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In the late 1990s and early 2000s, a new virus (HIV) that caused the devastating disease, AIDs had emerged and spread around the world. The impact of this new virus on people and the economy was only just becoming obvious. People were terrified, the association of the new disease with sexual transmission was stigmatising, and doctors lacked the knowledge and resources to respond. One of the most upsetting emotional consequences of the virus was that it could be transmitted on to unborn children by pregnant mothers.
Scientists were working nonstop to develop new tools. In the early 2000s, a new drug was discovered to be extremely efficient in preventing HIV transmission from mother-to-child. A vibrant woman was chosen to lead its implementation in Nigeria. The Federal Ministry of Health established a new team, the National AIDS and STDs Control Programme (NASCP), led at the time by Dr Nasir Sani-Gwarzo (currently Permanent Secretary of the Federal Ministry of Humanitarian Affairs, Disaster Management and Social Development.)
The woman’s name is Dr Salma Ibrahim Anas, and she has just been appointed as the Special Adviser, Health in His Excellency, President Bola Ahmed Tinubu’s first appointment in the health sector.
With every new administration comes new optimism and expectations. The recently sworn in government of President Bola Tinubu seems to be eager to deliver on its campaign promises. This is a radical departure from the previous government which seemed to take its time to act on issues. Nigeria is facing multiple challenges across all sectors leaving the economy in dire straits. This is especially the case in the aftermath of the COVID-19 pandemic, which in addition to other global international and local pressures has had a negative impact on the economy, resulting in rising inflation, stagnant GDP growth, unemployment, and an unstable exchange rate. The health sector has particularly suffered a number of setbacks from previously earned gains. Women have been impacted not only by income and employment losses but also because they made up 70% of the global health workforce on the frontlines of the pandemic. This is why Dr. Salma’s appointment and subsequent appointments in the health sector are more critcal than ever before.
There are few people that could be more prepared for a role at the national level than Dr Salma, as she is affectionately known by those who know her. She has worked at all levels of the Federal Ministry of Health, at the state level as Commissioner of Health in Borno State from 2011 to 2015 to her role leading the Department of Hospital Services, NEMSAS (Nigeria Emergency Medical Services and Ambulance Scheme) and the Cancer Programme. She worked for many years for UN organizations, United Nations Population Fund (UNFPA), and the World Health Organization (WHO), in addition to leading a large DFID-funded project, MNCH2. She has seen the health sector from every possible angle, has worked directly with Ministers and Governors, has been part of the donor community defining agendas, and therefore understands the very difficult fiduciary responsibilities of working in our context.
Preparation for what lies ahead
Nothing could have prepared her more for her new role then being a mother in Nigeria. Our country has one of the worst maternal health outcomes globally, as well as being one of the most challenging places to raise a child from infancy to childhood, and this must be at the top of Dr. Salma’s mind. There is no doubt that Dr Salma, like everyone else in her community and most Nigerians knows someone personally who has lost their life in circumstances that should never have happened if we had a functioning health sector. Having a woman in this leadership position is critical, given that for her these cannot be academic challenges. Dr Salma will definitely bring her expertise and lived experience to her new role.
The second most important opportunity that would have prepared her for the role has to be being a commissioner in a state that has had more than its own fair share challenges. The insecurity in Borno State has limited access to many services that should be considered normal. Doctors and nurses are not in a hurry to live and work in security compromised areas. Yet in the last few years we have seen the gradual re-emergence of a health sector in Borno that is beginning to deliver for its people, especially with support from development partners.
The third preparation which she has had for this role is her work as a Director in the Federal Ministry of Health. There is no doubt that the ministry’s structures and leadership in the past few years have been slow in evolving in the realities of the day. While the world has moved on to more agile, flexible forms of leadership, directing innovation with change and purpose, our Ministry continues to work with manual methods, with documents in green folders physically transferred from desk to desk. There has been limited investment in the workforce, and not enough cohesion among its parastatals, and very little strategic leadership.
Her fourth opportunity for preparation is her experience working with UN agencies, UNFPA and WHO. Discussions among health sector development partners often reveal a certain sense of frustration. Despite the significant resources that have been committed to addressing the multitude of challenges in our health sector, outcomes remain poor. Dr Salma has overseen a large donor-funded project that was doing what state governments should do for themselves and their communities: funding basic maternal and child health programmes. As a result, she will have both frontline experience dealing with the nuances of the challenges that states face, as well as having the technical skills to deal with the issues head-on.
Finally, Dr. Salma is a part of everyday life in Nigeria. She buys her food in the same markets, drinks water from the same taps, and is just as vulnerable to emergency medical services as the rest of us. She has been called at a time when our political class is widely distrusted. This is now an opportunity for her to make decisions and become a part of history. Unfortunately, health is not always at the top of the President’s agenda (you might think that the COVID-19 pandemic would change that), so it is her unique responsibility to push it up the political agenda and keep it there.
We at Nigeria Health Watch wish her every success and all the very best as she assumes her new role.
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