the issue of politics from the fight against Ebola. So, we worked as a team with both the Lagos and Rivers state governments. I want to commend Lagos and Rivers states, the governors then and the commissioners of Health in the states. But again it was because I removed the issue of politics from the fight against the virus. So, we all worked as a team.
I am sure you have been monitoring the Monkey pox epidemic in several states of Nigeria today. What is your take on the development and do you think the government is doing enough to contain the situation? Is it that the present government is not making effective use of the structure you left on ground?
The structure we put on ground, the Nigerian Centre for Disease Control is actually what they are making use of. As a responsible person, you do not have to be in government but when you have things like that, on your own you can talk to those who are currently doing the job. I have spoken about two or three times to the CEO of the Nigerian Centre for Disease Control. I have not had a direct discussion with the Minister of Health but I have had two or three discussions with the CEO of the centre and I am aware of what they are doing. They are doing pretty well. The monkey pox is not like Ebola which is a very deadly disease. Monkey pox looks more threatening than Ebola but does not pose the danger of death like Ebola. That is the good thing about it but it would actually spread faster than Ebola. I think the only thing that may be missing is communication. In my time, I communicated a lot and it was a major part of my job that time. We communicated with many agencies and stakeholders; we worked with the aviation industry, the transporters, I held meetings with the National Association of Road Transport Workers(NURTW) and so on. That is the extent we went. I was also in touch with ordinary Nigerians because every other day, I would either be on radio or T.V. telling Nigerians how far we have gone and reassuring them that we are winning the war. I think it is always important that no matter how we look at any epidemic, the government spokesman should be briefing the country regularly. I think that is the only thing we are missing now. But I think with my discussion and contact with the Nigerian Centre for Disease Control, they are doing well.
A major drain on the nation’s economy comes from medical tourism; you have superintended over the ministry of Health, what is the problem and when do you think the ugly development would stop?
Well, under the Goodluck Jonathan administration which I served, we had a different approach to the matter. At least while I was Minister, we did a lot and now we have more quality private hospitals. If you go around Abuja, you see many of them. During my period, we generally encouraged them. However, there were things we wanted to do that did not come out fine. One of them was the committee that I set up to properly advise the government on the practical ways to encourage the private sector. Why am I talking about the private sector. I do not believe that people should keep on doing the same thing and keep complaining. As far as I am concerned, governments’ continued running of hospitals in Nigeria, has actually failed us. No matter how much we preach about it, it is not working. All sorts of professionals go there fighting one another. Non-doctors are fighting doctors and doctors are fighting non-doctors. We are doing the same thing all over. And all those who go for medical tourism, 99 if not 100 per cent actually go to private hospitals. Whether they go to America, Europe or India, it is the same. So, if people go outside and get treated in any hospital in India and they are happy, why can’t we promote the private hospitals here. During my time, we set up a very powerful committee which was chaired by Tony Elumelu, a successful businessman who I felt has the drive to succeed and other people not only doctors but people into investment including those living in America. We also included people from the health sector to give it a professional touch. That was toward the end of my tenure and you know before the president could consider it, campaigns took over. But already, one of the most important things that the committee did was that they invited anybody who wanted to establish a hospital or who already had a hospital but needed support. People responded and they were compiling a list. The idea was not for government to get involved in the running of the hospitals but to provide the enablers. I believe that the present government can look at the committee again. Then the other thing which we did under Jonathan is that while I was there, we had a list that we identified specific hospitals for specific ailments; the list would indicate to you that if you go to a particular hospital for instance, you get qualitative care for cancer or kidney problems, orthopaedic problems and so on. The Ministry of Health under me also commissioned a consultant in the teaching hospitals. We did not include the Federal Medical Centres in the list. We did an audit and we found out that in some places, we had the facilities but lacked the skills and in some places, we had the skills but no facilities. What I now told former President Jonathan was let us start with ourselves, the public servants. Fundamentally, you have a right as an individual to choose whatever hospital you want but what we are saying is that as a public servant, you do not have a right to use government money to go and get healthcare outside the country for a sickness that can be cured in Nigeria. If you want to go abroad for medical care, you can use your money and the president agreed. Initially, we thought it was something that needed to be backed by a law but luckily, the Head of Service at that time said that was purely administrative. The Head of Service now wrote to the president and he approved. The Head of Service now wrote to me, the minister of Health saying that so and so section in the public service rule says that the permanent secretary should recommend who among the public servants should be treated abroad and it is now the responsibility of the minister to decide. My final question would always be, can it be done anywhere in Nigeria. And because we already have the data, it was easy to establish what could be done in Nigeria. We tell them that whichever hospital they like depending on convenience and where the affected person is living, the government pays for it. It has three advantages. One is that it restored dignity to our health system since we can do it in our country. Two is that it would stop wasting foreign exchange. That money that we give to Indian, American or European hospitals, we give it to Nigerians. No matter whether it is a government or private hospital, the important thing is that you are giving it to a Nigerian. Let the money go back to the economy. Even though some people did not like it, I put my foot down. Some of them accepted my suggestion and they are happy today. Some got annoyed and spent their money abroad, it is ok, it is their fundamental human rights. We did that under Jonathan. Another thing we wanted to do was to establish something like an estate in Abuja which would be for the private sector and anybody capable of establishing a hospital would be allocated land there. It was meant to be a medical area. The idea was that you could go there and get all sorts of medical attention. The government was already allocating land by the time I left but you know because of the takeover by a new government, that has not been continued. Also, we encouraged a lot of the hospitals through the Public Private Partnership(PPP). They would tell you that as minister, I was very good at that.
The issue of restructuring has been a major talking point in Nigeria today. What is your perspective on the ongoing debate?
In the health sector, the restructuring that we need is to have a mandatory health insurance which I also flagged off before I left office. If you recall, we had a presidential summit in March 2014. Both the Senate president and the Speaker, House of Representatives were fully represented. In fact the Senate President was there physically and the executive was there at the presidential villa. We had the private sector and many governors participated and even chaired sessions. Also, my fellow ministers including the Minister of Finance were there. At the end, we made a declaration that it was the way to go. Before I left office, I set up a committee to begin work. I think the present Minister would work on it. We have already started work on those committees. The idea is that at the end of it, the National Assembly should be able to pass a law to make health insurance mandatory in this country. It is mandatory for vehicles to have insurance, how much more human beings. I think we can do that. Once we do that, you would see that our people can now afford to take care of their health. They would be demanding healthcare and it is demand that drives business. No medical doctor would like to go and establish in the rural areas because majority of the people there may not be able to pay you. A doctor would like to come and stay in a place where the patients can afford his bills. He wants to stay in a place where you have businesses and civil servants. But when a doctor knows that if he goes to the rural area, they can pay him, why suffer congestion in the cities. He can go anywhere and set up his hospital. First is that the demand for healthcare would increase and people can stay anywhere to go to hospital as they know they can pay because they have health insurance. It would also improve healthcare because it would be taken more to the rural areas when people find out that when they establish hospitals in such places, the people there would be able to pay because they have health insurance. And if people are paid and are happy, they would improve their own health facilities. Another thing we did was to get the National health act out; it was signed during my time. The National Health act also is for government to provide emergency services. So, there were many things that we did at that time. The other thing is making the health scheme to go more into private sectors because they are more efficient. But before we do that, we must make sure that it is affordable. Then restructuring the country, for me, my understanding of restructuring is not for us to split the country. I do not believe in that. I think that there is strength in a bigger country. For instance, even though I come from the South East, I am not in support of a geographical Biafra Republic. For me, Biafra is some kind of ideology for anybody who is marginalised. It could even be from the North East, North Central, South West and so on. Once you are complaining that you are not getting the best out of the federation, then you are a Biafran. So, the geographical Biafra is a no, no for me; it does not make sense. There is strength in harnessing all the resources that we have. We have enough resources in the country but we are not able to harness them and that is the problem. But definitely, I feel that government should be taken nearer to the people. Right now, nobody talks about the state government because we are thinking that the Federal Government is so powerful. Nobody is questioning the local government chairman on what he is doing because everybody is blaming the president. I think that is not proper. I think the Federal Government should devolve more of the functions and constitutional reforms should devolve more functions to the state. Let the states have more powers and let them compete. This idea of quota system is not working for the nation. I also feel that restructuring should also decide what are the federating units. The idea of the Federal Government creating local governments is not ideal. Let the states decide how many local governments they want to have. When you do that, you would find out that the states would be more sensible in creating the number of local governments they can handle. Why should people just want to create more local governments when the money is coming from the centre. We should have states as federating units and the Federal Government should not in any way deal with the local government including even giving them allocation. Let the states decide what they want and let them handle it at their level. So, the states can now have their own constitutions; that is what federalism means. The only time we had true federalism was in the First Republic because the regions also had their own constitutions. Go to America, apart from the federal constitution, each state has its own constitution. Many of them are unique in their ways. Let the Federal Government have its own constitution and the states their own. When people said the country should be divided into six zones, I said no, it should be voluntary and not mandatory. That is not what federalism should be. There are states that are already very rich and would not for any reason like to go back to regions. But in the federal constitution, any number of contiguous states that want to become one state because they feel they have some advantage should be allowed to coalesce. It should be voluntary. No state should be forced to enter into any group. Any group can be made into a state; after all, in America, some states are bigger than in landmass and resources than others. Everybody should go for what he wants.