Nigeria: Without the Health Sector, Nigeria Cannot Have Economic Progress

Erstwhile Lagos State Commissioner for Health, Dr Jide Idris, was the centre of attraction last week during a sent forth organised in his honour by the the cream of private medical doctors in the country. who appreciated him forr his exploits in shaping fortunes of the Lagos state health sector over the years. In this interview with Chioma Obinna, Idris, who for eight years, held sway at the helms of the affairs of what is widely acknowledged the most sophisticated health ministry in the country, speaks amongst others, of his successes and challenges as well as the importance of the health sector. Excerpts:

The beginning

In 1999, there were things that put in place by Asiwaju Bola Ahmed Tinubu when he was Governor. He set up different committees to address, one was on health. He established a committee headed by late Prof Olikoye Ransome-Kuti and that committee looked at the health sector and gave its recommendation; where it felt there were challenges. A major one was the primary healthcare; two, how to take care of the poor, and three, health promotion, disease prevention and the issue of immunisation, etc.

That committee gave some recommendations and when I came in and we looked at them and I said to myself the recommendations had made my job a bit easier. We saw the areas of challenge they highlighted. When we came we did not have to start grumping. We decided to start addressing all those issues. If you remember all those programmes that were started, such as blindness prevention, immunisation, HIV and AIDs etc., we were addressing them one by one.

But the challenge was that if we wanted to do health insurance and everybody was talking of free health, we realised that it is more like a financing scheme for any health system. If you have health system with no financing mechanism then you would not go far because no government can raise all the resources for the health sector.

As we got along a couple of years, we decided to have a review of the whole system. That was when we decided to embark on reform of the sector.

Health reform

We sensitised people on the need for reform. Reform basically is to look at areas of challenge that we need to address. We must understand that reform on its own is not the end product. As you are solving a problem, other problems will come up. To restructure the h system, we are going to address the system of infrastructure, human resources. We went about sensitising people and the essence was that restructuring the system has to be reorganising the system itself.

What we did was to let the ministry be seen to be doing what it was meant to do, which was policy making, planning and monitoring and research. We created avenues for people who would provide service delivery so that the hospitals and the facilities would do their bit but let us do the monitoring.

We faced the issue of primary healthcare knowing that primary healthcare is the bedrock of any health system. That is where 70 percent of the basic health problems can be resolved. Once you can resolve that, other things are easier to achieve. That is what health reform is all about.

In the process, we decentralised so many things. To make it easy for decision making so that people can go about doing their work without coming the centre to get direction.

Responsibility and accountability

That was when we decided to set up the Hospital Board for different hospitals to let them take decisions at that level. Gone are the days when you wanted to take a decision when you are in Badagry you will now have to come to Lagos.

If you recall, in those days, most hospitals were mere consulting rooms. If you didn't have a proper facility to work then the people would not work. The doctors were restless because they had nowhere to work and no tools to work with. Hard decisions had to be made. Of course we made some decisions, some people were not happy but the decisions we made were for the benefit of the people.

We addressed the issue of infrastructure, refurbishing hospitals, building new ones, modernising some. We needed to divert money to do that. Some things had to suffer. You could not recruit as many people as you wanted. But again, Lagos state has a huge population, as you are making progress more people are coming in and adding to your burden.