Ehanire
By Hassan John
When Dr. Osagie Ehanire was appointed substantive Minister of Health by President Muhammadu Buhari in November 2019, the expectations were sky high. He was the man stakeholders and development partners thought would address the myriads of health issues in the country.
The expectations were hinged on two pillars. One; that Ehanire was the Minister of State for Health before his appointment, and as such, was aware of the challenges and how to spring a quick-fix.
Two; he served under the then Minister of Health, Prof. Isaac Adewole who most development partners and health sector players believed made an appreciable mark in the sector, especially in the areas of attracting more funding to the sector through the 
Consolidated Revenue Fund and other means, revatilization policy for 10,000 primary health centres across the 774 local governments, minimizing strike actions, among others.
They expected Ehanire to continue with these policies and ensure they were executed to achieve the desired objectives. Did he introduce policies that impacted positively on the health of Nigerians in the last four years? Did Ehanire actually add value to the health sector? Or is the sector still the way his predecessors left it?
Of course, while the Minister is rolling out drums, saying that he has done remarkably well given the circumstances he found himself, others however differ.
In fact, some stakeholders are of the opinion that Ehanire may pass as the worst minister of health Nigeria has ever had.
While unveiling the score card of the federal government in the health ministry under his watch, recently, Ehanire insisted that the Federal Ministry of Health has made remarkable progress and achieved a lot.
To him, the war against COVID-19 and structures put in place to contain and possibly prevent its spread in the future was one achievement the sector made under him. While describing this, in addition to increasing molecular laboratories from three to 145 as the halmark of his administration, he forgets that so far, only about eight million Nigerians have received their second dose of COVID-19 vaccines, which amounts to about four per cent of the entire population.
He also noted that Nigeria has made progress in the fight against HIV with prevalence reduced from 3.5 to 1.5 per cent. But isn’t this the result released in March 2019 during Prof. Adewole’s reign as Minister of Health?
Dr. Ehanire also argues that significant investment has been directed towards ensuring federal tertiary health facilities were resourced to deliver essential and specialized services including training of health workers.
Other notable achievements of the health sector under his watch, the Minister reiterates, include the commissioning of National Emergency Service and Ambulance System; having 90 oxygen plants as against 30 inherited by this administration; the establishment of 16 infectious disease treatment centres within Teaching Hospitals and Federal Medical Centres, immunisation coverage from 48 to 57 per cent between 2016 and 2018, certification of Nigeria as a polio free country, among others.
While the above listed achievements are commendable, there is however, concern among stakeholders that most of the programmes and policies mentioned were initiated and executed during the tenure of the former Minister of Health.
Brain Drain on the Rise
For example, the actors in the sector are worried that the rate of brain drain has gone beyond imaginable proportion. This, most experts attribute to lack of good policies and incentives that should attract the doctors and other medical workers to remain in the country. This, they insist is a demonstration of lack of initiative by the minister.
Responding to questions from our correspondent, the National Vice Chairman, Joint Health Sector Unions (JOHESU) Dr. Ogbonna Obinna, said that the Dr. Ehanire performed far below expectation.
On the issue of brain drain, Dr. Obinna said: “If we want to assess him from our own union and professional platform, we will not rate him high. “Why are health professionals leaving the country? Some of the allowances that are supposed to be enhanced are not there. People are dissatisfied with the treatment; therefore they are leaving to other countries to seek greener pastures. Medical laboratory scientists, radiographers, dental therapists, and opthometrists are all leaving in their hundreds. It is not only the nurses or the medical practitioners. It is not now that we are going to see the effect of this their leaving; give Nigeria another five years. The effect will shock everyone.
“One thing is that the government thinks they are producing medical doctors every year so they can take over. It is the experienced ones that are leaving. If the experienced ones are leaving, who will coach and train these graduates they are producing every year. That is the area they have not looked at.
Lack of Clarity on BHCPF
Another area the Minister has suffered intense criticism is the handling of the Basic Health Care Provision Fund (BHCPF).
Though the Minister said the Fund was being operationalised in collaboration with relevant agencies and partners and has improved accreditation, stakeholders have, however, faulted this claim.
According to some of them, the BHCPF which is aimed at providing quality healthcare for poor Nigerians by ensuring availability of a basic health minimum package of health services has suffered huge set back under the watch of Dr. Ehanire.
A staff of one of the international agencies operating in Nigeria, who spoke to Africa Health Report on the condition of anonymity said he feels ashamed whenever the performance level of the minister is being discussed in diplomatic circles
“This minister has failed us. Initially we felt he is someone that could cause the needed change in the health sector considering his long stay, but he has ‘fallen’ our hands. There is the belief in the diplomatic circle that he lacks initiative and does not have human relations.
“The implementation of the BHCPF is supposed to have gone farther than what it is now. But most of the initial funders of the scheme including the World Bank and British Department for International Development (DFID) have tactically stayed back. They are not providing the support in the pace they promised because they do not understand the direction of the Minister.
“This is a huge setback for Nigeria. Maybe the organisations and corporate bodies that initially indicated interest to support the scheme will return after a new minister emerges, maybe not,” he said.
Revitilisation of 10,000 PHCs
Another sensitive area stakeholders are bitterly complaining about is the revitalization of primary health centres in each ward in the 774 local government areas.
The project was initiated by Prof. Adewole when Dr. Ehanire was the minister of state. The stakeholders are worried that Dr. Ehanire could not continue with the project.
While responding to questions from journalists on April 7, 2019, few months before he left office, Prof Adewole disclosed that the Federal Government had rebuilt over 4000 PHCs across the federation in line with the10,000 rehabilitation target of the President Muhammadu Buhari administration.
“Our target is to rehabilitate 10,000. We have done over 4,000. Federal Capital Territory (FCT) Abuja is doing 225, Osun State, 332 and Kaduna, 250. We are moving towards the 10,000 mark,” Adewole had said.
However, a recent report released and commissioned by Embassy of Kingdom of The Netherlands in Nigeria and put together by PharmAccess Foundation’s Nigeria Office (PAF), titled “Nigeria Health Sector: Market Study Report,” revealed that 80 per cent of the facilities are still non-functional.
The study concludes: “As part of its goal to ensure access to healthcare for 100 million Nigerians, the Federal Ministry of Health plans to build 10,000 PHCs throughout the country, with at least one PHC per ward (that is, an administrative unit with 10,000 people) to facilitate healthcare access across a wide geographic area.
“It is understood however, that 4,500 PHCs have been covered so far with support from donor partners,” he said.
With this report, it is clear that almost all the 4500 PHCs were revitalized during the tenure of Prof. Adewole.
This, according to keen watchers of the health sector, it is a demonstration of abandonment of the project by the current minister.
Crisis in the Health Sector
Most actors in the sector are of the opinion that Dr. Ehanire, coupled with his poor human relations does not have the capacity to manage crises.
Prior to the COVID-19 pandemic, there were agitations by different professional groups in the sector. Most of the issues that fuel the agitations remain unresolved up till now.
According to the JOHESU Vice Chairman, Dr. Ogbonna Obinna, “The reason why strike was not too obvious in the past few months was because of the introduction of no work no pay by the minister of labour.
“Many people feel that this government will beat you and prevent you from crying. Even if you go to court and get judgement, they are not ready to implement it. The only thing is not to withdraw services entirely but use other means to get across to the government.
“It was not because he (Dr. Ehanire) had the joker but because the members felt that this was not sensitive. If the education sector was on strike for eight months and the government withheld their salaries and nothing was done; if we also go, they will also show that type of attitude and that is not the good.”
He gave example of the issue of the adjusted CONHESS salary structure, which according to him, “since 2014 we have been clamouring for it. He inherited it and we thought he will do it better. But to our amazement, up till now, it has not been done.
“For him, we did not have the forum to interact with him. He was not accessible for us to dialogue with him. He was not available for us to hold series of meetings that could have helped in solving some of these issues.
“There are things that are still pending which we think the Permanent Secretary not being a medical practitioner may have an open mind to look at.”
Still on the failure of the Minister, Dr. Obinna said: “That discriminatory attitude is still there. That is one area we feel he has not really done well. But we thought if he had understood our demands before becoming the Minister of Health, he could have done well.
“We are praying that in the next dispensation when they want to appoint minister, the Minister and the Minister for State should not be from the same professional calling.
“Moving forward, the health team should be holistic in nature and all professionals should be involved. It should not be predominantly medical professionals.”
Funding the Health Sector
On funding the health sector which still stood at less than 5 per cent, Dr. Obinna said the current minister does not have the needed push to ensure increase in funding for the health sector.
His words: “On funding of the health sector, we have discovered that the budgetary provision in the health sector is less than 5 per cent over the years which are far below AU’s recommendation of 15 per cent. We thought that by now, we are supposed to surpass that 5 per cent. This is not something we can rejoice about,” he said.
Actors in the sector are, however, worried that despite lack of enough funding for the health sector, the Ministry of Health under the watch of the Dr. Ehanire lacks the capacity to spend the little money that they get from the government and other donors.
This, most actors in the sector describe as a display of lack of capacity to utilize the funds in the required areas that will make impact in the lives of Nigerians.
However, take it or leave it, Dr. Ehanire did not fail in all areas. Just like the JOHESU Vice Chairman puts it: “We can give credence to him and his team on how he managed the entire COVID-19 crisis.
“There was a very good team involvement. He involved all professionals in the health sector. That is the way it is supposed to be. If he had sustained that team spirit after the COVID-19 pandemic – that could have been fantastic.”
The general stakeholders’ consensus is that Dr. Ehanire failed woefully to impact the health sector over four years. He had the opportunity.
