Nigeria Health Watch

Muhammad Pate’s resignation, a profound loss for Nigeria

On Tuesday 23rd July, the health sector in Nigeria was rocked by the resignation of the Minister of State for Health, Dr Muhammad Ali Pate. It was announced that he was resigning to take up a position as Professor for Global Health at Duke University in the USA. It was also reported by Mr Reuben Abati that Mr President accepted his resignation while saying that it was a testament to his “star studded” cabinet, an indication that the cabinet was made up of “stars” who were sought after by different institutions. This is one of the extremely few voluntary resignations by a cabinet of minister in Nigeria, and the most consequential since Mrs Ngozi Okonjo Iweala walked away from Chief Olusegun Obasanjo’s cabinet in 2006.
Dr Pate Addressing a Conference in London in 2010

Dr Muhammad Pate was appointed into the cabinet after President Goodluck Jonathan’s election in 2012.
Prior to his appointment, he was the Executive Director of the National Primary Health Care Development Agency (NPHCDA), a position he held for just over 3 years. At the time, Prof Onyebuchi Chukwu was already the substantive Minister of Health, having been appointed for the 7 months prior to the elections into the position that was lost by Babatunde Osotimehin, following the machinations surrounding the sides various ministers took during the prolonged illness of the previous Nigerian president, Umaru Musa Yar’Adua. Prof Chukwu’s occupation of the substantive “Minister of Health” role meant that Dr Muhammad Pate could only be offered the position of Minister of State for Health. At this point, many colleagues did wonder if it was not preferable that Dr Pate stay at the NPHCDA, where he had a clear mandate with a direct budgetary stream to deliver on, and where he had initiated the transformation of the institute to the scale last seen during Professor Olikoye Ransome Kuti’s era.

I first met Dr Pate just after he was appointed as Executive Director of the NPHCDA. We had been introduced by Professor Ibrahim Abubakar, a dear friend and Chair at the University College, London. Just after accepting the position, he was still shuttling between the United States and Nigeria, where he had worked with the World Bank, after concluding his residency in internal medicine, with a specialization in Infectious Diseases. We met at the Costa Coffee shop just opposite the exit of the just completed Terminal 5 at Heathrow airport. We had scheduled to meet for 30 minutes but spent 2 hours talking about his dreams for primary health care in Nigeria. He listened more than he spoke, absorbing every word, making notes. My instincts were that NPHCDA, was about to be transformed into the institute it had been set out to be, squarely on the side of the “ordinary” Nigerian.

Dr Pate with Professor Grange and Dr Ugo Okoli

Prior to his arrival, the NPHCDA was the laughing stock of the health sector in Nigeria, completely bereft of leadership. Further to the merger with the National Programme on Immunisation, NPHCDA was responsible for driving immunization activities in Nigeria. Nigeria was single handedly threatening the success of Global Polio eradication efforts, into which billions of dollars had been invested. The graph below, presented by Dr Abdulsalami Nasidi at a conference in London “Nigeria, Partnership for Health” summarises most poignantly the state of NPHCDA at the time of Dr Pate’s arrival (but maybe also depicts the state of the country).

The state of immunisation in Nigeria before Dr Pate’s arrival
Dr Muhammad Pate turned NPHCDA around completely. It re-aligned its focus and priorities to the functions it was actually designed to perform. Taking on one of the biggest challenges of our time in the health sector, NPHCDA initiated the innovative Midwifery Service Scheme (MSS), recruiting retired midwives from across the country to support under performing antenatal clinics across the country in order to reduce the unimaginably high maternal mortality rates in Nigeria. For the first time in the Nigerian health sector, a leader was not accepting the limitations of existing structures. The polio eradication programme was given new energy and new strategies were designed. Dr Pate described his vision for NPHCDA thus: 

“Nigeria will be a nation of healthy people with equitable and affordable access to primary health care through a system that delivers quality, integrated services with the participation of all stakeholders”

NPHCDA not only spent their budgetary allocations as most agencies, but under Dr Pate’s leadership, the agency began to attract substantial funds from external organisations such as the Bill and Melinda Gates foundation. Bill Gates was to eventually form a strong bond with Dr Pate, in whom he must have obviously identified unique leadership potential. In addition to the Duke University post, he will also be serving as a Senior Adviser to the BMGF. In addition to the programmes, the biggest change at NPHCDA was in its people. From the gateman to the Directors, every time I visited during Dr Pate’s tenure, I felt a sense and urgency around speeding up the delivery of primary health care in Nigeria. He told Guardian’s Chukwuma Muanya in an interview just before going on his first retreat with NPHCDA staff that 

“…my third objective is to see the agency re-positioned internally, meaning our strategy or structure, our systems, our people actually well positioned to deliver on our mandate.”

As Minister of State fr Health, Dr Muhammad Pate pushed ahead in his unique way – engaging with Nigerians all over. Recognising the significant role of Nigerian health care workers in the Disapora, he participated in a webinar with Nigerians across the world. We asked Dr Pate the first question of the webinar – “What objectives he had set for the health sector”. Previous Ministers of Health have answered this question in dubious ways, listing
the number of primary care centers to be built or CT scanners to be bought. So, we were quite excited when Dr Pate, probably for the first time since we started writing on health issues in Nigeria said explicitly that he will set health oriented outcome measures and process indicators to measure these. He went on to list the 4 strategic objectives that the Ministers of Health had set themselves during this tenure as; Improve basic service delivery at the front-lines,  focus on the prevention agenda – immunisation, health education, etc, focus on clinical governance and to improve the quality of care in the Nigerian health sector, and finally to unlock potential of market forces to support and drive innovation and improvements in the health sector.
His last major initiative as the Minister of State for Health was the launch of the ambitious objective of “Saving a million Nigerian lives by 2015”. This was the first time I can remember that a Minister of Health in Nigeria was providing Nigerians with a clear unambiguous objective, in health terms. While he sadly will not be there to deliver on his dream, I have no doubt that the decision to quit was not an easy one. 
Dr Pate at the launch of the Saving a million lives initiative

I do not know why Dr Pate left his job, but I am quite sure that it had nothing to do with the unique attractiveness of Duke University (where he was already an adjunct professor before his appointment as Executive Director of the NPHCDA). It also definitely has nothing to do with a perceived “star” status as allegedly described by Mr Abati. Leaving this position was, no doubt the most difficult decision Dr Pate has ever taken. In taking this decision he had to make a choice very few of us Nigerians are willing to make – to take a stand on a matter of principle, when there is a direct personal cost.

Walter Isaacson, wrote about the difficult virtue of “honour” in reference to Colin Powell in TIME magazine. Colin Powell as we all know, is a revered former Secretary of State under the Bush (Jnr) administration. He famously made that last presentation to the UN before the second gulf war, insisting on the presence of weapons of mass destruction. Isaacson wrote about how much Colin Powell struggled with the virtue of “honour”. Honour is that difficult mix of being honest to one’s principles, at the same time being loyal to one’s boss. My hypothesis is that this is what Dr Pate struggled with the most. Like Powell, he tried to find the balance for a considerable period of time, but at the end he probably succumbed to the demands of his conscience.

Today, Powell is one of the most respected former public office holders, on the right and left of the American political landscape. I suspect that Dr Pate will be given the same recognition within the Nigerian health sector. Not, since Professor Olikoye Ransome Kuti has Nigeria been blessed with a Minister of Health with the right mixture of professional competence, and personal integrity. We hope this is not the last we have seen of Dr Pate, and like Ngozi Okonjo Iweala, that he’ll be back to take on an even more important mandate in our polity. For now, the loss is Nigeria’s to endure. We are left with the leaders we deserve.

But, why does leadership matter so much in the health sector? The problems facing our health sector in Nigeria are often over-simplified as relating to the lack of funding, appropriate technology and human resources. These are all true, but do we really think that given the resources, equipment and personnel our hospitals will be buzzing with activity and our immunisation programmes would work? I would suggest that the single biggest challenge in all our health institutions from the Ministry of Health to our health institutions in Nigeria is one of leadership. Now more than ever, we need leaders who will develop innovative policies and programs, and assure that systems are maintained and improved, within whatever resources they have available. We just lost the best shot we had at that.

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

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