Dr Wahab Adegbenro is the Ondo State Commissioner for Health. He spoke with Line Editors on successes of his ministry in the last two years which he said included putting in place Contributory  Health Scheme, Teaching Hospital, additional five Mother and Child hospitals, recruitment of medical workers and provison of funds for  the implementation of these and many other  projects. 

 Excerpts:

What has been the achievements of this government in the health sector since inception?

This administration has done a lot in the health sector. The health sector is a social service sector. We have to do a lot of things for the people because their health  is important. Before we can do anything, we must all be alive and well.

There were some issues when we came on board. There was the need to set up a Teaching Hospital because this state has a medical university and we now have medical students at 400 Level and they obviously need a teaching hospital for training.

That was why the government quickly established the Medical Science Teaching Hospital which is a multi campus set up. That is, we have some facilities in Ondo and  in Akure as well.

At Ondo, we have the Medical Village that is made up of Trauma Centre, Kidney Care Centre, Mother and Child Centre and  a State Specialist Hospital in Ondo.

In Akure, we have the State Specialist hospital. All these form the nucleus of the teaching hospital complex and a bill to give legal backing to the initiative has already been passed.

So we have now established a teaching hospital complex that is primarily to take care of the training needs of the medical university and to provide tertiary healthcare for the people of this state. That is one achievement.

The second one is that we have got the Contributory Health Scheme in place.  The bill has been passed and in addition to that we are taking care of the paper works.

If you come to our ministry, you would we see a brand new ground floor . That is the office that will house the contributory health scheme.

Some days ago, an advert was placed asking people to apply for the position of the General Manager. So, we are on the verge of employing the General Manager because we want the place to run like a business  outfit and  not the usual civil service bureaucracy.

When we have the General Manager in place, then other things will fall into place too. Then after that I think Mr governor will approve the board because there is going to be a governing board that will provide the policy guideline.

We are hoping that towards January ending or February, we should be able to start the scheme. Why we cannot do it now is because we want the agency to be in place to decide how the scheme is going to run, how much people are going to pay.

It is the agency that will determine that and when we have that, maybe latest by February, we should be able to start the programme officially; maybe it will be part of the second anniversary of Mr Governor.

I should tell you now that Mr governor has  approved a minimum premium of three hundred million naira that the government would pay to take care of vulnerable groups. These are the pregnant women, under five children and the physically and mentally challenged.

What about the aged?

I told you that the agency will formulate the policies. We are also going to take care of the aged, probably those who are above seventy years. I think the agency may do something about that.

We have that fund now. As soon as the agency is in place, the money will be released to them so that whether these set of people register or not, they will access healthcare free. But those who don’t belong to the vulnerable groups will have to enrol in the scheme.

When you enrol you will be entitled to free medical service.

Are those you call vulnerable include indigenes  only or everybody?

They have to be residents of the state measures will be taken by the agency to monitor this.  We have learnt from the experience when the last administration started the Abiye program that people were coming from Edo and Ekiti and Osun.

Even my local government which shares boundary with Osun, people would come and find an address somewhere in Ilara and say that I am a resident of Ilaramokin. But we are going to take measures against that, so that such don’t happen. That is one thing this government has achieved.

You are also aware that when we came in, we had two Mother and Child Hospitals, which are mono specialist centers, to take care of defined groups of people, the pregnant women and the under five children and you know the two mother and child hospitals are located in the central senatorial district, one in Akure, the other one is in Ondo.

So this administration thought that somebody in Ikare may find it difficult to come to Akure if she is pregnant and wants to access healthcare in Akure. So the government in its wisdom decided to create some new mother and child specialist hospitals, and the number has increased from two to seven.

Where are they?

We have one in Ikare, that is at state specialist hospital, Ikare; then we have one in Owo, also at General Hospital, Owo, for the northern senatorial zone.

The facilities were existing there but they would now have special sections that take care of these two groups of people: the pregnant women and under five children.

Then to the south, we have three because of the peculiarity of that environment. The General Hospital, Ore is going to serve as a mother and child hospital. The State Specialist Hospital, Okitipupa will also serve as one, then the General Hospital, Igbokoda, towards the riverine area, will also have one.

In short, we would now have about seven of them in place, and Mr Governor has also made provision for the running of these centres. That is another area that we have covered.

Then when we got on board, there were some problems with our World Bank supported projects in the Ministry of Health. About a year ago we were suspended because of some abnormalities in the system.

Mr Governor took up the challenge, and we had to run up and down and we are happy that the programme has been revived. This would help the funding of the primary healthcare centres.

This state has over 500 primary healthcare centres that have also been designated as some form of mother and child centres. That primary healthcare centre that is in your ward would serve as a small mother and child hospital that the woman who lives along the street can walk in and take treatment. We are looking at things like malaria, gastroenteritis, typhoid and normal antenatal care and delivery that they should be able to access that in those places.

Again, we have done something, and the law has just been passed by the House of Assembly, that all the primary healthcare centres would now come under the control of the primary healthcare development board, what we call Primary Healthcare under one roof.

Up till now the issue of the management of primary healthcare has been between the primary healthcare board and the various local governments. Some staff are under the control of the local governments, while some are under the control of state primary healthcare development board.

But it is now harmonised so that all the staff in the primary healthcare centres in the local governments will transfer to the primary healthcare board so that they can come under one supervision, one management.

This is also one of the requirements of the federal government that we must put the all the primary healthcare centres under one control. This we have just done. This is another achievement of the state.

Let’s talk about the traditional birth attendants. What is the government doing to curtail their excesses?

With what we are now putting in place, we don’t expect a pregnant woman to say I want to go to a traditional birth attendant. They do that because they assume that the services of those people are cheaper than what you get in the hospitals generally.

But we are now putting in place a system through which people can go to even private hospitals for free. Private facilities will also register for the insurance scheme.

If a woman comes to a private hospital that is registered under that scheme, she would access healthcare free of charge. Why do they have to go to the traditional birth attendant somewhere? There is no reason for that.

Do you think the private institutions would support the scheme?

They are going to  get paid as well. We will expect a minimum standard from them. Before they are registered with the agency, the agency will visit them and see what they have on ground; the staff and the equipment, and if the agency is satisfied that the private facility can provide the needed care for the people, they will be registered.

Whoever enrols there will access healthcare free of charge. It is the agency that will pay the hospitals. The government facilities will also compete because they must also measure up to standard.

The premium of the vulnerable groups will be paid by the government. So there would be no issue like, ‘I’m not able to pay premium, therefore, I’m not qualified’.

The situation would be such that  the government would have paid for you and you can walk into the facilities around, either private or government-owned and get free antenatal healthcare service, delivery, even surgery.

We now expect that there would be no reason for the pregnant woman now to go to agbebi  in a corner somewhere.

Precisely, this scheme will take off in February?

Insha Allahu, we are hoping, from what we are working on, that it should start by February hopefully.

Let us look at the controversy surrounding the establishment of the teaching hospital. In every state the teaching hospital is  established in the capital city, what is the  status  of the state specialist hospital in Akure?

It is part of the teaching hospital. That is the position. Teaching hospital cannot start on a virgin land.

When the University of Ife Teaching Hospital started, it involved Seventh Day Adventists Hospital,  Ife;  General Hospital Ife; Wesley Guild at Ilesha. Those formed the  complex that was named Obafemi Awolowo University Teaching Hospital Complex.

After some time, the Seventh Day Adventist Hospital was returned to the original owners and the hospital started developing what we used to know as General Hospital Ife, as the main teaching hospital. I think they are on the verge of releasing Wesley to their original owners.

In Ondo State, a medical university has been established, medical students are already undergoing training and they need a teaching hospital, otherwise they become stagnant there; they would not move on again and that will be a disaster.

We therefore needed to establish a teaching hospital from existing facilities. For example, this afternoon a private university came and said they want to engage even the state hospital here as the training center for their university.

And that is fine. An hospital can serve the interest of three, four or five universities. That will be to our advantage because the university wanting to use our facilities for training has to drop something.

Let us get one fact straight, that the government established the hospitals and they are its properties and the government reserves the right to use those facilities from what they think will be of benefit to the people.

Akure has a teeming population. If we have a teaching hospital, the people will benefit from it. Apart from enjoying what we know as secondary healthcare, they will now be enjoying tertiary healthcare. We would have a lot of lecturers, a lot of consultants, a lot of professors who will do a lot of things above what we used to have at that place.

Development will come there. Nobody is removing the structures there. That is the situation and that is why we said and the name of the teaching hospital is University of Medical Sciences Teaching Hospital Complex.

I don’t think there is any problem. Also, as part of the activities of the government, we have moved the School of Nursing and School of Midwifery to the university and the nurses who qualify there will have degrees and would no longer be termed staff nurse, staff midwives. They would graduate with BSc nursing certificate.

When you are a staff nurse, your bar is level fourteen but if you have BSc, your bar is level seventeen, you can even become a permanent secretary. By this we have harmonised things.

You talked about having access to tertiary healthcare when all these are done. The last administration claimed that they hired about fifty consultants. How many consultants do we have in Ondo state now?

I don’t know the figure off hand but what happened was that when the medical village Ondo was set up, the government hired  a lot of consultants to work there. Later on the government was no longer in the position to pay and  all of them left.

Now, because of the special interest this administration has in the teaching hospital, we are about placing external advert that people can apply from outside.

We have just concluded what we called internal advert, that is, people who are already in the service of Ondo state government and want to move to the teaching hospital we have just concluded the interview  and they have been moved.

We are putting together the staff position and the critical need of the teaching hospital. I am happy to inform you that Mr governor has approved take off fund for the teaching hospital complex.

How much is it?

I think they have been given about one hundred and twenty million naira to start doing certain things. And they have something in the budget. We have just finished the issue of personnel that has to be included in the budget.

What is the government going to do to reduce the number of turnover of medical doctors who prefer working in the federal medical hospitals and teaching hospitals?

In fact, I think the reverse is the case now. If I tell you the number of requests that are on my table, doctors looking for job… It is not that doctors are not available or not enough, it is about the inability of the government to employ more.

Even consultants are beginning to look for job. We have not met  the requirement of WHO which says that there must be one doctor to a population ten thousand people.

We still have a long way to go in that direction but I think we have the challenge and will face it squarely. Doctors are available, it’s just for us to be able to employ more and more.

We now have a lot of medical schools around here. When people like us were trained, Nigeria had only six universities, but now even Ondo state has seven, so a lot of people are being rolled out.

We have a lot of people going to Ukraine to train and they always come back here because Ukraine will not employ them. So we have capable hands around but we are struggling to accommodate as many as possible.

What about doctors in the employ of government who also have their private practice. Is that not a  distraction?

The law allows what we call minimum private practice. This came to being during the military era after the enactment of a decree banning private practice even among civil servants.

But along the line, it became clear that even the salaries are no longer sufficient for people and they should be allowed after office hours to do one or two things on their own to earn more naira.

And that was why the doctors in government employ were allowed to practice privately minimally. But how do you define “minimum”. When you now admit people, operate and so on and so forth. When you are not there full time, that can be dangerous even for the patients because things will happen and you are needed but you are not there. Like somebody working in Ondo and has a private practice in Ore. It will take him about one hour to run from Ondo back to Ore.

In recent time, the government has been battling with the  problem of drug abuse and this has led to the ban of some drugs. The major problem people  adduce as a factor is the lack of government control to ensure that people don’t get drugs from the counter, except through prescription. How can this be rectified?

The problem is with our people. If you go to Europe, for instance, you discover that people obey laws. The chemist there will not sell to you unless you present a prescription duly signed. And every signatory is coded. Anyone can touch the computer and the data of the doctor will appear and the chemist will sell, having been  assured of the authenticity of the prescription.

But here because of our love for money even drugs that you know are dangerous…can you imagine a patent medicine store selling an injection that we use to sedate people for surgery. Because of our general attitude in the society, anything goes. These days, a patient will visit a patent medicine store owner, to them he is a doctor, and he would even give injection in the shop.

Now tramadol has been banned but some people still find a way to bring them in. That is the issue. So we hope that if we all behave well all these issues will get out of the system.

Let us look at the issue of yellow  and lassa fever that are ravaging some parts of the state, what is the state government doing about them?

We are doing a lot. We have upgraded our Infectious Diseases Hospital located very close to School of Nursing. We have just finished the construction of the laboratory. We are expecting some equipment from NCDC, that is the National Center for Disease Control, to help us equip it.

We are thinking that very soon we will be able to start managing lassa and other haemorrhagic fevers even at that place. But in the interim, the state government has partnered with the federal government and we are using Federal Medical Centre, Owo as treatment centre.

You know that FMC is owned by federal government, but there are no federal patients. It is those of us in Ondo State that the centre will treat. So we’ve partnered with them. We are supplying them with materials that are necessary to threat patients, We are working fine together. No problem.

Yesterday, the executive director of NCDC was in this state. He left this morning. We are working together. No problem.

Currently we take samples to Irua in Edo state. We gave them two vehicles, one ambulance and one hilux, that will take samples to Irua every day and bring results back because we need to confirm; and our workers are moving out trace contacts. And I think so far that we are on top of the situation. It is also a lesson for all of us that we must all be careful because certain things are coming out that we were not used to.

Recently you heard about the yellow fever. Although, no case has been reported in Ondo state for now but we are on the look out because we share boundaries with Edo. It is in Edo that we have a lot of these things, both Lassa and recently yellow fever. That is why we have a lot of lassa cases in Ose and Owo and to a little extent, Akoko South West but we have found cases in Akure  and Ondo. There have been some mortalities but this year it has been minimal.

What is the condition of the state when it comes to infant mortality?

We are not doing badly because we are quite advanced. In our recent meeting in Abuja, they said that Ondo you have not been doing well; you have only moved on by two percent from a baseline of eighty percent.

For you to move from eighty to eighty two is a lot of effort but what about those with base line of twenty percent moving up to forty, they would say they are  doing wonderful well, though they are still at forty percent while we are at eighty two. I think we are not doing badly, but with the introduction of those things I have mentioned, I think the best is yet to come.

What about the issues of wrong diagnosis from hospitals, specifically private hospitals?

We have a monitoring unit in the ministry of health that goes round to monitor health facilities, even state-owned facilities are also being monitored to make sure that they do the right thing at the right time because they are dealing with lives.

We need to get it right so the monitoring unit moves round to be sure that the right thing is being done and wherever they discover that there are issues they seal the place up immediately.

What about quackery in the health system?

It’s another major issue and it’s also the Nigerian factor. Anybody that works in the hospital is a doctor to anybody outside, even a ward maid, our people will go to them.

Even in some patent medicine store, you will see people sitting down for consultation, which is not supposed to be. We have to blame the system, the attitude of our people to what we are supposed to do.

We have a monitoring outfit that goes out to monitor the patent medicine stores. It’s a team, they come from the federal, involving the ministry of health, the police, even the military.

And this is the only state that has the machine for detecting fake drugs. When the pharmaceutical team are going out, they take it with them.

We have a lot of fake products in town and that is one of the challenges of the medical profession, because if I prescribe a drug and you buy it and what appears as the drug is something else and you begin to take it and you are not getting well, the doctor becomes worried.

That is why people say they prefer to travel abroad to take treatment. And Nigerian doctors are among the best in the world. If you get to Britain or America, and visit a clinic, it’s likely you would meet a Nigerian doctor there.

But the issue we have is that anything comes in. In some places you will see flours loaded in front of a building, but inside they are manufacturing fake drugs. The bags of flours are to deceive people that it is a bakery and the drugs are brought into the market and people will buy and use.

The machine that we have that screens drugs is one of the achievements of this administration.

What about health personnel, does the state have enough?

No. Recently the state gave approval to recruit health personnel, all of them have been posted to the field. But we are still working on the possibility of getting further approval to recruit more. We hope that the finances of the state will improve so that a lot of things can be done.