By Doosuur Iwambe – Abuja.
The Executive Secretary, National Primary Health Care Development Agency (NPHCDA), Dr. Faisal Shuaib in this exclusive interview with Doosuur Iwambe, identified the challenges confronting the NPHCDA, his determination to ensure adequate vaccination of children as well as the strengthening of health care facilities across the country. Read the excepts
Q – What innovation have you brought on board to make the operation of the NPHCDA different from your predecessors or what have you put in place that Nigerians need to know?
I came on board with a four point agenda; that is to transform a system that had variously been described as failing, poor performing and corrupt NPHCDA. When I resumed work here at NPHCDA, the office was under the cloud of “mistrust” from development partners and donor agencies around an audit of the system by the Gabby Allians, which is really an alliance of different organisations for vaccines and immunisations. So, what really happened was that, a determination was made that funds and resources made available to the NPHCDA were not being used in a judicious and effective manner. But apart from the issue of funding, there were also issues of how well NPHCDA has done in achieving its core mandate of providing primary health care services and other auxiliary services.
So, what we did was to be very clear about the challenges that we face as an organisation. There is a huge array of challenges that we face in primary health care. You can go to a primary health care in your community and find that the services that they provide are nothing to write home about and that is why people tend to go to the tertiary healthcare institutions, they want to go to the teaching hospitals, Federal Medical Centres; they want to go to the National Hospital. In some places they would say they want to go to the general hospitals.
Q – What are the priorities that you put in place to address these challenges?
We have taken some measures that will address the livelihood of our people that live in our communities and that is why we now prioritised the strengthening of our health care to deliver better quality primary healthcare services to Nigerians which is the first priority. The second priority that we identified was to strengthened routine immunisation and ensure that vaccines are available. The third priority was to finish the job of polio eradication.
We had embarked on a journey (and I was part of this process since 2012 that really changed the narrative around polio eradication) by setting up Polio Emergency Operation Centres (PEO), we are able to drive polio out of Nigeria except for two local government areas in Borno state that we could not access. Unfortunately these were the same local government areas that led to an outbreak of polio virus in 2016. So, from a technical point of view, those were the three programmatic areas that we needed to prioritise and deliver on.
However, what I viewed as the most important issue that we ought to address was the image of the agency, what to put in place that will make the agency more efficient as well as perform at a high level to deliver on these mandates.
How to include the financial management processes; especially coming out of a situation where people have concern about how funds have been mismanaged in the past. You may recall that the Global Alliance for Vaccine and Immunisation, GAVI, had asked the Federal government to refund almost $8million and they stopped funding Nigeria immunisation. So, we have to demonstrate that the new NPHCDA is real by putting in place measures that will build confidence.
Q – So, what are the things that you’ve done to build this confidence?
For the financial management processes which is also one of our top priorities, we brought in KPMG, we got donors to pay KPMG to come and look at our financial management processes, to look at the loopholes and close those loopholes. They recommended some actions that needed to be taken to close those loopholes in the system so that it will become illicit the chances for anybody trying to misappropriate funds. And what we also did apart from the financial aspect, was to call in a management consulting company, it is a globally recognised firm.
We asked them to look at our human resources and see whether our people were fit for the purpose and whether we are using the best practice. We have a situation where 60% of our work force is in enabling position; that is the Administration and Accountants while the remaining 40% are in a core technical role. But since we came on board, those are the things that we have been able to unearthed.
We are also saying that we have too many smart people staying in Abuja, working in the headquarters, how about spreading them across without any change in their nomenclature; by taking them to the zonal areas to also designate those zones as directorates. This is because when they go there, they are closer to the States; they are closer to the Local government areas. As you all know, the problems are not in Abuja but in the villages and that is why we say why don’t you get people that are very experienced to these places, so that they will be able to study and understand the people; provide technical support to the states. In summary, one thing that I know for sure is that we cannot have the business-as-usual attitude.
Take for instance, you cannot get good primary health care facilities in most States; our routine immunisation is very poor. In-fact, it is one of the poorest in the whole of Africa. We are at a point where only about 33% of our children are being vaccinated, only 33% of them get full vaccination. So, what happens to the remaining 77%? That means they go without the vaccines despite all the efforts of the Federal Government. The FG makes sure that these vaccines are available but we have a challenge in terms of getting these vaccines to the people where they live and work in the communities and that is why we say we are strengthening the process of getting the vaccines to the communities. This is what we call routine immunisation.
We want to finish the job of polio so that all the resources we have been spending for polio campaigns, to look for polio vaccines and train polio staff will be channelled to something else, to other diseases like Malaria which is very common to us. That is how we are prioritising to finish polio.
Q – How do you intend to repositioned the Primary Health Care
For the Primary Health care, we are saying that we live in communities some of which do not have a single presence of a health care centre or even if they have, they have been reduced to what we call consulting centres. That is why when I came on board, I keyed into the President Muhammadu Buhari’s vision of reducing this inequity that existed amongst Nigerians in terms of accessing primary health care services that are of good quality. We made it very clear that we want to reduce that inequity; the gap between those who have money and who do not have money in terms of access to health care facilities.
The minister of health had also in his policy direction from day one insisted that he was more focus on health care facilities, that we should at least have one functional health care facility in all the communities. It doesn’t mean that we are going to build new ones, we are going to renovate, provide human resources, provide the equipment and medicine in those primary health care centres at least one in every ward so that everybody will have access to it.
We are currently putting in place what is known as the Community Health workers Program. This Community Health Workers Program is called (CHIPS) Community Health Influencer Promoter and Services. This is an initiative that is aimed at enhancing excellent delivery. Once this is achieved, the NPHCDA will liaise with the traditional and political leaders, the youth in every ward where they will be charged to identify 20 women who are morally upright, responsible and who care about their neighbours.
We will train them for about 3months on how to address simple ailment in the community and they will be spread across the communities to take care of the household by going round every day with a first aid kit that will contain a test kit to give the sick ones first aid treatment before taking them to the hospital. This will go a long way in improving the lives and health of the people in the community.
Everybody knows that community health workers are very essential. Every single day about 3000 women and children die in Nigeria and most of these women die of pregnancy related causes. We believe that by rolling out this community health workers, it will help in curbing these type if cases to the barest minimum.
Q – What is the experience of your staff with these innovative ideas, how are you coping with your workers in accepting your measures?
For the first time, people are beginning to recognise that things are no longer the same at the NPHCDA; people are beginning to feel the wind of change in the NPHCDA, because they now feel motivated to come to work. People now come to work early because they can now clearly see that there is a direction and that if they align themselves with this direction, it can bring positive change in our health sector especially in Primary Health care.
For instance, we just looked at the Routine Immunisation Program and said it is not acceptable that Nigeria with the kind of human resources that we have, with the kind of respect that we have garnered globally as very smart people, it does not match our capacity as a country to have only 33% coverage of routine immunisation.
So, what we do at NPHCDA immediately we got this report about two months ago, we declared an emergency, we said, there is a need to do things differently. It is not enough to have beautiful plans; we have to deliver on the plans by executing the plans. So, the first thing we did was to convert our immunisation working group once every two weeks sometimes once every two months. Now, we call it the National Emergency Immunisation Routine Coordination Centre; now we meet every single day from 8:30 to 10:30am.
We also meet with our development partners. It is not a question of I’m the Chief Executive, so I will not be there. No, I will always be there with them at 8:30am every morning. Sitting down and asking very tough questions on how we got it wrong, how we missed the boat, how we are doing things differently by meeting just 30% when the target is about 80% of our children. We are looking at the data and asking tough questions and also engaging with the States around on how to do a better job of carrying out routine immunisation activities.
And it is with this emergency mode that we also saw what was happening during the meningitis outbreak in the North – West states of Sokoto, Zamfara, Kebbi and Kaduna. There was an outbreak of cerebral spinal meningitis that was killing fast and we met and said, we have to take immediate action. So, we did an emergency procurement of vehicles to address the need of this outbreak. So to answer your question, the staff to the best of my knowledge including the union are excited about the new innovations.
For the first time they can see clearly that we have bought vehicles to take care of specific tasks.
Q- How do you plan to reach out to areas where they lack good access roads?
It is the role of the Federal Government to provide oversight and also engage with the States for good management around how they can do a better job of providing good primary health care services to these communities. For example in the rural areas; where the roads are bad or where there is a river that cuts the community access to the nearest health care facility. That is why we are rolling out the CHIPS agents. It is a sustainable way of ensuring that people get access to these facilities.
Also one thing that the Minister of Health has made very clear is the need for us to have at least one functional health facilities in the ward so that in the end, if a health facility is far from this community, it will be closer to these communities without access totally. We are bringing the primary health care closely. It may not be at the door steps of these areas but at least, it will be closer because it is one functional health centre to that community.
Q – The world is currently being driven by technology, what is the agency doing to show that it works in line with the global trend using the technology to its advantage?
Everything we do at NPHCDA is to see how we can align with the modern technology. Right now we are working on a data base that makes it possible for us to sit down in my office and with the click of the mouse, I will be able to pull off a health facility thousands of miles away in some remote areas and I will be able to tell how many health workers are there. We view the health centres that are not providing the required services.
This screen in my office, (pointed at a large screen on the wall) once you switch it on, you can look at any health care facility and will be able to know the things we are supposed to do. For the first time we are saying that if a health worker carries out an immunisation session on a daily basis, instead of waiting until the end of the month, before the data is brought to the local government Area or to the State level.
If you vaccinated a hundred children, send the data immediately to the National level. And then when we look at the data showing that you’ve vaccinated over a hundred children and our data shows only 30, living in the community, then we ask where you get the extra and pick up the phone and ask very hard questions. That keeps the workers accountable and always on their toes knowing that they cannot give a wrong figure.
That was the trend in the past, health workers use to pad children that they vaccinated, giving an outrageous figured they never covered but that cannot happen today because of this modern technology. There is an app on the phones of all our health workers that was developed here, with just a click of the button, you can send the data. We feel that when we have this close supervision of our health workers, they will be on their toes and give us the most accurate data..