By Uche Amunike
My Icon for this week’s edition is a quiet, unassuming, intelligent and focused gentleman who cuts the picture of dedication, passion for his job and honour. I actually met him the first time at the Fides premises as he paid a visit to some guests of the FIDES Director. The guests were actually from the Dangote Group and had come as a team to understudy FIDES. They were to return to Lagos that morning, so I was exchanging business cards with them when this fine gentleman walked in.
In my usual gay manner, I introduced myself to him and demanded for his business card too. How was I to know he was the new Commissioner of Health in our dear state? How was I to know that behind that mien of simplicity, lay a great mind with great plans to bring the much desired change to the Ministry of Health. Well, I eventually got to reach out to him and get him to talk to Frank Talk about his plans for the sector. I heard him out alright and I was glad because in the next two years, the Anambra state Ministry of Health would have attained a height that can bring it at par with her counterparts in any part of the western world.
Kindly read through this most educative and inspiring interview with the Anambra State Commissioner of Health, Dr Vincent Ogochukwu Okpala, as he talks about his experiences, plans, motives and dreams for his primary constituency…
Kindly introduce yourself, Sir.
My name is Vincent Ogochukwu Okpala. I am the Honourable Commissioner for Health, Anambra State.
How long have you served the state in that capacity?
I’ve been here just little over a month.
So, how did you find the Health Ministry when you came on board?
It’s actually an interesting and exciting Ministry. People will say that second to Education, that Health is the largest Ministry and a number of things have been done in the Ministry. However, a lot still needs to be done. With the dwindling resources in the country, we’re basically faced with a lot of challenges. Yeah. Some great things were done, like last year, Anambra state won the best state in Immunization in TB Diagnoses. All the same, there are still many other things that need to be improved upon. So, looking at the indices, like under-5 Mortality rate, infant mortality rate, maternal mortality rate, and so on, I look at communicable diseases. A lot of things have been done in that area. But there are things about the structure that needs to be looked upon. Attitude of workers need to change. People have to be more responsible. With that, we can have a more robust Health Ministry.
You came in from the USA. How do you compare the health sector over there to what we have here?
I will say they are basically light years apart from each other. The health care system in the USA is, looking at the sectors, sectorally speaking – the public and the private. The government hospitals are about 5% while the health system is mostly private driven. In Anambra state, before now, people will look at it that it is mostly public but it’s equally true that 75% cure is provided by the private sector while 25% is driven by the public sector. We learnt this by a study that was done by the European Union about two years ago. However, in the USA, the Healthcare financing model is different. People are willing to pay for cure. Their insurance system is there. It’s one of the key drivers of the economy, while locally here, we still look down on health. We don’t believe that we can generate money through our healthcare. So, it’s being seen mostly as a social service. So, people are not focusing on using that as a revenue generating tool for the citizens. But when we look actually at things like Medical Tourism, where the country spends about $2bn annually, down here, if the state positions itself well, we can turn things around and do what we call …Medical Tourism where the income is now generated in Anambra state . Comparing the two systems, the system out there is much more better but we have to work on it. It didn’t start overnight. There was a time I believe it must have been like what we have over here. So, the services over there is more developed. When you go to the hospital to see a physician, the physician understands that he has to provide service and the patient becomes the client or customer and your job in the hospital is to make sure that the clientele is happy before they leave. So the patient has the right to go to social media and score the doctor and you’ll see how the doctor is ranked, based on the services and his attitude towards the patient. The patient can also score the hospital. The healthcare facility that they went to and the hospital itself actually wants the physician and the healthcare providers to be accountable. So, after taking care of the patient, they actually encourage the patients to give feedback on the type of care that they received.
So, you see that customer oriented service that they already modelled, where the customer is the king. So, the hospital and the facility works to make sure that this patient is happy by the time they leave the hospital. Come to our place in Nigeria, it’s still paternalistic. So, you want to tell the patient what they will like to hear and not what the patient thinks that is good for him. At the end of the day, because money is not tied to the service they modelled, that model is poorly developed in our system. So, it’s something that we would like to work on.
Okay. Let’s look at the healthcare system in rural areas. The situation in these hospitals have left much to be desired. Some of them have dilapidated structures and we hear about snakes crawling into them because of overgrown weeds in the premises. Most of them lack medical supplies and worse still, most doctors do not want to work there because of obvious reasons. I don’t know what your ministry wants to do about improving that situation.
One of the goals of my administration would be, through the support of our able governor, Chief Willie Maduaburochukwu Obiano, is to strengthen the healthcare system. When you look at the healthcare system, you look at six basic blocs. The components of these blocs are Service Delivery; the workforce; the health Management functional health system; governance and leadership; the availability of essential drugs; the health finance model. So, when you look at these building blocs of a functional health system, our goal is to strengthen them. Okay? So, whether you’re looking at the teaching hospital, or the secondary care facility which is the general hospital, or the primary healthcare centre, each of them can benefit from any of the components of the six building blocs. Take for instance, you go to a primary healthcare centre, if you don’t have essential drugs, you cannot deliver the service that you ought to deliver. Somebody steps on a rusty nail and goes in there to get techno shots and the vaccine is not available, they end up not getting the service that they want to get and maybe if that person comes and the techno shot is available and the service is available but the person cannot pay because there is no health finance model and that health finance is actually the last of the six building blocs. So, there’s no health finance model that is centred on insurance that will enable him to pay because he does not have money to pay, he’ll still not get the service. So, the component is missing there. Or you go there and these things are there but you don’t have a trained healthcare provider to provide that service. Ours is to x-ray this, get it done organically to the very basic roots so that each facility can really have a functional model and blow this model to become the pre-existing model that we have in the state. So, there is a big emphasis on that and I’m glad that the European Union came to do a survey and they’re investing in that to see how they can help strengthen our healthcare system. On our part, their role is to back those building blocs with the governance and leadership. So, we have policies we can make to help and drive home some of the impacts and outcomes that we expect to have in the sector.
So, policy wise, I’ll give you an instance, we have an Anambra state health Finance policy which came out two years ago. So, this actually, is kudos to governance and leadership. There are many other things we can do in governance and leadership that will help to revive our health sector. Some of the policies we are looking at in the future will be Vital Registrations. Right now in Anambra state, for every child that is born in this state, we don’t have a central collating system for vital registrations for births and for deaths. And without that, we cannot plan. If you ask a question now, what is the most common cause of death for the Anambra citizen, we don’t have an answer to that question. Without that, you cannot plan. So, it becomes a major problem but we’re already working on strengthening the society and system.
We’re working with partners.
We’re trying to re-orient our Ministry style to understand that if we have this approach to interventions we’re making to the work we’re doing, they start to realize that we’re working as a team. Initially, they seem to think that we’re working in silence. We’re working on Malaria and we’re working on TB. But when we start making them realize that we’re working for a system and towards a certain goal, that team spirit starts coming in. Same thing applies to the hospital system. And the workforce, which is still part of this building bloc. We don’t have enough physicians at this point and His Excellency, Chief Willie Obiano is working hard to see that we recruit and retain physicians and it’s something that we’re presently working on. And not just physicians, other healthcare providers, nurses and other supporting staffs in the hospitals. So, these are existing problems and must be addressed and we’re working towards that. Currently, we’re doing facility tours to see the state of our hospitals. We have 34 general hospitals. We want to see how these hospitals are and as we tour these facilities, we are having highly interesting findings. There are good things to be said about them. There are lots of challenges.
And your motive for this tour is?
To make interventions where there are shortcomings. That will help the system deliver the services that they were built to deliver.
So, talking about physicians, there was a strike action about two months ago in the state by doctors. How was it resolved and how do you intend to prevent such problems in the future?
The strike happened when my predecessor was here but when we came in, the strike was resolved. So the things that were identified as reasons for embarking on the strike were noted and currently, His Excellency has the health of NdiAnambra at heart and he doesn’t want to see that situation rear its head again. So, it’s something that he took passionately at heart.
So, the problems that were raised by the striking physicians is being addressed which was one of the reasons why they went back to work. So, we want to have a holistic approach, so whatever is being discussed will eventually get to every healthcare worker.
What do you advise NdiAnambra to do medically in order to aid the Health ministry in the work you do?
Awareness is big, so right now we have a Functional State Insurance Scheme, ASHA. As of today, they have about 42, 000 people enrolled in this insurance scheme. This insurance is actually a way to pull resources so that when you’re sick, you can get to the hospital and receive medical care. So far, so good. Talking to NdiAnambra, visiting facilities, we’ve got a lot of good feedbacks about how this scheme functions. We go out there and talk to people.
One of the biggest benefits or advantages of this insurance is that we have a model called the Adoptee Model. This is when the individuals that are well to do can actually go out there and buy insurance for those that are not well to do, that is talking about the underprivileged. This is at N12,000 per year. For the first time, it’s N12,000 a year, but subsequently, it is N12,500 per year. So, it comes down to like N1000 per month and the person is covered for a whole lot of conditions. They go to see their doctor for the practicing clinics or hospitals. They have zero pay there. And then, when they go to participating labs, they have zero there, and then when they go to participating pharmacists, they get 10% of whatever the cost of medication is and you cannot beat that. Even in the US, we don’t have something that good. So, that’s one thing we’re doing better than the USA, if you ask me. So, in that wise, I encourage every Anambrarian to key into that. So, it’s peace of mind. Another thing is being health conscious. Eat right, sleep right, walk right. So, most of the deaths we notice around us might be from non-communicable diseases like hypertension or complications from hypertension like kidney failure, heart attacks, strokes and all those. etc. If people are eating right and exercising right, there’ll be a decrease in the spread of these diseases and equally, hand washing, watching what you eat, not eating a lot of purified stuff- artificial foods because of the risk of remitting a high emergence of cancer in the state. So, when we hit on these things and then infection control, sleep under the mosquito net or take care of the environment so you don’t get exposed to mosquitoes that might give you malaria, having good practices that will prevent spread and contraction of HIV, etc. So, if we embark on all this, I’m sure we’ll have a very healthy state. Our governor is doing so much in the health sector and trying to encourage us, so that we’ll have a have a healthy state. I think ultimately, looking at some indices, Anambra is great, but we can do better.
Finally, what’s your expectation of this ministry in the next two years?
Thank you so much for that question. In 24months from now, I will like to see a ministry that has midwifed a change in the system where Mr Okeke suffers chest pain and he goes to a facility and they do an EKG and they realize that he’s having a heart attack and he is able to go to a hospital in Anambra state that has a Computerized Tomography(CT) Laboratory and he goes in there, they do a CT and they burst clot in the heart and he walks out of the hospital alive. Something that would have actually killed him if interventions were not made.
Mr Okonkwo suffers a stroke and Amaku was notified. Within three hours, he gets in there, he gets a CT scan, they see that it’s an embolic stroke and they’re able to give a clot burster and he’s able to raise his hand again and he walks out of the hospital fully recovered. So, we want to see these key interventions. I’m working towards seeing a state in two years time or before two years, where a citizen in Anambra is diagnosed with breast cancer and is not being shipped out to India or Ghana to go and get Radiotherapy. And he has an Oncology Center here where the radiation treatment is done. I’m looking forward to a state where I walk into a ward in Amaku and I see a patient that was referred to us from Sokoto or from Kaduna because it became a centre of excellence to address some conditions that would have been treated abroad. So, a state that has managed to start turning around to create the hub for medical tourism and earning revenue by turning around the money that would have actually left the state to our offshore facilities. So, I believe in two years time, that we would be able to have laid the foundation towards this. And that’s what we’re working towards. I believe in the next one year, we’ll start seeing signs towards that direction. I also expect to see us push some significant policies to the House that will actually help to add value to the Health sector with the help of this government. That’s where I see us in two years