When Professor Isaac Adewole assumed office as the Minister of Health on November 11, 2015, he promised to make changes in the health sector. Nearly four years after, some areas of the health sector have witnessed changes and innovations under his tenure, while others have remained unchanged or have grown worse.
Medical tourism and brain drain
One of the minuses of Prof. Adewole's tenure was that he was not able to reverse the high rate of medical tourism by Nigerians. The state of many of the country's hospitals: tertiary, secondary and Primary Healthcare Centres (PHC), is still not at par with international standards. Many public hospitals still suffer from dearth of requisite equipment, inadequate manpower, dilapidated infrastructure and high cost of services.
It is often said that if Nigeria's health system was okay, President Buhari himself would not have continued to travel out of the country for medical care. These challenges that have not been overcome negate the president's pre-election campaign commitment on health to reverse medical tourism.
Prof. Adewole was also not able to mitigate the number of doctors leaving the country in droves to seek greener pastures. Medical doctors and medical associations have blamed the state of the country's health system and poor remuneration for the exodus.
Industrial rivalry and disharmony
While disharmony in the health sector preceded the Adewole administration, there were expectations that he would change the narrative. Instead, during his tenure, there were repeated industrial actions; from the Joint Health Sector Unions (JOHESU) and unions of nurses, to medical laboratory scientists, pharmacists, among others.
These groups accused the minister of being discriminatory against them and favoured doctors over other health professionals in his decisions and policies. However, the President of the Medical and Health workers Union (MHUN), Comrade Biobelemoye Joy Josiah, said lasting solutions could only be achieved if the Federal Government stopped appointing only medical doctors as Ministers of Health, and also stopped entrusting the management of health institutions and hospitals to only medical doctors.
There were also skirmishes between the ministry and the National Health Insurance Scheme (NHIS) under Adewole which delayed the implementation of the Basic Healthcare Provision Fund (BHCPF).
Also scoring the minister's administration, Dr. Ifeanyichukwu Casmir, National Publicity Secretary of the Association of Medical Laboratory Scientists of Nigeria (ALMSN), said the minister did not do enough to improve Nigeria's ranking in the world's health systems.
"Under Adewole's stewardship, we were rated 188 out of 192 countries. We never moved up. We were only better than countries like Myanmar and the Democratic Republic of Congo (Congo DR) which are war-torn countries. We also ranked 52 out 54 countries in the sub-region; that is also an abysmal rating," he said.
He further said the protracted health workers' strikes under the minister were not resolved on time because he treated other healthcare professionals with disdain.
"As we speak, the April and May salaries of JOHESU members that embarked on strike are yet to be paid, whereas the Nigerian Medical Association (NMA) and Association of Resident Doctors (ARD) went on strike several times and were paid their salaries.
"His leadership style has not improved our health indices. The segregation he has introduced in the management of healthcare professionals in Nigeria is akin to none," he added.
Teaching hospitals are not at their best as they are overwhelmed with cases that should ordinarily be handled by PHC and general hospitals; which are mainly the responsibilities of state governments.
According to Dr. Joseph Amedu, the Director, Hospital Services of the ministry, "If most of the illnesses that are taken to the tertiary hospitals are taken care of at the primary level, of course the secondary and tertiary hospitals will have less troubles, and through the referral system, the teaching hospitals will be able to do what they are meant to do; which is treatment at the tertiary level, research and training of medical students."
Failed promise on open drug markets
Prof. Adewole promised many times to close open drug markets in the country and gave the deadline as January 1, 2019. But till date that has not been done. The closure of open drug markets is expected to sanitise drug distribution in the country and reduce the menace of fake and adulterated medicines.
Basic Health Care Provision Fund
Two weeks ago, Prof. Adewole announced the disbursement of N12.7bn into the Treasury Single Account (TSA) of the National Health Insurance Scheme (NHIS), National Primary Healthcare Development Agency (NPHCDA) and the Nigeria Centre for Disease Control (NCDC) at the Central Bank of Nigeria (CBN).
"The specific funds are as follows: NHIS N6.5bn (50 per cent of available resources), NPHCDA N5.8bn (45 per cent), NCDC N327m (2.5 per cent)," the minister said.
The sum disbursed is part of the Basic Health Care Provision Fund (BHCPF). Many pundits view the allocation and disbursement of the fund as one of the biggest achievements of Prof. Adewole as the health minister. BHCPF is derived from a minimum of one per cent of the Federal Government's Consolidated Revenue Fund (CRF) aimed at making quality healthcare services affordable and accessible to Nigerians.
National Strategic Health Development Plan (NSHDP II) 2018-2022
The launch of the second National Strategic Health Development Plan (NSHDP II) 2018-2022 by the Federal Government early this year is also something pundits view as a milestone by Prof. Adewole that will reshape the country's health sector.
The plan is a five-year roadmap for policy implementation on improved health and well-being of Nigerians. It also prioritises health promotion and intervention. It was designed to enable the federal and state governments implement health policies in the country according to laid down procedures. The implementation of the plan will in the next five years greatly improve Nigeria's health system and drastically reduce maternal mortality, said some experts.
Health humanitarian response in the North East
The health humanitarian response to the debilitating effect of the insurgency on the health system in the North East in the last three years is another area where the minister made impact. Millions of people were displaced in Adamawa, Bauchi, Borno, Gombe, Taraba and Yobe states. The situation resulted in destruction of health facilities, equipment and supplies.
The Federal Ministry of Health and the Government of Borno State declared a health and nutrition emergency on June 27, 2016, to address the effects of the Boko Haram insurgency on the health of the people. The ministry under Adewole implemented the programme tagged Health and Nutrition Emergency Response Project (HNERP), and through it, provided emergency nutrition and strengthened the health surveillance system targeting the Internally Displaced Persons (IDPs) in camps or host communities.
Public Private Partnership (PPP)
There was increased Private-Public Partnership (PPP) under the minister, including the recent signing of the Management Contract with MDS Logistics for warehousing of quality commodities and drugs in the MDS' warehouses in Abuja ad Lagos. This is the first time the ministry is making such arrangement with the private sector.
Tackling diseases: Lassa fever, meningitis, others
The Adewole administration helped increased awareness and preparedness against health emergencies and diseases such as meningitis, Lassa fever, yellow fever, monkey pox and others.
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