Why we’re changing current 33 percent access to vaccination – NPHCDA boss

The Executive Secretary, National Primary Health Care Development Agency (NPHCDA). Dr Faisal Shuaib, in this interview with TONY AMOKEODO, MATHEW DADIYA and FRANCESCA IWAMBE, says the NPHCDA under his watch will change current 33 percent access to vaccination by children as well as strengthen health care facilities in the country. He also speaks on other wide range of issues including his initiatives and reforms in order to change the narrative at the agency

What innovation have you brought on board to make the operation of the NPHCDA different from your predecessors or what have you put in place that Nigerians need to know?

I came in with a four-point agenda to transform a system that had variously been described as failing, poor performing and corrupt. NPHCDA, when I resumed office was under the cloud of mistrust from development partners and donor agencies around an audit of the system by the Gabby Allians, which is really an alliance of different organizations for vaccines and immunizations. So what really happened was that, a determination was made that funds and resources made available to NPHCDA were not been used in a judiciously and effective manner. But apart from the issue of funding, there were also issues of how well NPHCDA has done in achieving its core mandate of providing primary health care services and other auxiliary services. So what we did was to be very clear about the challenges that we face as an organisation. There is a huge array of challenges that we face in primary health care. You can go to a primary health care in your community and find that the services that they provide is nothing to write home about and that is why people tend to go to the tertiary healthcare institutions, they want to go to the teaching hospitals, Federal Medical Centres, they want to go to the National Hospital. In some places they will say they want to go to the general hospitals.

What are the priorities that you put in place to address this challenge?

We have taken some measures that will address the livelihood of our people that live in our communities and that is why we now prioritise the strengthening of our health care to deliver better quality primary healthcare services to Nigerians which is the first priority. The second priority that we identified was to strengthened routine immunization and ensure that vaccines are available. The third priority was to finish the job of polio eradication. We had embarked on a journey (and I was part of this process since 2012 that really change the narrative around polio eradication) by setting up Polio Emergency Operation Centres (PEO), we are able to drive polio out of Nigeria except for two local government areas in Borno State that we could not access. Unfortunately these were the same local government areas that led to an outbreak of polio virus in 2016. So, from a technical point of view, those were the three programmatic areas that we needed to prioritise and deliver on.

However, what I viewed as the most important issue that we ought to address was the image of the agency, what to put in place that will make the agency more efficient as well as perform at a high level to deliver on thesemandate.

How to include the financial management processes; especially coming out of a situation where people have concern about how funds have been mismanaged in the past. You may recall that the Global Alliance for Vaccine and Immunisation, GAVI, had asked the Federal governor to refund almost $8million and they stopped funding Nigeria immunisation. So we have to demonstrate that the new NPHCDA is real by putting in place measures that will build confidence.

So what are the things that you’ve done to build this confidence you may ask for?

For the financial management process which is also one of our top priority, we brought in KPMG, we got donors to pay KPMG to come and look at our financial management processes, to look at the loopholes and close those loopholes. They recommended some actions that needed to be taken to close those loopholes in the system so that it will block the chances for anybody trying to misappropriate funds. And what we also did apart from the financial aspect, was to call in a management consulting company, it is a global recognised firm. We ask them to look at our human resources and see whether our people were fit for the purpose and whether we are using the best practise. We have a situation where 60 percent of our work force is in enabling position that is the Administration and Accountants while the remaining 40 percent are in a core technical role. But since we will come on board, those are the things that we have been able to unearth. We are also saying that we have so many smart people staying in Abuja, working in the headquarters, how about spreading them across without any change in their nomenclature, take them to the zonal areas to also designate those zones as directorates. This is because when they go there, they are closer to thestates; they are closer to the local government areas. As you all know, the problems are not in Abuja but in the villages and that is why we say why you don’t get people that are very experienced to these places, so that they will be able to study and understand the people; provide technical support to the states. In summary, one thing that I know for sure is that we cannot have the business as usual attitude.

Take for instance, you cannot get good primary health care facilities in most states; our routine immunization is very poor. In-fact, it is one of the poorest in the whole of Africa. We are at a point where only about 33 per of our children are being vaccinated, only 33% of them gets full vaccination, so what happen to the remaining 67%? That means they go without the vaccines despite all the effort of the Federal Government. The FG makes sure that these vaccines are available but we have a challenge in terms of getting these vaccines to the people where they live and work in the community and that is why we say we are strengthen the process of getting the vaccines to the communities. This is what we call routine immunisation.

We want to finish the job of Polio so that all the resources we have been spending for polio campaigns, to look for polio vaccines and train polio staff will be channel to something else, to other disease like Malaria which is very common to us. That is how we are prioritising to finishing polio.

Then for Primary Health care, we are saying that we live in communities some of which do not have a single presence of a health care centre or even if they have, they have been reduced to what we call consulting centres. That is why when I came on board, I keyed into the President Muhammadu Buhari’s vision of reducing this iniquity that existed among Nigerians in terms of accessing primary health care services that are of good quality. We made it very clear that we want to reduce that iniquity, the gap between those who have money and who do not have money in terms of access to health care facilities. The minister of health has also in his policy direction from day one insisted he was more focus on health care facilities, that we should at least have one functional health care facilities in all the communities. It doesn’t mean that we are going to. The old new ones, we are going to renovate, provide human resources, provide the equipment and medicine in those primary health care centres at least one in every ward so that everybody will have access to it.

It is one thing for you to have a primary health care centre and another thing for people to come. Instead, some of our women and aunts in the communities go to their patent medicine stores where they do some funny mixtures for them.

Will are currently putting in place what is known as the Community Health workers’ Programme. This Community Health Workers’ Programme is called (CHIPS) Community Health Influencer Promoter and Services. These are community health workers; it’s a new case that we are creating that is going to be residents in the community. In every ward, we are going to liase with the traditional and political leaders, the youth and say, identify 20 women who are morally upright, responsible and who care about their neighbours. We will train them for about three months on how to address simple ailment in the community and they will be spread across to take care of the household by going round every day with a first aid kit that will contain a test kit to give the sick ones first aid before taking them to the hospital. This will go a long way on improving the lives and health of the people in the community.

Every body knows that community health workers are very essential. Every single day about 3000 women and children die in Nigeria every single day and most of these women die of pregnancy related causes. We believe that by rolling out this community health workers, it will help in curbing these type if cases to the barest minimum.

What is the experience of your staff with these innovative ideas, how are you coping with your workers in accepting your measures?

For the first time, people are beginning to recognised that things are no longer the same at the NPHCDA, people are beginning to feel the wind of change in the NPHCDA, because they now feel motivated to come to work. People now come to work earlier because they can now clearly see that there is a direction and that if they align themselves with this direction, it can bring positive change in our health sector especially in Primary Health care. For instance, we just looked at the Routine Immunization Programme and say it is not acceptable that Nigeria with the kind of human resources that we have, with the kind of respect that we have garnered globally as very smart people, it does not match our capacity as a country to have only 33 percent coverage of routine immunisation. So what we do at NPHCDA immediately we got this report about two months ago, we declared an emergency, we say, there is a need to do things differently. It is not enough to have beautiful plans; we have to deliver on the plans by executing the plans. So the first thing we did was to convert our immunisation working group once every two weeks sometimes once every two months. Now we calm it the National Emergency Immunisation Routine Coordination Centre; now we meet every single day from 8:30 to 10:30am. We also meet with our development partners. It is not a question of I’m the Chief Executive so I will be it be there, no, I am there with then at 8:30am every morning with them. Sitting down and asking very tough questions on how we go wrong, how we miss the boat, how we are doing things differently or meeting just 30% when the target is about 80% of our children. We are looking at the data and asking tough questions and also engaging with the States around how to do a better job carrying out routine immunisation activities. And it is with this emergency mode that we also saw what was happening during the meningitis outbreak in the the North – West. Sokoto, Zamfara, Kebbi, Kaduna. There was an outbreak of cebral spinal meningitis that was killing fast and we met and said, we have to take fast action. So we did an emergency procurement of vehicles to address the need of this outbreak. So to answer your question, the staff to the best of my knowledge including the union are excited about the new innovations. That is the sound message that we are getting from the staff. For the first time they can see clearly that we have bought vehicles to take care of specific tasks. These vehicles will end up going to the States. We want the vehicles to be where t

How do you plan to reach out to areas where they lack good access roads?

They are needed in the States and in the Local government. We’ve also provide idea vouchers to the drivers so that when the time come for then to move and investigate and conduct supervisory visits, toy won’t say there is no fuel or money for that. Anywhere you want to go, we have fuel stations, all you have to do is to present the fuel vouchers and you move ahead. Apart from that, we have also gone into an agreement with providers for help; it is an organisation that manages vehicles. So what it means is that wherever our vehicles break down, we have an understanding. They will send a vehicle to replace what we are using.

Tony Amokeodo, Mathew Dadiya and Francesca Iwembe, Abuja