Health must be seen, felt and palpated in every household

With these words the new Nigerian Minister of Health, Professor Adenike Grange started of her the talk titled “Implementing Health Sector Reform for better Performance” delivered at the the annual lecture of THE LANCET, one of medicines pre-eminent journals. Her primary objective would be to get health care to those who need it most in the most cost effective way. Professor Grange made no apologies of her pedigree in service, teaching and management of her peers (President of the International Paediatric Association), describing herself more as a technocrat than a politicican. This is probably the most exciting aspect of her emergence as health minister. Listening to her speak, one could feel an openesss about the sad situation we have sound ourselves in and a genuine intention to turn things around. Maybe there is a realisation that the health of 140 million Nigerians can no longer be left in the hands of politicians. She started by by elucidating her perception of problems facing the health care sector in Nigeria. The divergence between policy formulation and implementation; the rigidity of the civil service; the challenges of managing a sector where the lines of management are poorly defined between the different tiers of government; a sector where the most crucial arm of health care delivery (primary health care) is in the weakest arm of government (Local Government); and a low consumer awareness of what to expect and demand in terms of their health.

The saddest single statistic that she presented was that, maternal mortality ratio (death during and around child birth) in Nigeria had worsened from 704 to 800 deaths in 100,000 life births between 2000 and 2004.

However, she went ahead to state 6 priority areas for her tenure: 1. Reduce the disease burden 2. Improve availability of health resources and their management 3. Improve access to quality health services 4. Quality assurance 5. Improve the stewardship role of government 6. Strengthen the national health system While these are not necessarily new, they do mark a departure from the past where goals in the health sector in Nigeria were always made in terms of health care centres to be built (or not), or teaching hospitals to be refurbished. While these huge infrastructure projects were attractive to our politicians for obvious reasons, no mention had hitherto been made on health and health care indicators! In 2005 only 35% of Nigerian children had been vaccinated against measles, a vaccine that costs less than 30cents per dose, the scandalous maternal mortality ratio mentioned by the Honourable Minister. She termed these relics from the past as “Poverty-determined decision making”…I would term them as “Greed-determined decision making” So it is a breath of fresh air to have a Minister that seems to understand that health must be counted and delivered on health terms. She introduced a few new concepts; the establishment of a National Council for Health; made up of all the stakeholders in the health sector that will meet once a year to advice the Minister on priorities for the sector. A National Health Investment Plan, to harmonise the flow of funds towards health improvement projects, the establishment of a National Hospital Commision to regulate not only public but private hospitals.

Finally when asked to give 3 priority health targets on which the Nigerian people can evaluate her tenure, she listed;
1. An improvement of routine immunisation rates
2. An improvement of maternal mortality ratios
3. A continued reduction of HIV prevalence …although the minister would not be tied down to be more specific in what size of measure of improvements to expect (yes…she is learning the art of politics :))

…she obviously has her eyes on the ball. She has a good chance of making history, and affecting the lives of millions of Nigerians as she does so. We wish her well. Richard Horton, editor of THE LANCET, concluded the evening eloquently when he declared the time for talking is over….it is now time to “GO DO”. Therein lies the challenge for Prof. Adenilke Grange.

Find more information about Prof. Adenike Grange’s career here