 The panel that is going to come on will talk about one of the most important things in all of modern human existence, healthcare. So let me invite Loreta to give us some opening remarks and we'll get into a conversation on the challenge of healthcare in Nigeria and what we will be doing. So after Loreta's presentation, Loreta is joining us by Zoom from Sheffield I believe in England and we'll take you Fanya and Austin who is here with me. Yes, go on Loreta. Thank you very much Professor, good morning, can we all hear me? Yes, loud and clear. Excellent, we are walking and turning on my video if you want now. Okay. Fantastic, so good morning everybody, good morning Professor Pax who told me and good morning to every single person watching across the globe. Nigerians across the globe and friends of Nigeria across the globe. It is very exciting to be in the first ever skeleton, organized in Nigeria by Nigerians for Nigerians. And it's looking at how we are going to help raise funds for those who have decided need to take Nigeria to the next level, the OB that it's in. Well done everyone. Delving straight into healthcare, Prof, I just want to thank you for that initial preamble that you have given, you have made my work really simple. And the truth is across the world globally, we all know that there is no modern day economy who is what it sells that does not have a standard healthcare. And I will introduce this subject matter today by saying well done and thank you to every single person who has worked with us from the nurses, the physiotherapists, to even the potters, the health economists and the technical people. Too numerous to mention, because oftentimes when people talk about healthcare, they think it's just the doctor and the nurse, no, it's a lot more than that. Healthcare is a system. And I'm going to approach this in what we usually would term the S back today. But before I go into that, I'll say thank you again, Prof, for introducing me. My name is Loreta Dwario Borofo, and I am an obstetrician and gynecologist by training a consultant in the United Kingdom. Apart from that, I'm a medical simulation education specialist and a background in public health research from the University of Edinburgh. So let's look at this in a situation, a background, an assessment and recommendations sort of module that the OBDAC team has adopted. The current situation is that whether we like it or not, and the principal admitted to this at Chatham House recently, Mr. Pital B himself, his excellency told us that healthcare system in Nigeria needs revamping, summarized. Nigeria has a dysfunctional healthcare system that is not delivering safe, available, affordable, accessible, in a quality and equitable proportion to all of us who make up the around 200 million population of this country. So that's our situation. And this has not been cost in one day. It has been a gradual deterioration over the years. So when you now look at this background, you can just sum it up by what the National Bureau of Statistics released in November 2022. And they told us how 133 million of us are in multi-dimensional poverty. So the OBDAC government when we come on board as the team that is managing the affairs of Nigeria have decided that we must make healthcare a front burner issue and bring its threats to those 133 million people and beyond. It must go back to the basics. So we did an assessment for my sister Okeke and all of the other people, sat down across the world and decided that what can Nigeria do. We looked at healthcare systems in developed countries like the UK where you have the NHS. We looked at America where you have the capitalist system. And then we looked at other countries in Asia and how they sprung up as well. After looking at all of these systems, we came back home and did a strong situational analysis on Nigeria as well as a root cost analysis. We also looked at our strengths and weaknesses and opportunities and threats in terms of healthcare. And then following this assessment, we came to the conclusion that for us to bring healthcare right to the basics to the front burner to be available to these 133 million people, we have to domesticate. All of this information we have gotten from studying all of these other people, domesticated to a Nigerian solution-based healthcare system. So what recommendations did we make? The recommendations that we made are the interventions you are going to be seeing in this social contract with the people, the manifesto and what you'll be dirty government plans to do. These recommendations are along seven lines. If you go on to Google and you Google the pillars of healthcare, WHO is going to come up and tell you that there are six pillars of healthcare standard. However, following the domestication of the solutions to our own healthcare indices that are not very brilliant in Nigeria, for instance, you have approximately 150 women dying daily maternal mortality rates in Nigeria when you bring it down to the granular level because WHO says it's 600 per 100,000 live birds. But I have done the statistics and brought that down to the granular level and it's an amazing and saddening 150 women on an average dying in Nigeria daily from just performing their reproductive duties. These indices are not nice but the recommendations are in seven fold if we want to domesticate our own. It is not the standard statistics fold of the WHO and this is what we are going to see in the OBDAC manifesto as well as when the OBDAC government comes on board. The first pillar that we are very concerned about is leadership and governance. I'll run through them a bit quickly and then just take them very, very quickly. You have leadership and governance. It's key. You have human resource. Human resource for health is very, very important. Then we have healthcare financing or funding. Nothing is going to happen without funding or financing. Of course there is health service delivery which we are pointing out. We must mainstream primary healthcare if we want to get to those 133 million people. You have healthcare information systems and management. And we have number six as medicines, vaccines and pharmaceuticals. And number seven of course you are going to have research and development where you are going to have your robust auditing systems monitoring and evaluation. So this is a big summary of the seven pillars that we are adopting in the OBDAC government. Now leadership and governance. Every healthcare system what it sells must have the right pegs in the right hole. You must have a focused leadership at the top and this is going to trickle down to all other components or sub-professionals in the healthcare system. Again I am using the word system. So you are nursing, you are nurses, you are midwifery, all of that. People just think it is the minister for health. No. There is a lot more that happens than the minister for health. Healthcare does not stand alone. It is going to dovetail into other ministries, departments, agencies of government. We must have an interagency and collaboration as well as an intergovernmental collaboration. So that means at the federal state and local government level driving the PHC. People will say that primary healthcare is under the purview of the local government. Yes that may be right but then we need the federal government to actually provide leadership at that level. Everything we already need in healthcare is in our National Health Act from 2014 and the OBDAC government is going to make sure that this is properly enacted when they come on board with respect to all of these pillars starting with leadership and governance. Now if we go to the next pillar which is human resource for health you are going to find out that there is something we need and that is data, data, data. How many doctors are in Nigeria? How many graduated? How many are left? How many nurses do we have? Physiotherapists? Healthcare workers? Choose what is happening in these different sectors closer to this 133 million people. So there is going to be a mapping of Nigeria's healthcare occupational categories and then an overhauling, restructuring, training for all healthcare providers in their different cadres. And then we need to make them fit for purpose. We need to make them fit for purpose because sometimes we are deceived that when we have hospitals, you see people just building hospitals, building structures but those structures will not provide health. Those structures are not skilled. So human resource for health is key and this is where we are going to think about things like task shifting and task sharing and what does this mean? It's simple. In the WHO recommendations for instance, they will tell you that you need to have at least one doctor to about 601,000 patients. However, in Nigeria we know that that is not the case. So the OBDAC team as well as the policy group on health turned to the multiple men and women across the world sat down and thought what do we do? And we find out that Nigeria, with 200 million population, a lot of them in the rural areas, we need to become primary healthcare base heavy. It's like a triangle. The base of that triangle is primary healthcare which is going to increase our prevention and it's going to cut cost eventually if you look at the economics of health in terms of interventions and when we get it right. So how do we cater for 200 million people with our task healthcare provider availability when a lot of them nurses, midwives, physiotherapists, pharmacists have all gone abroad? The plan and the key is with task shifting and task sharing. Take for instance, we know what community health extension workers are, we know what they do. So as part of the human resource for health development for instance, we are going to ensure that these people are trained school of health technologies are working, they are trained and they become skilled and properly regulated. So what then happens? You are able to devolve these people into the rural areas as far as they are well trained and know when to refer to the tertiary institutions. And then you are going to have less attrition rates because a lot of them will probably be from these areas and of course there will be incentives as well. So task shifting and task sharing is very important who have to develop the number of advanced nurse practitioners. And I heard someone saying the other day that the principal, his excellency Peter Obi was saying that he would establish nursing schools across the local government areas in Nigeria. And I said they may have misunderstood that because it is building the capacity of health care providers across the 700 and for the local government areas of Nigeria, not necessarily establishing nothing smooth in each of them. And we must realize that a lot of structures are already in existence, so it is a lot of renovation. If you move on from human resource for health to healthcare financing, we need to know that the SDGs has us number three that health is paramount and must be financed. And there was an Abuja declaration which stated that we should have at least 15% of our national budget devoted to health. My brothers and sisters, friends across the world, today's current budget fraction for health is abysmal. It looks like we do not understand that each and every one of us are potential Nigerian patients. Even when Mr. Peter Obi and his eyes assume power tomorrow, there are still potential Nigerian patients and every single Nigerian patient is worth it. So for this number three pillar of healthcare financing and funding, the plan is to increase gradually scale up the budget for health as a person. Scale it up over the first four years and make sure that we get to that 15% that is recommended by the sustainable development goals and the Abuja declaration. It is very important and then we need to then think about other ways to generate funding for health. And we need to step out the box, which is what we did in the policy team with the deep dive team as well helping us. We found that the National Health Insurance Authority Act is there, but implementation has been low. This document, which is made up of, I think, 10 parts and 60 sections is something that the Obidati administration is going to go back to. Like I said, all these things that are already there, we need to implement them. And we are going to implement them to the letter at the state and federal levels. But then we must also make sure that we push that there is no repetition because that's a major problem right now. We have identified that and we are going to make sure that at state and federal levels, your cover within the National Health Insurance is actually suitable for you. And one thing that we have come up with is that every managerial must have a unique health identification number. And I will explain this a bit more later. But other than our own budget increasing and the NHIA Act being implemented at all levels, we have to reason out of the box and think about ways of financing healthcare. The public-private partnership models that have worked in other countries can also work in Nigeria. We need to get our industry's production agents big merchants and big entrepreneurs to start came into healthcare as part of their corporate social responsibility. Take example, there's nothing that stops a big industry or entrepreneur in Nabea or Qatar for instance from adopting a primary healthcare center, renovating it and bringing it up to speed following a pact with the local government in that area as it may be. So these are things we are going to look at. We are going to also look at special taxes on example like tobacco, alcohol and many other things. We need to consider and this has been given great thoughts. Duty waivers, duty waivers for imports that are going to improve Nigeria's healthcare system, especially when they relate to primary healthcare. And obviously there will be special funds and endowments for specific tertiary care aspects like cancer. Some of these things existed but they were never followed through or seen to a logical manifestation that benefits the 133 million people. Probably because we didn't understand that every single Nigerian patient is worth it. If we move on from healthcare financing and we want to service delivery which is the next part, we need to understand that at this point we need to mainstream public health care. Again it's coming back to public health care. This is going to be a bottom heavy approach. We must reach those in talents and how are we going to do this? We are going to domesticate our approach. We are going even in terms of transportation and emergency responses for instance. Think about the water laden geographical areas of Nigeria. Think about the rocky areas, the savannahs. And then think about how do people there get healthcare and how are they referred? How do they get to the nearest referral centre, either secondary or tertiary? A simple example, if you are in the riverine area for instance, have you thought about it that a motor boat as an ambulance would be more effective than the conventional ambulances you see in other countries? These have been trialled and it works. So as part of our health service delivery, all of these are things we are going to implement at the OBDAC government level. Domesticating healthcare so that the 133 million dimensionally poor and other Nigerians know and are able to say yes, we have a healthcare that knows that we are worth it. If we move from healthcare service delivery, we go on to health information systems and management. Our world has moved on. The world is a global village. Healthcare is not left out at home. And if you look in the manifesto, you're going to see where we've talked about using ICT to bring healthcare home back to the basics. We have electronic medical records being developed and being centralized. So we are going to trickle down and also move up. And we are going to find out that this is going to revolutionize healthcare provision in Nigeria. Because if we have a solid ICT system in health and information, nothing stops us from having a consultation. With a medical team in the United Kingdom or with another in the United States. And this is also where along with the resource for health and even service delivery, they all overlap. We are going to tap into our diaspora population. Whether we like it or not, a lot of people who live Nigeria, they live Nigeria gets to the resource rich nations. I don't like to call them developed nations because we are developing our own way as well. The resource rich nations and they change their professional pathway. So looking at the population of Nigeria and dynamics outside of Nigeria, you find that we are healthcare professional providers heavy. Now, why can't we not utilize this tool? Why can't we not reverse brain drain to actually become brain game and utilize this in human resource for health and obviously in health information system and management. So if you have a team of, for instance, maybe a retired, or even retired, maybe you have a surgeon in the United States. You have another one in the UK. You have a radiographer in Pakistan and you have maybe a midwife in Indonesia. They are all Nigerians. What stops them from forming a team that electronically can be linked and they can be consulted from a village in those states. Maybe Ubioko or Udo or somewhere in the North, Karanamoda. Nothing stops us. The world right now is borderless and very fluid. So this number five healthcare information systems and management is where you are going to have all of the data and all of the info systems and all of the technology. Don't tell it into the other pillars. Pillar number six, which I would have really loved if I okay to talk on. I don't know if he's here right now, but he can unmute and talk about pillar number six and pillar number seven. Pillar number six is medicines, vaccines and pharmaceuticals. And the endurance, in case you don't know, let me tell you that the Ubioko administration when they come on are already looking. Already looking to create and domestic malaria vaccine. Well done pharmacists if I'm okay. Do you want to talk to us about medicines, vaccines and pharmaceuticals as well as research and development? Because like you know, yes, we are moving from consumption to production. So write down sir. Can you share your video? Yes, my video is on. Okay, we can see you now sir. Okay, thank you very much. Can you hear me clearly? Yes. Okay, you can hear me. Let me briefly on the area of vaccines, medicines, self-medicines. My name is Ifani Justino Keke. I'm a pharmacist. And I want to thank Professor Fatou Tony for this opportunity. And also I'll tell you Dr. Loretta about your call. You've done justice to the topic and as a matter of fact, you've also made my own job easier. So what I want to say is that the Ubioko team is going to remove obstacles that have been holding us down in this important area. Of our health system component, which is the area of safe, good quality and affordable essential drugs for our citizens. We have our essential drugs law. We also have our National Health Act. And giving you a little background because I'm going to talk from experience. I'm going to talk from experience. Having lived in Anambra State for all the years of my practice. And you know that I experienced firsthand an obese government, eight years in Anambra State. So and I'm a pharmacist of over 25 years experience. I'm a fellow of the Fomachi Society of Nigeria. I'm also a fellow of the West African Postgraduate College of Pharmacists. And I'm also a trained lawyer with over 15 years, this 15 years experience. In my village in Anambra State here, I'm the chairman of Health Committee of my village. Overseen the health post. And I'm also the chairman of the Health Committee of my world. Also overseeing the health center. So I'm also a community pharmacist. And also have a background of medical marketing. I've lived all my life practicing in Nigeria. So the wonder about of the Ubioko team dwells on disease we've been talking about. Competence, capacity and character of the team. But in from the character I want to draw out the another three C's. That I have seen my former governor as which is compassion, courage and credibility. Bringing it down to the area of pharmaceutical manufacturing. I want to say that UbiDati government is going to launch the first malaria vaccine from Nigeria. That's a takeaway. We have the capacity to do that. In fact, Nigeria used to have a vaccine lab here in Oshoni. Which was later acquired by Mayor Baker. UbiDati government is going to remove every obstacle. And make and ensure that our first malaria vaccine is launched. Because prevention is an essential component of our healthcare delivery. Other vaccines that will be launched under UbiDati government include five important childhood vaccines for diphtheria, ketosis, tetanus, polio and hemophilus influenza type B. These are killer diseases for children. And also very important vaccine for pregnant mothers, which is tetanus toxoid. This Nigeria is going to be a hub for these vaccines. We import them from India and China. And from the data we have from United Nations concrete database shows that Nigeria's importation in 2021 was 1.3 billion dollars. When we talk about moving from consumption to production, what UbiDati government is going to do. Is to, apart from manufacturing of these vaccines locally, we are going to export and also make revenue from them. Having said that, I want to talk about active pharmaceutical ingredients. You know that everybody, in fact, there's no way you go to hospital and go home satisfied without your drugs. Most of our active pharmaceutical ingredients are imported into Nigeria. We have many of them in Nigeria, but we still import. Let me give you an example. Our common beta leaf, we eat it every day. Research has shown that beta leaf is used in the management of diabetes. Our researchers in Nigeria have done a lot of work. Why can't we have beta leaf tablets in Nigeria? Some parts of the world are already marketing it after they are clinical trials. So we are going to produce active pharmaceutical ingredients in Nigeria, not just active ingredients. UbiDati government is going to ensure that accidents are produced locally because we have them here in our bundles. For example, pharmaceutical grade starch. We have a starch in Nigeria from your maize, from your cassava. But we don't process them for the use of our own local manufacturers. UbiDati government is going to remove every bottleneck for these starches to be produced for our tablets, for our syrups. Not just for Nigerian consumption, but for import. Let's say we have a technical glitch for pharmaceutical KKDAT. The current Nigeria has happened to him, but rest assured that once UbiDati comes on board, that Nigeria that has just happened now will be a thing of the past. So just to complete from where he has stopped, the pharmaceuticals are going to be big, like he said. Production in such a way that we even become super producers and generators of income. I know that healthcare everywhere gups income. But the plan by the UbiDati administration is to turn our healthcare around in such a manner that even while we are catering for the 133 million dimensionally poor and all of Nigerians, we are still able to generate income by thinking out of the box, by moving from consuming to production. And an example just to further buttress where he rounded up is think about having sub-regional centres, big ones in Nigeria, just by a reversal of our brain gain and optimization of our workforce and getting the right pegs and the right holes as well as working across different NDAs in Nigeria. They are already happening. You can imagine us having interventional cardiology where I know that a lot of Nigerian diasporans have come back home as well as neurosurgery and in the atroplasty having big hubs and big centres for these places run by people who actually have this skill as it abounds in resource rich nations in the world. Just imagine what will happen. We are going to become a hub in sub-Saharan Africa for delivering this specialised care. So to sort of round off and I want to thank Pharmacist Okeke and all the people around the world who have really really worked on this, people like Dr. Aizemiel, OJ, Pharmacist Remira, the many nurses and midwives and Dr. Douglas O'Call, a lot of them, Salvation Alibor, who doesn't sleep by waking up in the middle of the night. Nigerians across board for all the ideas you have sent to us. We want to sort of round off. I will round off now and let the people in the studio continue for a while and come back if we have to. I'll round off by saying that healthcare is not free anywhere in the world where you have standard, safe healthcare. And we must make it available, accessible and affordable by all, especially our 133 million multi-dimensionally poor. I didn't say it. Loretta O'Dwara O'Call didn't say it. That is the result from the research carried out by our own national bureau of statistics just in November last year. We need to bring this healthcare to that market woman in Aba. That market woman in Sokoto, the person in Oba markets in Nigeria. Think about it. Our mothers sits in this market. They don't have healthcare systems that they can go to. They just want to trade a massive awareness in all the local languages. And actually bring healthcare to them. That's what you call community entry point in public healthcare provision. Go to the chiefs. Go to the psychies. Go to them and let them be the community entry point. They will hold our hand. This is what the Obidati team is planning. Where the people will hold our hand and say, look at this, our primary healthcare center. It is not functional. And then they watch us renovate it. Some of them will be the bricklayers renovating it. Some of them will be the carpenters. They will not have ownership of this process. They will not have ownership of their own healthcare provision apparatus. And they will protect and guard it with their life. It's been experimented in outback areas in Canada and it works. There is nothing that says that we cannot domesticate these approaches. And then we actually empower those healthcare providers who will now be in those areas. Take the traditional healthcare attendance for instance. They are all in our villages. I'm sure we all know those women who deliver women in the houses. But nothing stops us from actually going out and training these people. Training them so that they know the signs of what to look out for. And I like to use the examples because he brings his clothes at home. We train them and we set it by them. And they know that if a woman has been in labor for over 12 hours, they should start sending to the nearest healthcare, secondary healthcare provision place, like the general hospitals. They know that if a woman is bleeding suddenly, a lot more than they can manage. We can tell them what to use to measure. It may be two parts. By the time two parts is soaked, she needs to be referred. By the time they know all of these things, then they'll refer. The question is for instance, if there are bad roads that people cannot navigate. Then we can provide them for instance. We try cycles. It's been trialled in Kenya. And they get these people to the nearest areas. So when they get to the nearest areas, they get to the right areas where they can then assess health in the right way for them, individualized to that problem. So we must begin to think out the box. We don't have all the doctors, nurses and midwives in the world to manage our 200 million population. But like I stated clearly in the several pillar recommendations that will come up with following our assessment of Nigeria's unique healthcare challenge, you can see that we just need the will and the right leadership, which is what Obidachi administration is going to provide. And they're going to do this for one reason and one reason only. And that is because they know that every single Nigerian patient is what it is. We are what it is. Thank you so much, Loretta. Thank you. I mean, what a remarkable explanation of a major challenge. By the way, Loretta is practicing in the UK and her husband who is a neurosurgeon came back from the UK and is practicing in Abuja and the contributions that come from this kind of engagement of Nigerian healthcare professionals can really make us a destination for medical tourism rather than pumping money into India and all of that. But that's part of the program of the Obidachi administration as it comes on. We'll just quickly round up healthcare. Austin and I are sitting here in the studio because we need to go to power and I know Jerome is anxious before he gets on the flight to speak to that. But Austin, you know this healthcare business, it's a very, very painful thing. I was going to, you know, the centre for values in leadership had these clubs around and I was going to speak several years ago at a CVL club at the University Medical School in Shagamu to the CVL club members. And speaking before me was a very provost I think of the University of Lagos College of Medicine professor, I think it was Funchal also. And as I came in, his words were the Nigeria healthcare system is a man-made disaster. Now, how do you, with all the talent available, what do you think we should be doing to create with the awareness and the policy focus which the team in this case with Dr. Loyota and Ko have worked up stuff. How do we get people to own this process, realize that their health is truly their wealth and that is in their hands. The starting point is the mindset. We need to change the mindset, starting from the government for instance so that they will realize the value of the human life. That the value of the human life matters a lot. And from that you can begin to do the health system that will give that assurance that if anybody is sick, he goes to the hospital and then he will get the medical attention that he requires. Accountability, people who have account to account for ensuring that life is... And it goes with just the attitude of the health professionals. I am a case in point. I am just recuperating from health issue and when I was really sick I went to the hospital. One, the doctor never opened his mask to let me see the face. He never smiled. Those personal service things. Now my BP was about close to 300 and they rushed me to the emergency and they attended to me right in the car. There was no space for anybody to come out. You see cars parked and they say, what is wrong with you? They check your temperature. They made the auto recrimination. He walks away to the other car. I said, where in the world do you have that system? My nephew, I call him my nephew, my distanced relation. Over the weekend and the 14th, 12th year and they took him to the same general hospital, the same old bed space. Bagada general hospital, no bed space. Right now, at the private hospital. So these are the things that at a certain point and then the doctor made a point of the diaspora population, the human resource, which also you are quite aware helped India to to a great expense to build a new nation as we are trying to build now. And most of the, some of the major medical facilities built by India is in Nigeria. So rather than taking the whole thing out, they're not bringing it in. So it's something that Obidati Government will able to address as soon as the income on stream to be sure that everywhere that health is actually wealth. I just realized that. I've been through it. Yes, yes, yes. Nothing that teaches like experience. But just before we go to the next segment a quick thing appointment by a pharmacist about manufacturing in Nigeria. I mean, we're talking about going from consumption to production and part of the strategy, economic strategy that the Obidati team is working on is called essentially building on your latent comparative advantage where you look at your factor endowments and construct your global value chains in which maximum input is made in Nigeria manufacturing for export and for local consumption. Nigeria could become a pharmaceutical giant manufacturing and exporting even though we are putting literally everything now. Amongst the things that you get complaints about is oh, don't get industrial grid that cassava is all over the place. So we must have industrial policy that facilitates being able to dominate setting global value chains where the factor endowments allow us to play there and it clearly puts us in a position to become leaders in pharmaceutical exports rather than today being modern net receiver of inputs of pharmaceutical production or in fact of medicines coming from around the world. I think that this is part of where the economic strategy teams the pharmaceutical and healthcare teams ensure that there is synergy and that our competitiveness as a country goes up. I think we can keep healthcare there will return to it all through the conversation today will come back to healthcare in different ways but will go on to other issues This is the time to have a little bit take it away and find out where Dr. Jeremy Okulu is so that we can get to him and the power people.