Our Report Card - Health Commissioner

May 03, 2019

Dr Joe Akabuike, Anambra State Health Commissioner

The Anambra State Commissioner for Health, Dr Joe Akabuike, in this interview with Fides crew of editor-in-chief, Jude Atupulazi and Chioma Ndife, opens up on the strides of his ministry and government in the health sector in a no-holds-barred manner.

Excerpts

Mr Commissioner, we are here to get your report card on the activities of your ministry since you assumed office. Can we have a resume of what you have been doing?
Actually our policy on health is based on human resource defacement in health, equipment, facilities and training and retraining of health workers. And when you want to talk of health, health is usually categorized into primary, secondary and tertiary. And all we have been doing is based on the structure.

Before the inception of this administration, the primary health centres were disintegrated; there was no policy, there was no format and I am sure that most of the people from here know that most primary health care centres were not functioning, some of them were completely collapsed. Apart from areas where some communities took up the challenge. And then when we came here, we were able to bring primary health care under one roof. It is what we call Primary Health Care Development Agency. What we did was just to pass some resolutions, pass a bill that will make primary Health Care to be under one government that has the chairman and executive secretary, and their own function is to assemble and manage primary health care. And since then we have had a lot of changes. Right now we have renovated over 115 primary health care centres. There are still a lot of challenges because we still have up to 570 that need to be improved upon. At least there is a pattern and there is a format to it. But the agency has the full function of making sure that primary health care centres, you know in terms of the structure, in terms of management, in terms of linkages with both national and international bodies, that they will be able to do it. Within that primary health care that we have done, we have been able to attract a lot for the agency. Right now Anambra State is one of the 13 states that are qualified for the Basic Health Provision Fund.

That means that one percent of the federal consolidated revenues should be going straight to states that have primary health care and Anambra State is one of them, because we have primary health care and we also have health insurance scheme. And a lot of things have also gone into the primary health care in terms of other things we have done like introducing Keke Ambulance Model and the speed boat in the riverine areas. And in the same primary health, we have been able to win a lot of awards. We have been the best in immunization in the country up to 2016. And other things like best in the neglected tropical diseases and just about three weeks ago, one of the doctors, Dr Okoli from here, won the best prize in the country as best in TB tracking and management.

So at the secondary level, we have been able to upgrade three general hospitals, because when we came, there was a shift because most of the general hospitals had problems and about 37 of them were almost met in a comatose state. So what we did because of financial challenges was just to pick three and tried to upgrade them to a specialist hospital. That's General Hospital, Onitsha; General Hospital Enugu-Ukwu and Ekwulobia. That of Onitsha is almost completed and will be commissioned, while that of Enugu-Ukwu is undergoing a lot of work. When we went there, we found out that there was never any hospital, what they had were like shackle buildings, so we started a complete structure that will befit a standard world class hospital. The one in Ekwulobia has also gone far. And we also intervened in other general hospitals; about 15 of them have renovated. The essence is to make sure we have the structures and then equipment that will help us to re-engineer; at least to have a starting point with which to move the health system forward.

At the tertiary level, we have two teaching hospitals in the state. One belongs to the federal; that's Nnamdi Azikiwe University Teaching Hospital in Nnewi, and then Chukwuemeka Odumegwu Ojukwu University Teaching hospital, in Awka here, and that's the one that belongs to the state. So what we did in this administration was to try to upgrade it.

Before the inception of this administration, the medical students were there for ten years because of challenges with accreditation. But when we came in, His Excellency, Chief Dr. Willie Obiano, demanded that we should proffer solution to the issue. And within that one year of his inception, 2014, we got accreditation for 4th MBBs, 5th MBBs and in 2015 we graduated the first set of medical students. From then we have graduated four other sets. We have also upgraded the teaching hospital to the level that they have now started specialist training for doctors, what we call residence in O and G, in pediatric, and in community health. The essence is to make sure that we structure the three units of health care in such a way that they will continue to grow.

So what have been you most pressing challenges so far?
The most pressing challenge we have in health care is, I will say, having to integrate all these problems. For instance we could have as well started renovating all the general hospitals at the same time. But we had constraints of funds, so we began to do it piece meal.

And then came the issue of human resource. We have quick turn over of doctors. When you get young doctors, they stay for just one year and go. So you will be having challenges of having to recruit and replace doctors, because most of the health workers don't stay for a long time.

There was once a report in one of the papers that the hospitals lacked doctors. So how have you been able to fill that gap?
Yes, the gaps are still there. Because what we did was to do the station analysis in knowing the hospitals that are concerned, the number of health workers that are there and, for sure, we have actually compiled the list and soonest the governor will address them. He wants to address it in line with the recent new minimum wage. Because we have to balance two of them. We are going to do recruitment soonest to fill all those gaps.

There was also this report that Umueri General Hospital, had been taken over by rodents; that nothing is happening there again.
It is not true. It is more political because I know that if there is any place that I have done anything, it is that Umueri General Hospital. When I came on board, I was the person that actually started putting life into that hospital. We recruited doctors, nurses and then I did the first surgery in that hospital. It was after then that people began to have confidence that people could go to that hospital because that hospital had lot of problems, I think that came up from the fight they had; the Aguleri, Umueri thing that affected the hospital. So is not true, but I know that some of the challenges we have is the question of non-sustainability of medical staff.

Because what happens is that if you have a medical doctor that is beginning to be used to an environment, if suddenly you change that doctor or that doctor leaves, to bring another person is just like starting afresh. So that's the particular problem we have been having; having doctors in quick succession, but we are trying to address it. And then one that we have generally as a challenge in most of our hospitals, is that most of our doctors don't live within the hospital premises because of lack of Doctors' Quarters. If someone is coming from Ontisha to Umueri, you know what it means. But in that place, we have put up about three buildings for the doctors and even for the corps members and we want to scale it up to other hospitals, to make sure that our doctors and medical staff live within the hospital and if they live within the hospital, definitely the issue of coming and not seeing the doctors, which is actually the genesis of hospitals not doing well, will not be there.

Alright Sir, during the launch of Save One Million Lives Programme in Anambra State, you made mention of attracting foreign agencies that have actually come in place in Anambra State and commenced renovation of some primary health care and completing the said renovation within a space of two days. Can you still throw more light on this?
Yes, because of the structure we have on ground and because of the milestone we have achieved. We have some foreign bodies that are interested in our people's health. One of them is Save One Million Lives. The programme is a World Bank funded project and they are concentrated on maternal and child health. So they are doing intervention in family planning, infant mortality, maternal mortality and others things that are associated with that. The essence of this is to make sure that people deliver safely and the children born are medically sound.

Along the line, there is what we call the Challenge Initiative which is actually supported by the U.S. Government. And so, they are interested also in reducing maternal mortality and also working with the state. And what they do is what they call shift over and what they do is that they can renovate primary health care within a space of 72 hours. That's the maximum it can take them and it is magical to some people. They have renovated about 8 primary health care centres; one at Engwu-Ukwu, one at Akwuzu, and what they did was that they will come and assess what the primary health care requires, in terms of equipment, in terms of renovation and call people around, they will see it. They usually start on Friday and if you come there on Monday, you will be surprised. So they usually take 72 hours to renovate and that has actually been a big innovation, which we as a state have adopted. Because if they could do it, we will also do it. If we are actually using that system, that means that within one to two years, we will have ended up renovating the whole primary health care centers in the state.

How was the state able to attract these international bodies?
What actually happens is when you show interest, you know there is what is called networking. So if there are programmes that are done at federal or international level, you mix up with people. So I think it was when we went for National Council on Health at Abeokuta in 2017. We met this body there and we showed interest; that Anambra State would want to work with them, they told us what and what we should do and we felt we met the criteria. They came and assessed us, then they started partnering with us and they are still here in Anambra State now.

Now, what is the relationship of your ministry with the Anambra State Health Insurance Agency, I ask this because in most cases when such parallel body exists, there seems to be a clash. Are you working together very well?
Well, there shouldn't be any clash because the ministry of health has oversight function of any agency that is connected to health. The health insurance agency is actually the brain child of his Excellency and the present commissioner for health, which we worked for four years to come up to form an agency and also have the people that are running it. The job of the executive will not allow him to have the nitty-gritty of what is required for the agency. But we are working it out. It's my brain child and brain child of the governor, and we are working on very well. And right now, we are getting to almost 40 thousand enrollees within a space of three months. We are working very well and the executive secretary is doing his work, the commissioner is doing his work, the Governor is doing his own and both are all matching the process.

So what's your assessment of the last flooding in view of how the IDPs were handled? What's your assessment of that?
Health wise it was excellent, because I can bet you that through what we did, we mobilized doctors and health workers to those places. I was personally there for two weeks and within the short period, we had 27 deliveries and one of them was delivered by caesarian section and I was there and I assisted. We did the surgery and everything went on well. Along the line we were able to attract assistance like the Nigerian Medical Association that came in to help us. And then the NEMA that came later to offer the assistance. And throughout the process, we didn't lose anybody to flooding, except people that I could say died natural deaths. The man that fainted was a hypertensive person, he dropped and died. We were able to manage the displaced people effectively.

So those camps, are you planning on making them permanent since these floods are becoming a yearly event?
Definitely they will have designated camps, that, we will say, are semi-permanent, because what we do is that we make use of some existing structures, some schools designated for such purposes, and you know that during that time so many schools are also displaced. So that's why I said it's semi-permanent because we still put them into use afterwards. So they are performing a dual function. For now they have been fulfilling our demands in that aspect.

So how equipped are the hospitals in the State because sometimes people get complaints that if they go there, some facilities will be lacking. How equipped and how ready are they to operate maximally?
Yes, remember I told you that we are still in the process of rehabilitating most hospitals. There are some of them that we have reached, and if you go to the social media, they will show you some pictures but gradually we are putting them into use. On the issue of equipment, our problems are not mainly equipment. In fact some of the hospitals that I personally visited, I was shocked that most of the equipment are packaged inside and locked. Some of them, some people don't even know what they are meant for. So our problem is having to make effective use of what we have. That means, it requires more than buying equipment, it requires some training and re-training of doctors that we are doing today and making sure that we have enough workers. You know to get these things, you have to uphold them properly and give all the necessary attention the patients require.

So why will someone lock-up equipment in a room and people will not be using them? Whose fault?
Well, I think it's the fault of the system because normally some of these doctors don't show full commitment. You cannot be working in a place for some time and you have such things and they are locked. Some of them were discovered when we were doing inspection. Although some of them like General Hospital, Ekwulobia, the equipment were packed up because of the renovation that was going on there. But all in all, our major problem is not equipment, in short what we are doing now is redistribution of equipment in regard to some that were packed. So what we are now doing is trying to take some that are lying waste and not being used and fix them to places that they will be put to use, at least for now.

Sometime ago, the general Hospital at Enugwu-Ukwu had its mortuary burnt and many speculations were flying. What actually happened, what actually was the cause?
Well, the governor's committee is set to look into it, they are yet to make official pronouncement of what happened. But from preliminary investigations, we felt that the fire actually came from a burning bush around there and eventually got the mortuary. I think what actually happened that complicated the issue was that there was a lot of chemicals that were used in embalming corpses and most of them are highly flammable. And the place where they preserve most of the corpses makes them also to be highly flammable and that's why within a space of 30 minutes to 1 hour the whole thing got burnt down. And what saved us was our vision because before then, I had looked at the mortuary system in Anambra State and found out that there was no regulation, the people that are actually managing the mortuary, the morticians, have no formal training. It was like if you were bold enough, you could begin and we felt like it shouldn't be like that. So we have to call them together, formed Anambra State Association of Morticians, got a consultant pathologist and trained them for 6 months. And now we have that union where we are training them. And one of the things that we told them is that they should not keep chemicals in the same place they preserve corpses. But they didn't do that and that was why immediately fire gutted that place, the whole thing went into flames. We thanked God for that unit because they were people that actually helped us to identify the corpses and then manage the burnt corpses that we were able to savage.

Now talking about the burnt corpses, you know that the families they belong to will naturally want to claim their corpses, so are you resorting to DNA test?
Definitely we have started the DNA test and almost completing it now. Because what governor opted for is the world best standard in that regard, because I know that some of the affected families want their corpses but some don't want. But we decided to do the proper thing by doing the DNA test which was not easy because it's only in Lagos that they do that. And at times they had to invite a specialist as they had never done it at that extensive level. You know, when you begin to do DNA on about seventy bodies. So they had to import some of the things they use from UK and I thank God and His Excellency for the commitment. We are about rounding off the whole process.

So you mean up to seventy bodies were burnt?
Yes up to seventy bodies and we have been able to identify 46 of them through the forensic pathologist. So it is only about thirty some thing or thereabouts, that we are still having challenges with. Although the DNA will cut across everybody there.

Okay, given the high rate of accidents in the country, how are you coping with your emergency response?
Yes, we have actually constituted Anambra State Emergency Medical Services. And we have trainings, because what we do in this administration is that we are trying to institutionalize things so that it will last beyond this government, that's what we call the legacy things. So we have formed the Anambra State Emergency Management Services which involves the Ministry of Health, the Road Safety, the Civil Defence, the Police, the Paramedics, and so many other groups that are interested. What we did was to have a call centre, where, if you have any emergency, when you call, the call centre will alert all the necessary people that are involved. This also has to do with the fire service. So we are still rehearsing on it. But we have been coping because last month we had two terrible accident cases that involved big trucks. One at Umuchu and the other one at Upper Iweka, and we were able to respond the much we could.

At Onitsha we were able to save about 17 people but 10 died. Of course, I will say they died on the spot. On that of Umuchu, 17 people were taken care of and they survived but three people died. But there is still a lot of work that we still need to do because we have to perfect the system so that it becomes automatic. That's what we are aiming at and we should get it within the shortest possible time.

Can you give us the time frame?
The system should be able to give attention to emergencies within 15 minutes. Once you make that call, there is what is called the help centres and those help centres are located everywhere in the state. So the help centres will react first and then begin to call for help. For instance, if you have any accident around Onitsha, one of the call centres is Borromeo Hospital, so once you call them from Awka here, they will rush there and pick the patient with ambulance. If it's a bigger case that may involve 20 people, within that time they would have called Awka, called Umuahia and everyone will be coming. And it also involves integration of private ambulance owners so that you can assemble almost 100 ambulances within a short period. It's just networking.

How do you assess the success of immunization in the State?
We have remained the best in Immunization in the country and this time around, we are trying to mop-up some other challenges that we have. And it has to do with riverine areas. Anambra State still remains the best in immunization, best in skilled birth attendants and best in nutrition in the whole country. And we have been trying to sustain it.

Okay, Coming to HIV, is the number decreasing in the State or Increasing?
Yes, I think we have had some problems with having the actual rate of prevalence of HIV in the state because the previous data we were using was about 9%. What we have now is 2.3 but even that 2.3 still places us 5th in the whole country. So it's still high on the average and the highest is 5% from Cross River. But it should be remembered that what is called prevalence cannot tell you whether the HIV cases are increasing or decreasing because what prevalence says is that once anybody has HIV, it remains in the blood as long as the person is still alive. So what it means is that, the more people that are surviving, the more the prevalence. But we are doing very well in this area and this time around we have a lot of international bodies that are interested in working with us to make sure that by 2030, there will be no case of active HIV in the whole country and I pray that Anambra State should be one of them.

So how do you intend to achieve this? Is there any plan for awareness creation among the people in Anambra State?
Yes, that's the primary thing that we want to intensify, because we have a lot of drugs now making people that have HIV to live a normal life. So HIV is taken as a medical illness and that makes people to begin to underrate the effects of HIV, feeling that there is no HIV. A lot of people that have HIV are doing well because of drugs. We also want to emphasize that anybody who is still on drugs is still a potential danger and that HIV till now has got no cure.

Now, there is this issue of people in Anambra State receiving mosquito treated net and not sleeping under the net but using it for farming activities. As the head of this ministry, how do you intend to enforce the use of these nets and making mothers to ensure that immunization drugs were given to their children at school to avoid overdose of the drugs being administrated?
That has to do with the Save One Million Lives Programme Initiative because it has to do with curbing malaria, it has to do with infant growth, that's why we are talking of vitamin A. What we have done in recent time is that we have carried a lot of sensitization. But apart from that sensitization, we have gone to the extent of going to hang nets in some homes, particularly in riverine areas and also encouraging them to use them. And we also trying to offer some incentives, because we are trying to do a survey, to know people that are actually using it. It generally has to centre on sensitization. And then for vitamin A, we have what is called Vitamin A Card that was first introduced in this country by this state. The essence is to make sure that the child receives Vitamin A and to ensure that they don't have overdose as no child is supposed to take Vitamin A more than twice a year. Because it can cause some problems. So before they administer the Vitamin A, they will ask for the card. And this time around, we are also liaising with the State Ministry of Education. We are now sharing nets because the net is given to under 5 children; that's the area of our concentration because the effect of malaria is highest within people under five years of age. So we are now using school system, because most of them are in nursery or primary one, so we are using teachers to distribute them. And when you use teachers, teachers will usually instruct the children on what to do and how to tell the mothers about hanging the nets. The teachers on the other hand must get reply from the children on whether the nets were hanged or not. And remember children, once you tell them something, they will disturb the parents and make sure the teachers' instruction is carried out. And from the checks we have carried out, we have had remarkable improvement in net usage following its challenge.

In summary, we have introduced a lot of health reforms in the state, what I will call the legacy project of Chief Dr. Willie Obiano. I told you, that we formed Primary Health Care Development Agency, which he passed into law and it became a law in this state. It has the sole responsibility of making sure that primary health care functions effectively. Then we have Anambra State Health Insurance Agency that one also has a bill that has been passed into law. It will live beyond this administration and of course you know what insurance does, it helps with health financing. And that is the greatest challenge we have in this part of the world, were people do out of pocket expenses and when they don't have money they will die. But this time, it has been reverted to a process, whereby you need to get to the hospital without having money because of the process of health insurance.

We have also introduced Traditional Medics Board, trying to regulate the activities of all these people that go about giving people herbs. We are regulating what they do now.
We have a State Emergency Management Agency that has been formed and inaugurated. Then we have the Morticians Association which I told you we are first in Africa and I'm sure that so many international bodies have acknowledged our boldness in trying to make sure that we get these people and train them. And people that are handling the dead bodies should be taught how to take care of themselves and the bodies too to prevent epidemic, particularly now that we are having dangerous diseases like Lassa Fever, Ebola, and all those Monkey Fevers that we do not know. This government has actually done a lot of reforms.

One of the things that government introduced is Oxygen Gas Plant and remember that oxygen is life. And if you go to most hospitals, they don't have it, they don't even know the usefulness. Somebody is dying, and they are doing mouth to mouth. Something as simple as oxygen should be in every hospital, because if a doctor does not know what to do, he should be able to sustain people's life and take such people to a referral centre and that's what the government has done. So the Oxygen gas plant that is at COOU Teaching Hospital, Awka, is the highest in Nigeria and it has the capacity of producing 207 cylinders in 24 hours and that will serve all the hospitals in Anambra State, both private and public, and even go to the Southeast. It's going to be commissioned in the next two weeks by his Excellency.
You can also talk about what the State government has done in respect to those living with sickle cell anemia and your efforts in curtailing TB in Anambra State.

Well, the sickle cell anemia is one of the inheritable diseases and what is the most important thing is education. We are very grateful and thankful to the Church for the support it has given. And remember that before you have sickle cell, you must have two people that have the abnormal gene, so proper education, making sure that two persons with abnormal genes of AS and AS don't intermarry. This will completely eliminate sickle cell. And I bet you that the incidence of sickle cell has grossly reduced in this state and the country at large because of the sensitization by the churches. They have almost made it mandatory that before someone weds, the person's genotype must be carefully looked at. Remember we have the sickle cell gene machine that can track people that have sickle cell from infancy. Before now what we did was what we call hemoglobin electro forensics and you cannot detect someone that has sickle cell till after one year when they start getting sick. But if you have gene expert machine, this genetic machine is able to track sickle cell from birth. We have it at COOU Teaching Hospital, Awka and we are also working with mission hospitals. We are happy with the whole sensitization, the essence, or what everybody should be aiming at, is to eliminate sickle cell and the only way to do that is by education. The management of sickle cell has to start from birth, if you detect sickle cell on time, there are some drugs you give them like penicillin. It makes them to have less frequency of attacks. And when they have less frequency of attacks, they will have less complications.

In extreme cases there is what we call bone marrow transplant. What it means is having to get another person's bone marrow from an active person and infuse it into another like you transfuse blood. It is practiced in some countries and Anambra State at the moment doesn't have the capacity to do that.

The past government was noted for pioneering support to mission hospitals. So far, has this government been able to key into that?
That was part of the noble things that were introduced by our immediate predecessor, Mr. Peter Obi; giving assistance to mission hospitals. And you know that what is important with health is having facilities that can offer the assistance in terms of medical help. So it is independent of whether it is private or public and this government has actually toed that line. And within the past five years, the government has spent over 1.8 billion Naira across in building some mission hospitals and also giving them some financial assistance. And that's a very noble thing that we are doing and we are going to continue in that line.

Has there been supervision of private hospitals in the state; at least to know their activities and their mode of operation?
Yes, it is the sole function of the Director of Medical Services in the Ministry of Health to register and regulate the functions of all hospitals, irrespective of whether it is mission, private or public. And for some time now we have been locking some hospitals because we are going about to do what is called re-stratification. You must have base line facilities and also the human resources. But the greatest findings is that up to about forty percent of the hospitals are never registered. Some of them are manned by non-professionals and we are going now. Almost last week we locked about four of them in this place. And it is the duty of the ministry and is independent of whether mission or private. It has to do with whether you are practicing in accordance with the guide line, if not you will be closed down.

Alright Thank You Sir.

Oxygen Gas Producing Plant at COOUTH, Amaku


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