 We're back with the Breakfast in Plus CV Africa. It's a fast conversation here. It's World Health Day and today is like I mentioned earlier on, the World Health Organization will be celebrating 75th anniversary because in 1948 countries of the world came together, founded the WHO. The essence was to promote health, keep the world safe and save the vulnerable. But has that been the case? So for everyone everywhere that can attain the highest level of health and well-being. Today is a great time to look at our public health as a country. That's Niger and as a continent, as a globe as well. The successes that have been improved upon in terms of the quality of life during the last seven decades and the shortfalls as well. At this particular point it was also stated that the theme for this year's event, that's the World Health Day 2023 is the health for all which highlight the significance of universal health coverage for individuals worldwide, particularly in developing nations like Nigeria. We have a guest joining us this morning is the Nigerian Country Director at the Warn campaign in the FCT. Stanley are not true. I hope I got that well. Thank you for joining us. Then we also have Dr. Samuel O'Kareen Day who is a public health physician in Lagos University Teaching Hospital. Dr. O'Kareen Day, thank you so much for joining us. Yeah, thank you for having me. So let's delve straight into it. I started with Atronio. What is the significance of today, especially when we look at our public health, you know, the health sector for us as a country? What are the successes and, you know, what are the failures that we can actually reflect on? Thank you again for having me and the compliments of the money they send to everyone, to your viewers as well. Today, as we commemorate the International World Health Day, it's a significant day considering the myriad of challenges that we face as a country in our health sector. We have some of the worst health indices in the world, but we have also overcome some of the most challenging health issues that the world has been confronted with. You look back to Ebola. When Ebola hit, Nigeria was one of the countries that successfully managed that outbreak. We also did tremendous work in managing the most recent COVID outbreak, where the world was projected that the number of deaths on the continent, certainly countries like Nigeria, would be tremendous. Nigeria was able to overcome that challenge and avoid the worst outcome in health. We have some of the best health experts and health workers in the world. Despite the challenges that we face, and when you go around the world and you meet Nigerian doctors, they are some of the best of those in the world. Only the challenges that we are not able to harness, these human resources that we have on our hands to make sure that we deliver the best of health care to our citizens. Today we look back to the progress that we have made. We have started a health insurance scheme for the poor. We are delivering improved primary health care to attend to tackle health challenges faced by the poorest of the poor. But we still face tremendous challenges and for the size of the country, there is a lot to be done. Our secondary and primary health care needs a lot of attention. Funding remains a mission. But in all of these there has been some progress that has been made, but there is a lot more to be done for us to get the quality of health ourselves, deliver the best to our citizens. Let's speak with Samuel this morning, clearing day. Doctor, who is a physician, has practised in Nigeria. I would like to show your thoughts. How do you feel today? David celebrates what's the feeling for you? Are you excited? Are you sad? What's the emotion? Thank you very much. I want to say I'm delighted to be here. Today, of course, you know, they set aside by the World Health Organization to highlight the important issues of the challenges and sometimes also the successes that we've had in public health space. I want to, you know, your earlier speaker, Stanley, said a lot about how I feel about Nigeria. Even though we've recorded some successes, I will most always say that because it's not just that you keep, you know, talking about the negatives and you don't talk about the positive. Ebola, of course, for example, was one of the successes that Nigeria was able to record. Then COVID too, of course, as opposed to what was, you know, postulated or, you know, thought that would happen to Nigerians in Africa. Africa and Nigeria was able to, you know, put themselves together and also let me know that there is indeed potentials if we're able to enhance all the resources or if we're able to put our heart together. Africa and Nigeria has a lot to do. And so if you ask me, I will say it's more of a mixed feeling, not necessarily a wild appeal for the successes that we have. I will say that when I look at the gaps and the deficits that we have, it's really something to ponder and think about. But I'd like you to speak to it because you're a practitioner, I mean, right here. What are the challenges so far, so good? 75 years, WHO will be celebrated, they have existed. But I'd like to ask you specifically, what are the challenges in the health sector in Nigeria that you have experienced first hand? Okay, so if you want to talk about the challenges, we have to, we want to put them close to the indicator, the indices. And like I said, Nigeria really, we're not doing well when it comes to those things. Let's start with them. The framework for having a functioning healthcare system, okay. The WHO gives about six building blocks, okay, in the framework. And the first one, of course, is service delivery, where you have to talk about, one of the indicators is the number of hospitals per population. Nigeria has over 200 million people. And from the Ministry of Health website, we have less than 40,000 health facilities. And this is including primary healthcare centers, Teshara hospitals. And of course, the private sector, 40,000. If you look at it to the population, you find that that is grossly inefficient. Of course, the next building block talks about healthcare workers. Healthcare workers have to do with your doctors, your nurses, to the population that we have. Nigeria currently has less than 40,000 doctors. Of course, if you look at the register, you see that a lot of people with this jacquard syndrome and greenery syndrome, you see that we are actually also not doing well as opposed to the WHO saying one physician to 600 people. In Nigeria, you see one doctor seeing more than 4,000 patients, which of course has led to more people living in the system because there has been cases of burnout and all of those things. So in health care workforce, retaining our healthcare workforce is another big issue. Like Sally said, Nigerian healthcare doctors, nurses are well sorted out all over the world. Why? Because they are quite brilliant and they are very industrial. So when it comes to retaining our health workforce and motivating in one of the indicators for assessing your workforce is how motivated are they? Okay. Do they have the resources? Do they have the equipment to work with? Do they have the right quote-unquote work, positive work environment and these things, they are happy to come to work, a doctor who has to see hundreds of patients every day and still has to end the same salary that has not changed over time. That kind of person really can give its best. But when they leave the environment and they go to an environment where those things are there, you see that they shine every day. So when it comes to health workforce, there's still a lot of gap. Okay. And the other one has to be, another building block is financing, healthcare financing. Of course, whenever I talk about this, I'm saddened because as opposed to other budget, other things are budgeted for. For example, Nigeria this year budgeted over $6 trillion for subsidy, oil subsidy, which even despite the subsidy, we are not able to assess the commodity, there's sick use. But look at health, the amount that has been budgeted for health has never gotten to 7%. As opposed to the Abuja declaration that says, when all head of state came to Africa, Nigeria to be signed, Abuja in 2001 and said minimum we should budget for health is 15%. Nigeria has never, ever gotten to that level. And of course, if you don't pump money into health, the outcome will not be right. So if you look at all of these things, training, I think that it is still not the best to be done. Yeah. So Stanley is here now. Stanley, do you agree with him that framing policy formulation, framing and what have you, all the issues, personnel, lack of funding also be the challenges that the, you know, the health sector on Nigeria's face would? Totally. Dr. Karidze is spot on in his analysis. Of course, he is in the field, he sees these issues. And his analysis is quite right about the state of Nigeria and health care. And I'll do, let me re-emphasize one point he made about allocation to health. It's not just that the allocation to health is poor. It's also that the distribution of this allocation also makes our quality of health care service really challenging. A bulk of the health, public health allocation goes to tertiary and secondary health institutions. Ignoring the building block of health system, which is the primary health care. What that has transmitted to is that health issues that can easily be managed at primary health care centers are not taken to the secondary and tertiary institutions, thereby overwhelming health workers in these health institutions who should be attending to advanced health issues. I'm sure Dr. Karidze understands what I'm saying. If you have malaria, there is no reason why you should go to the general hospital. Your first point of call should be the primary health care center in your area, and same for others in regular minor health challenges that people face. We should have a system where advancement to secondary and tertiary health institutions should be by referral. But what we have at the moment is that if I have had it, my first destination is the general hospital or the teaching hospital. This shouldn't be things that health centers at that level should deal with. And the reason why everybody heads in that direction is because of the way, even in the small health allocation that we have right now, the way it is not distributed has led to the level of inefficiency, thereby overwhelming the entire system. So we need to, in advocating for additional health resources, which I agree with Dr. Karidze as well, we also need to be more efficient in distributing this allocation in the health system in such a way that it leads to better health outcomes. We are also a country that our health system is quite expensive. And it sounds like, oh, we're not paying anything. When you ask people, they say, oh, our health system is subsidizing. We actually have an expensive health system, both at the federal and state level. The out-of-pocket expense for another Nigerian is quite high, right? When you compare it to their parents elsewhere, our out-of-pocket expense for healthcare is quite expensive. And then we direct resources away from other things that people can tackle, right? And then there was also, and I know Dr. Okay, they mentioned this, our workforce management is very poor. And when I say workforce management, it starts with payroll. The wages are extremely poor, they are delayed. We are constantly forcing our doctors to go and strike to be paid properly. Well, if the health system is priority for our doctors, our health workers, if not be subjected to kind of treatment that we see them go through every year when there is cost of, there is need for cost of living adjustment, they are forced to go and strike to get that basic cost of living adjustment. We tend to treat them as a set of people that should just accept what they are giving and make the best out of what they are giving. For the kind of work they do, they need to be motivated. Our current wage system for our health workers cannot be demotivated. Sometimes I worry about their mental health. It has to be a lot to watch people suffer and die every day for things that you can handle, but we do not have the resources and equipment to tackle those things. So we need to be most important to our health workers because they face a lot of challenges. It's not that people tend to say, oh, health workers are wicked. No, you need to look at the environment, include the health rates. You need to understand the kind of equipment and environment to keep their force to manage the work, health, promotion is always a challenge. Areas payment is always a challenge. Infrastructure in which, in the environment where the work is terrible, so the health, the education system is also becoming very challenging for them. Of course, and there's the challenge of corruption in the health, in the management of these cash resources in health. So there's just a lot of challenges in our health workers. But quickly, I mean, for the want of time, because in no time, we'll probably might just, you know, call this a wrap now, but I'd like to ask you, Stanley, that WHO has specific functions. The reason they exist and today 75 years would be celebrated. Do you think that WHO has lead up to expectation? I mean, when you look at Nigerian Africa as a content in terms of as a continent by the way, in terms of promoting health, keeping the world safe and the vulnerable as well. These are some of the key objectives of the WHO as an organization. For instance, COVID-19 and its vaccine, especially for Nigerian Africa. So again, the WHO plays a complementary role to what our own government should do does in respect to health. They have always provided the policy backing and support that countries need. In fact, if you need the best of information around Nigeria health system, you rely on WETU, more than you rely on Nigerian government. So they provide the necessary technical support. With respect to COVID, it was a night opener for not just Nigeria, but for no income countries. They may not say Africa, because we tend to think that the most challenges are in Africa. For COVID opened the eyes of the world to the inequality that exists in the world that we live in. When vaccine was made available, when vaccine was discovered or manufactured for COVID, the WETU countries bought up supply, bought up the entire supply running into three, four, five years while the poorer countries were left hanging without any vaccine supply. There was also the inappropriate pricing where the vaccine manufacturers were sending to the highest bidder, living low income. There was that uneven lack of fairness in who could assess vaccine. That's how we ended up with the WETU countries not turning vaccine distribution into a charity. US have donated this number of millions of vaccine. Spain has done this, UK has done this. We shouldn't have been in that situation if WHO had put in place a first system of distribution of vaccine. This is not to blame WHO because they did call out the unfairness. They did put mechanisms in place to make sure that all countries are able to assess this. There was a lot of criticism of WHO, especially in the run-up to this in the days leading to and after the COVID outbreak. But we also should recognize that there was a lot of effort to weaken the WHO as an institution. They are a trusted source of public health advisory globally. As we saw during COVID, questioning the expert's opinion, questioning the policy direction they were given did not help in managing COVID. I think that this is something that needs to, what did I need to think through about how we treat international institutions such as WHO? Where did they fail in some aspect? Of course, there was a lot of uncertainty with COVID. There was a lot that was unknown with COVID. Did they try their best to make the best of policy recommendation? Yes, they did try. They did it to the best outcome. Sometimes they failed as with every other human institution. But I think that they continue to play an important role. They have saved the world a lot of times. They have also learned lessons. They've set up health emergency centers across the world to monitor potential outbreaks. They are doing better in terms of changing the discussion around access to vaccine. Right now, they are working with the African governments to make sure that we no longer have the vaccine system where vaccine access is now restricted to two countries. We need to take a pause there. Let's get back to Dr O'Kerinde. O'Kerinde, I'd like to bring this to you. If you don't already know, I want to assume that you know already that there's a bill that has scaled through the second reading. It is to prevent Nigerian medical or dental practitioners from being granted full license until they have worked for a minimum of five years in the country. Like I said, it's past the second reading. It's just to ensure that people don't die within your sector. How do you describe this entire bill that has gone through the second reading? O'Kerinde. Thank you. I must say that in one of the things that one of the reading block I was going to talk about is leadership and governance. Okay. And very, very important in that reading block is political will, policy, and all of those things. And we can see that there is a major problem with our health workforce. And what are these problems? Workers are not well compensated. They are not motivated. And like Sally said, there is no written version. You know, their basic allowances are not paid. You have to go and strike before you can get those things that you are entitled to. All right. And of course, no infrastructure. There are sick doctors. You know, there's a lot of burnout. And the response to that, instead of, you know, improving the worth here, in giving them, for example, motivating them, there is a reason why those people are living. What we call the poor factor. All right. You have the push factors. There is no job security. There is no loan capacity. They are not happy. And then to further worsen the system, instead of you attending to those basic things, all we could think about is stifling them, taking away their fundamental rights. There is a free movement. There is a workforce mobility, you know, and all that the government can think about other than solving the problem. It's like cutting a head, you know, because of an, because of eddy, instead of looking for what the problem is and solving the problem. I think it's indeed an unfortunate situation. And I must say at this point that it is not only doctors or health workforce that are living. We have even other people in the banks, you know, we are having, you know, we are having like an epidemic. People in the banks, engineers, professionals in other fields are living. So if all that our Senate could think about, our House of Representatives could think about, instead of putting legislation that makes life easier, better, creating more medical schools, improving their wages, all you, if all you could think about is legislation, I think it's really an unfortunate situation. And I don't think they are going to be nice. What that we do is to further demotivate health workforce. And they will say they are not, I mean, you come for them to come to work, they will resign, and maybe they will start selling paper or sand or something that will be able to take care of their needs. So I think they need to look into that law or that bill that's just passed a committee and it should be, it should just be queued. That bill should not move further. I can't, I think that Stanley also needs to share his thoughts on this one, especially when you know you are the country director at one campaign with policies like this. Before this, I'd like to ask what are the contribution of your organization, you know, to the health care sector in Nigeria, development of it. And also, what are your thoughts on this recent bill that has killed the second reading automatically just to pit down, you know, those in the medical sector, put them down or tie them down as it were. So they can't, you know, jack ma in the words that we have, you know, coined for lead to other parts of the country. And some people think that, hey, there's a rationale behind that that you can't be training, we can't, you know, afford to train our doctors with our resources and then have them, you know, to go out and work for other countries. Someone said that talents go where the resources are available. And that is what has happened to Nigeria Health System. The talent are going where they can put their talents to use and be rewarded for that talent. You cannot train a doctor, provide them the worst environment to work in and then expect that they remain in that environment when there are places where they can deliver quality and then also be rewarded for it. So as Dr. O'Kerry mentioned, the governance component of our health is solely lacking. The quality of thoughts that we see from the leadership is also solely lacking. If this is of all of the myriad of challenges, there's a lot of people that are living in the health system. And when you make a long list of the challenges in our health system, the factors from the health sector rank very low, right? There are, maybe you would have listed 10 things before you get to the point of doctors are departed as a talent. And you then leave all of the challenges at the top and then tackle the one that is the least of the problem. Because once you solve the problems at the top, this one will stop. So it's unfortunate that this is the quality of thinking we're seeing as providing governance and leadership for our health sector. Really, really unfortunate. And I hope that there is a way to think. The question I was speaking to you when I read about this news and the question we asked you, if you say that we cannot be given a license to practice until after five years, what would they be doing in the five years? Are they going to be practicing with our license? There's just a lot of questions to be asked about this kind of thinking. And I hope that cooler heads step in and give the House appropriate recommendation on how to tackle the challenge facing health. Definitely not this approach. In terms of what we have done at an organization in health, we have been here for a while. We joined other NGOs working in the health sector. We collaborated with the health sector from coalition, the coalition of NGOs working in health to champion for the passage of the Nigeria Health Act, which is the foundation on which the Nigeria Health System and Legislation and Governance is built on. Really, in championing for the passage of that law, we have since the law came into effect, we have championed for components like the basic healthcare provision fund. We spent two years pushing the federal government to make that fund, which was covered in the National Health Act as well, making that operational. And it took two years of campaigning to get the federal government to commit to funding, to making that fund operational. In the last one, two years, since the fund has become operational and is the supporting fund primary health care center, we are now because of making sure that it provides the most quality to people, citizens. I really don't want us to just go away. It's world health day. It's not every other time we have the opportunity to talk about these issues. So actually, let's take a breather to you now and speak with Dr. O'Kerrynday. O'Kerrynday, what policies or what statement, what exactly do you think the focus should be on this particular day? I mean, I like the fact that it's world health day. It gives us the opportunity to talk about all of the issues and what's the way forward? What are the policy formulation, direction? What's the, what are stakeholders expected to do at this point in time to ensure that we have a better society and better health care system? Okay. So the theme for the world health day basically talks about health for all, which is basically calling all actors of stakeholders to ensure that there is an universal health coverage. And what we know is that the best form of health care delivery or health care system has to do with PHC, health care, which basically is the bedroom, is very critical to achieving health coverage. So we are saying that number one, the policy should be that the government should invest massively in primary health care. Okay. That is, that has been said, you know, as way back as the, you know, amateur declaration and the national declaration in 2018 is there. Number two, let's, let's, let's localize some of these things down. Practical one, there needs to be a policy that balance all public orders, all politicians from going out for health care services. You know, instead of putting a policy that ensleeves or hold back health care professionals, doctors, let's put a barrier to see all, all public office from the president, right, to the list of public office that do not go out to seek care so that they can see the decades, decades of the rots that we have with they have to stay back, then they will be willing to invest. They have to be policy about training and retraining. They have to be policy about, like he's also said, the problem about the financing, you know, the, the renumeration, the compensation. And I'm also say that one of the reasons why doctors health workers are living is because they are also not secure. Several doctors have been killed. Why they are providing health care services to the populace, to the people, you know, because there is no facility, you know, there's no infrastructure to take care of those things, of those people. Then the people take it on the doctors and they, you see doctors being stabbed, doctors being kidnapped, even other health workers. So we need policies that will ensure that doctor, doctor's securities is ensured. And so just look at those, all the issues that we have raised, improve their renumeration, improve their working environment, have more infrastructure, starting with talking about the distribution. If you go to the rural communities, they are, you know, they are particularly disparity. We have to go now. And I am, I am very saddened that I have to let you go really. And that's because we have to join the next guest for our conversation but Stanley Atronu, thank you so much for being part of the show. He is the Nigerian country director at one campaign in the FCT, right here in Nigeria. Thank you once again. And Dr. Samuel Okreinde, thank you so much for also making our time to speak out, you know, and talk about, you know, the challenges of the health sector in Nigeria. We look forward to, you know, having this conversation, you know, in the next couple of days or thereabout. He's also a public health physician. He practices in Lagos, that's a university teaching hospital. Thank you gentlemen for being part of the show. Thank you for having us. All right then. We take a break. When we return, Monday Thomas joins us this morning on Friday to talk about spots. We'll be right back.