A few weeks ago I got a message from the PA of the Honourable Minister of Health of our Federal Republic. He was passing through London enroute Nigeria from the World Health Assembly in Geneva. He asked to meet me. It was short notice and I was in the middle of managing a major infectious disease incident. I was worried of being berated for articles on this blog that might be considered critical. But at the end of the day, I rescheduled a few meetings and hopped into a cab to meet Professor Osotimehin at a London tube station. It always feels a bit strange when you meet an important Nigerian politician looking very ordinary, without the entourage and the hangers on. But there he was, standing beside the “Boots” shop as arranged. We looked for a quiet restaurant to talk. Thanks to the small bundles of technology we carry around these days, I quickly found a quiet place. “Its a 10 minutes walk, Sir”. “No problem” he said….

We found somewhere, and sat facing each other, removed jackets, and ordered water (I could have done with some brandy :))

First he said…he wanted to listen. I had structured my thoughts a bit and did my best to share my views (shared with many of you that read this blogs). He listened patiently
….then he spoke; passionately, articulately, in extemporaneous detail, very much aware of the small window he has bring the change we seek.

I thought hard about the appropriateness of reproducing his words on this blog. I have not had the time to go back to ask, now I do not have to. Professor Osotimehin has written a letter to the Nigerian people, published in THISDAY on 05/06/09. He says all the things he said to me…but most importantly…he says it to the Nigerian people, and us to “COUNT ON HIM”.

Find the entire letter re-produced below. It is an important read, as it discusses many of the issues we have been highlighting here.

We are grateful for his promises, we will keep the letter and hold him to account in 2 years time.

For now…lets work together …for the best interest of the people who it is all about!

Our Health System: Matters Arising

By Babatunde Osotimehin, 06.05.2009

Our health situation has lately invited us to ponder on steps to take in initiating immediate and long term solution. Without sounding immodest, the leadership of the Health Ministry understands the urgency of our situation and is responding with its entire zeal, within the broader spirit of President Umaru Musa Yar’Adua administration’s promise of efficient service delivery. We understand the recent threat of swine flu, and the subsisting presence of Lassa fever, cerebrospinal meningitis, and polio situation, amongst others. Overall, we are saying, it is important to improve our health care delivery system. In fact, our Primary Health Care system does need rejuvenation. We have been working at this, as it is important to focus on nearly every area of our health care system, not least so is maternal and child health. To bring about this improvement, I have said it elsewhere; it will need an alert from all tiers of government, particularly the state and the local. Resources would then have to be adequately provided, while human resources should not be lacking. Then the management of drugs and consumables have to be better than it is, apart from the institution of a good referral system. What should stop us from achieving these? Absolutely nothing really.
I say nothing if we are determined as a people. There is absolutely nothing that a collective will cannot make us achieve. By encouraging our health workers who labour across the length and breadth of the country, without being celebrated, we should have taken a significant step forward. Human resources galvanize. It drives processes to the desired level, and may be undermined only at our own peril. This cannot happen at a time we are even striving to accomplish a significant programme, which is the 7-point agenda of President Yar’Adua. We understand that the Nigerian health system and the health status of the citizens are experiencing a low rating from the estimation of the World Health Organisation. But like I have been saying, we can collectively increase our ranking.
On the part of the government, we are already providing the required energy in the system, through a repositioning of the environment and the leadership to enable the right contribution from all. Then we are seeking to improve our health service delivery not only via a holistic change in our Primary Health Care, but by strengthening referrals with secondary and tertiary institutions to reduce the disease burden that would then shore up the countries’ health status.
Besides, we are enhancing the financial resource mobilization through the expansion of the NHIS and other Public Private Partnership (PPP) arrangement. Then again, we are enhancing the coordinating role of the ministry and its interface with states and local governments, while also providing the much needed improvement in its overall performance. This is because the requisite human resources must be ready in all its right combination, just as the skewed distribution of workforce need to be dealt with. More than this, because one of the key weaknesses in the Nigeria’s health system is the lack of data to guide planning, a strengthened Health Management system is necessary to provide this needed data. Rest assured that the ministry is working on urgent steps to strengthen HMIS.
In the area of communication and public relations management, we are mobilizing and galvanizing public support for increased personal responsibility for health through utilization of preventive and health promotive services. The media is crucial in this role, which is why we are utilizing several media to ensure that timely and comprehensive evidence-based information about its activities are made available to build broad-based understanding of and foster acceptance and support for the new strategic agenda of the ministry and government.
Without any doubt, the above elements of our stewardship over the next 24 months or so are also being worked into the much broader and long term national strategic health development plan. Importantly, we started the process of developing a costed National Health Investment Plan. At the same time, we were embarking on a parallel initiative, a follow-on programme to the Health Sector Reform Programme (2003-2007), as the health sector contribution to NEEDS2. This was just before NEEDS was re-christened by government as the National Development Plan (NDP). The two initiatives: Health Investment Plan; and the Health Sector/NEEDS2 initiatives have now been harmonized into the preparation of a National Strategic Health Development Framework and Plan (NHSDP) process that is being led by the Federal Mini
stry of Health working with all the states, development partners, and non-state actors, amongst others. This process is currently being managed via the Health System Forum, and has attracted participation from many.
The NSHDP is aimed at a single country health plan, a single results framework, a single policy matrix and a costed plan that will be the basis for funding. There are also one single policy matrix; one costed plan that will be the basis for funding; one single mutual monitoring and reporting process; one single country-based appraisal and validation process for country health plan; one single fiduciary framework; benchmarks for government performance, benchmarks for development partner performance; agreement on aid modalities; and process for resolution of non-performance and disputes. These are the cross cutting principles of the IHP+ built on the Paris Declaration on Aids Effectiveness.
We recognize that domestic funding should make a significant contribution in meeting the challenges for Health-MDGs. Thus, the government has steadily improved on its funding support for Health-MDGs in recent years: N15 billion in 2008; and N22.5 billion proposed for 2009. We are internally challenged by issues of efficiency and in spending wisely and we are thus looking for technical assistance in this regards, especially in building capacity for power costing for Health-MDGs, and in innovative mechanisms that offer tremendous potential to save lives through new and creative solutions. Domestic funding alone is unlikely to meet all the challenges of funding Health-MDGs. We also remain concerned on whether or not we are making real progress in terms of the indicators.
Arguably, the greatest burden of disease in Nigeria is attributable to the index diseases of HIV/AIDS, malaria, and tuberculoses (ATM), and the diseases are at the heart the Health-MDGs Global compact. As mentioned above, the level of resources, both from within and external, to fight these diseases has increased steadily. However, the national response remains complex and confusing with multiple overlaps and poor coordination. Progress has been very slow. We certainly can do far more and we intend to do so. For this reason, a task force on ATM has been established, under my direct supervision, as part of a renewed spirited effort to ensure visible progress on Health-MDGs.
Membership of the task force are drawn from the Federal Ministry of Health, other Federal Ministries (National Planning, Ministry of Finance/Budget Office), and representative of state MOHs, members from cooperating partners active in ATM, representatives from civil society, and representatives from private sector bodies. The committee has focal point persons from the Federal Ministry of Health to assist in both technical and administrative work of the committee. I shall be the Chairman, with the Honourable Minister of State for Health serving as Alternate Chairman and member of the committee. Importantly, we have since moved forward, and we are continuing in this trend. Constant review and determination as exemplified in the President Yar’Adua’s directive remain our top priority and we shall not shirk our responsibility in this respect.

You can count on us.
• Prof. Osotimehin is Minister of Health.