 Welcome back to the breakfast on plus TV Africa, our next major conversation is going to be talking about, you know, simply review of the Nigerian health sector. We currently are in a pandemic. The government has announced that we, you know, are in the fourth wave. And of course, in the news this morning, we spoke about the poor vaccination figures that we currently have in Nigeria, and also the very, very poor level of testing with regards COVID-19. But that's not the only health challenge Nigeria currently has. There's still La Saffiva and a couple of others. This morning, we're going to be speaking with Dr. Tui Mabawondu, who of course is a regular on the breakfast. Good morning, Dr. Tui. Thanks for joining us. Good morning. Thanks for having me. We also have Dr. Babatunde Ipaya, he's a former health commissioner in Ogun state. Good morning. Thanks for joining us, Dr. Ipaya. Thank you for having me. Good morning, Nigerians. Good to have you. All right. So I'm going to start with my Zoom guest, Dr. Ipaya. Could you really help us paint the clearest picture possible of what Nigeria's health sector currently is and what it currently looks like across board? Well, thank you just to just re-echo what Nigeria leaders admitted for the first time during COVID is that many of the leaders admitted that they never know that their health sector is that bad. I could remember the secretary to the federal government of the federation and the chairman of the presidential tax force then on COVID said he never knew that the SESM is this bad. And so what COVID actually was to put on the front burner the appropriate status of the Nigeria health sector to describe the Nigeria health sector is just to say it's a sector that is underfunded, a sector where the best of the brains are lost to other climes after we have subsidized training with a system where efficiency is not the all mark of the services and that where we say something as a priority and then do something else. The national health policy that was first written in 1988 and the latest version reviewed in 2016 says in the primary care is the cornerstone for health care delivery in Nigeria, but that is in a level of care that is grossly underfunded. So we say that is that should be our priority, primary care everywhere, but of course it is a list that is funded by the federal government and the state government. And so the challenge is first to to to mean what we say and then put our money where we think our priority should be. Okay, well, it's scary when it's described that way, you know, remembering that we currently are dealing with COVID-19, you know, and nobody knows what 2022 is going to bring. But I'm going to go to Dr. Mabawon do now, you know, from what he's described, I don't know if you would agree with, you know, his description of Nigeria's health sector. But you know, can you also share with, you know, us, we have over time had conversations about improved budgeting percentage for health in Nigeria, but that doesn't seem to have worked. You know, if you look at even 2022 budget, it's still very, you know, seemingly mega figures that have been put, you know, for health care. So is it because of a complete lack of interest or does the Nigerian government maybe feel that there's really no need to spend so much money in health care? We're okay. Well, I want to reiterate again, like Dr. Iqaya said, what he said to the government of federation, what he said, April 2020, he went round on a tour, or he held facilities to assess the capability for response to emergency. And instead of listening, he saw a hospital with our beds. He saw emergency room with that ambulance. He saw an ICU with that power supply. And he saw hospital without doctors, without health workers. He was scandalized. And then he came out and told the National Assembly that our situation is actually pretty bad, worse than he actually thought. Yes, he will say that because most of them don't actually get treatment here. And if you do a cross-section and try to look at what the health is in Nigeria, our life experience has got stagnated. We're still at 54 or there, but maybe for women 55, a bit more than that. And then Malaya kills as much as the whole burden of Malaya in the world. 25%, one quarter, Malaya deaths in the world is in Nigeria. Martina deaths in the world, 20%. One out of every five of them died in the world because of pregnancy. It's in Nigeria. Then under five mortality, one out of every six died in this country. And then we now come to the budget issue. That is the country we're facing. And you saw doctors, about three doctors, to 10,000 people. Far, far. And then you now come to the budget. In 2001, Nigeria hosted the whole Africa, the whole world, in Abuja, and said that we're going to commit 50% of our budget to health. Rwanda has achieved that. South Africa has achieved that through incremental improvement in their health budgeting. Nigeria is still at 4% at the best, 4%. And most of this 4% goes to where recurrent expenditure. So there's no clear cut thing. And then look at it now. Recently, I see about 8,000 Nigerian doctors are now registered in US. Everybody's emigrating. And they are emigrating internally or they are draining externally. So you see a whole system, corruption everywhere, poor performance, monetary, and indices of health everywhere. And now COVID came. Last half of it is ravaging. Colour is always there. Management is there. And then we have the chronic illnesses, diabetes, hypertension, typhoid, all sorts in a country where we have now seen that health is not just a social concern, it's not just a social concern. It's a strategic security issue. And we're not getting that. See, we are under investing. Corruption is not really the place. And then doctors are on strike, at least this year, twice. We saw doctors strike in April. We saw another one in August. In one of the doctors' strikes, the president traveled out to go and assess health care. Two months, doctors were on strike from August till October. So here we are. It's a very precarious situation in such a way that if you're sick now, you just have to end up in a church or with one babala to help you get well. OK, so let's bring in Baba Tundepeye right now. Let's talk about the structure of the health care system in Nigeria. Of course, you know that so we can actually have quality health care being decentralized. You have the primary health care, the secondary and the tertiary. How far do you think that we're fairing with the structure? Well, thank you. I'm actually a community specialist. And the primary care is the baby in the tertiary. And you recall that at a time in Nigeria, there was a minister called Uliko Duransomukuti that committed enough federal resources to primary care and the International Coverage was as high as 80% to 90% one of the best in the world, you know, and then you could feed primary care everywhere in entire hospitals, no matter wherever you live and be able to get quality medications and so on. And so today Uliko has been celebrated. And so the problem is what has taken us away from that because the health care needs, you know, my colleague has spoken about, you know, the malaria border in Nigeria and how Nigeria constitutes almost 25% a quarter of deaths due to malaria globally. Of course, it is also said that 11% of maternal deaths in Nigeria is due to malaria and, you know, maternal mortality of about 586, 400,000 lives, but it's nothing to be proud of, right? So if you look at the structure, as you have said, the primary level, which is the health care of the majority, deserves to be funded by the three tiers of government. And unfortunately, for some or two reasons, everybody assumes that primary care government, the least resource level government should take over that. And I kept asking everybody, including myself, where was this written? Who said and who gave the impression that primary care government that, and we also know how local government and location is being managed in Nigeria. And even beyond the payments of local government workers, hardly do you see anything happens at the level of local government. And how can you now, you know, give the responsibility for, you know, delivering primary care in the hands of the local government for every sake? How? If you look at the national health account, OK, the local government financing for health is also problem for 2% of health care financing in Nigeria. And if you say 80% of Nigeria needs primary care, so even the little that is committed to health in terms of budget, we need to do far, far, far, far more primary care. And if you now take that side by side with secondary level care, which is usually seen as responsibility of the state governments, you see, you see secondary facility structure everywhere. And the, and many governors who want to build, you know, general hospital and award contracts. And at the end of the construction, what happens? So why don't we make the few ones functional? And if you develop, you know, a hub and spoke system, where the primary caretists, you know, care of the health care need of the majority, then the referral to the secondary care will be minimum. And we need less secondary facilities as we have in Nigeria. You also have seen recent time that everybody wants to build, you know, federal medical center teaching us to everywhere and this teaching us to likely manage malaria, you know, prevention, treatment, sexual and things that should be ordinarily be managed in the, in the, in the, in the primary centers. And so why should professionals and consult and sit in the teaching of the two, we create the kind of money they have made and they are, they are treating malaria and other primary care level diseases. It's, it's, it's seen efficiency. And so for me, what we need to do is that here's the street here, we need to actually get to a point. And if you go to small countries, Rwanda, my dear colleague at National Care, you will see that every drone you see in every city, every major city, the quality, the ice of quality, you will see in the remotest part of those countries. So if I have the most, the high quality anti-malaria in the rural part of Nigeria, why should anybody get to Shagamo teaching us to, to get to check for malaria? And so if you, if we must, if we must, you know, you know, bring efficiencies into our system, we need to reorder priority for investments and we need to bring further resources to support the primary care. We need to bring state resources to support primary care. And more importantly, like my colleague has said, there must be supportive supervision because even when a little is given to that level and, and, and I'm privileged to know because I've supported, you know, the control of HIV, TB, and malaria over the years in Nigeria and I see that even some of the commodities that get to that level also get into private sector market and they don't deliver, you know, the care for the poor and the middle. And so there must be a significant level of supervision which is lacking. And if that level of supervision is provided, of course we will see a system that everybody takes advantage of. Lastly, yes, I agree with my colleague in the studio that financing is, is, is poor and the Abuja declaration 50% never has ever met. I know that Nigeria has gotten to the eyes of some, some percent of healthcare financing that is less than half of what you committed to. But even when you compare Nigeria funding to some other countries, and I'll give you an example, per capita investment in Nigeria, between $100 per capita, okay? And then if you go to Rwanda and country like Kenya, it's about $39 per capita but their system is more functional. So the question is, why are they spending less per capita and getting, you know, you know, better at? Markdown mortality is like in Nigeria and of course mortality is like half 50% of that of Nigeria. So, so the question is, we are spending so little and the little that we are spending is not efficient, it's not effective. And of course the big elephant in the room correction is also, you know, affecting their sector just like it affects every other sector in Nigeria. All right, Dr. Mabon, the final question to you. It's pretty embarrassing. Some of the statistics that you mentioned with maternal and infant mortality, the fact that the giant of Africa is still dealing with Lassa fever. You know, we've only just got over our polio not long ago, I think sometime this year. I don't know if we are completely free from polio but once again, embarrassing. Was Nigeria just simply lucky with COVID-19 or do we still not have actual clarity on what our COVID-19 situation is and we're just, you know, braving it? Your first and foremost, the figure we imagine around the COVID-19 is a suspect. Obviously you can't test 3 million or 26 million and be using that as your statistics. It's not, it's not proper. If we are going to look at the major intervention that we say that this is top notch in terms of COVID, the first is testing. Okay, because the testing tells you, it's not short, this where I am. This how many people I'm having with the COVID, the severity and then this got the response. Now, okay, now you've just done how many? 3 million or just about 3.7 million testing all over. I am not improving on that, that one is stuck, fascination is stuck. So I don't want to actually look at the COVID-19 figure. But again, the fact that we're not seeing mortality, you know, as seen on the other parts of the world may actually be subdued to the other factor which we might come, you know, to realize later as research advanced. So but again, we cannot be trained our luck and say, okay, you know what, God is so faithful to us. We won't have cash royalty because even if this Omicron variant is just 1% later, if you take 1% of 20 or 6 million, it's about 2.6 million people. That's a lot. And you don't have the system that's gonna cope with that. So I mean, when we bandaged those people, I just look at it that we're not talking sincerely, we're not talking from the point of science. That aside, you know, what has happened to the health system in Nigeria is what you are seeing is silos, everything's in silos. You know, the tertiary is in silos like this operating, the second is in silos, and the primary is in silos. And then the public health, the private health system, I just also, everybody's just operating. We must find a way of integrating all these health systems to maximize the health worker we're having. I don't see why we cannot have as an ambitious program, every blessed Niger with NIN should be linked to a primary health center, 10,000 primary health center, barely 10% of them functioning, functioning. So how are you gonna deliver it? Health system is not building. So how could we not pay attention, you know, to the primary health care, you know, which is very, I mean, closer to the people like Dr. Babatili mentioned. He talked about the fact that there are some cases that should be treated, you know, at the primary level. For instance, you have had a malaria and what have you. In most cases, you find that, you know, being attended to at, you know, the tertiary or maybe even, you know, the secondary health system. We see what happened. You see, people already cleared from their leaders, okay? Have you ever even seen any of your leaders attend your secondary or talk of your primary? Is any of your family attending it? There's a student in remote areas in the corner or in the corner, packed somewhere. And there's no attention to read. You enter the place. The place is not properly equipped. We have to look at our funders, you know, to help prop up primary health system. The workers are not motivated. People are not working there. The place is looking anyhow. So how do you now think that people will be, you know, kind of happy to enter that place? Sometimes you get there, you queue forever. I did a study, you know, delay systems, you know, when I was in Sweden, working on delay systems in health systems. And you see every delay stations, you know, from when you get care, when you get there, you go to lab, you come back. But you've studied the whole day, trying to assess simple care in the center. It's not, that's not it. We must be able to leverage on technology and rule every Nigeria under one doctor or one health system as it were. So that in a way, there's a triangulation. You talk to that one. That one can find a way to refer you to the same system. And then also, let's use virtual hospital because now that is becoming the key issue. Because first of all, we're short in human resources. We're short in equipment and all those things. We must be able to use virtual things that can take people away. And then we have to push our prevention aggressively. If you don't do all these things, we'll be here and we'll be recording bad health statistics. And poor health is poor economy, is poor security. All right, we of course would have to end that here. It's not a very, very bright picture, beautiful picture that has been painted from our two guests this morning concerning Nigeria's health care. But of course, it's not breaking news. A lot of people know these things and have also been somehow, some way victims of a poor health system. But we'd love to speak with Dr. Babatunde Pae once again. He was the former health commissioner from Minogu State. We'd love to have another and of course an extended conversation with you again sometime soon. Thank you very much for joining us and for sharing with us this morning. We wish you a very beautiful day ahead. Thank you. And also Dr. Tui Babatunde, thank you all. So good to see you again. Always a pleasure. Interesting, thank you. Well, that's so much we can take. Thank you so much for being part of the conversation. We hope that you enjoy every beat of it. We'll definitely come through tomorrow. And in the meantime, if you missed out on any part of the show, it's all right to follow us on Facebook. We're at Plus TV Africa and Instagram at Plus TV Africa. Now subscribe to our YouTube channel at Plus TV Africa lifestyle. I am a messable fool. If you have yourself a Merry Christmas. And I am also getting a ball. See you tomorrow.