Providing sustainable medicare in Oyo State

Governor Abiola Ajimobi of Oyo State

Determined to provide sustainable healthcare delivery to the people of Oyo State, the Abiola Ajimobi administration recently launched of a N50 billion Health Endowment Fund.

The flag-off event, which occurred at the International Conference Centre of the University of Ibadan on Thursday August 3, 2017 drew in a huge gathering of high net worth individuals who identified with the objective of the government in creating a much more viable base for the management of health care in the state through the revamping of all state public hospitals and medical institutions, while also providing them with crucial equipment and enabling access to a prized pool of skilled medical personnel.

Oyo State Commissioner for Health, Dr. Azeez Adeduntan, told journalists at the event how he had been specifically headhunted to deliver on the effective administration of health care in the State by an administration keen on making sustainable health care delivery a cardinal aspect of its public intervention and legacy. Adeduntan is also a renowned Harvard trained cardio-vascular surgeon and professor of medicine at the reputed Morehouse School of Medicine in Atlanta, Georgia, United States (US). He spoke to his advent into driving the health care agenda of Governor Abiola Ajimobi.

What actually led to the conceptualisation of an endowment fund for healthcare in Oyo State?
When I first came, the Governor gave me the leeway to make sure that I arrest the rot and decay in the system. I went round all the 622 primary healthcare centres, the 57 general and specialist hospitals, and I found out that they were not practicing to the standard of care expected of such institutions. And, we cannot say because federal allocations to the State have dwindled over the years, hence we will now fold our arms; that will be very tragic. We needed to think outside the box to ensure the situation is salvaged and improved upon.

For instance, I went to Harvard Medical School and I know that thirty to forty percent of the capital expenditure of the Harvard Teaching Hospital is being funded by private individuals through donations. It’s the same thing in New York University. So, why can’t Nigerians come together to help their governments, not because the governments are begging but because this is a constitutional democracy rightly described as the government of the people, by the people and for the people; so we are all part of the government. That is what the advanced approach to health care is all over the world.

That is what brought that. The money is not there, and so we had to call on all well meaning Nigerians, whether they are low or high net worth, to assist us achieve what is obtainable in the advanced world where we all tend to run to. The standard of health care is high in America because the people also help their governments. That is what brought about that – to make sure we are not giving the excuse of the lack of money to be allowing our people to die unnecessarily because of the bad economic situation that Nigeria is in right now.

Were you encouraged by the gestures demonstrated by the people during the launch?
Absolutely! I was touched. Let’s keep it in mind that the gentleman who donated N100 million that day was from the United States. One is highly grateful to our Chief Launcher, Dr. Obono and a lot of well-meaning Nigerians, who have been contributing to the Fund, and we are reassuring them and so many others that this is not a Ponzi scheme; we have a Board of Trustees led by the very distinguished Professor Akinkugbe, who will monitor the use of this money. I believe that, by the grace of God, within the next six months, we will renovate all the hospitals in Oyo State, regardless of where they are situated, and there would be bill boards there saying, “Endowment Fund Working!” This is a Fund domiciled independently of the accounts of the Oyo State Government. It is being kept in a separate bank account and would be managed with the highest degree of transparency, so that there will be no accusation of the lack of probity in its administration. The managers of the Fund are high net worth individuals who have succeeded in their various fields of discipline and endeavour

I don’t think, giving the target you actually set, Oyo State were able to meet up with the set figure during the launch of the Endowment Fund. How do you intend for the State to ultimately draw in the princely sum of N50 billion?
The August 3 event was just a flag off. We never believed we would get donations of N50 billion in one single day. That’s a huge amount of money. But when we did the cost analysis, we discovered that if we are going to renovate all the hospitals in Oyo State and bring them to international best standard, that’s the kind of money we would need to do that. But we were able to make a sizeable amount on that day, which I am not going to disclose publicly for security reasons at this point in time. We launched the Endowment Fund on August 3rd and it is going to last two years. We have a consultant in-house, Healthcare Limited, who is running this show on behalf of the government of Oyo State on a contractual basis. The firm would be the one running round to collect the pledges and future donations to Oyo State.

We have two years for incoming donations to come through. By seeking N50 billion, we were not trying to be foolish, and we were only trying to aim high, and I am supremely confident in the Almighty God that before that two-year period, we would have gotten a sizeable amount of the money. We are not going to wait till every kobo comes in, and whatever we have right now, we intend to use for the low-hanging fruits first: We would renovate all our hospitals, paint them, cut the grasses, bring the operating rooms to international best standards, and make sure there is security of lives and property there, including continuous electricity, either through regular power from the national grid or by solar energy. We would probably go solar because we do not want intermittent power supply in our hospitals.

If you start spending part of the Endowment Fund now, don’t you think that it runs against the grain of endowing a Fund that should be fixed, and from whose interests and earnings health care delivery is supposed to be run for, say, over a century?
Yes, we are aware that we need sustainability, and that’s why we brought in high net worth individuals led by Professor Akinkugbe to manage this Fund for us. We are going to invest some of these funds, not in stock markets that can crash and then we lose our money, but in reasonable ventures that can bring money in. Secondly, we also believe that before Governor Abiola Ajimobi leaves power in 2019, we would have gotten an enabling law from the House of Assembly to make the Fund a Health Trust, so that whatever contractor comes to Oyo State to do business, would pay about 0.5% to 1% of whatever contractual fees it has with the government, to make sure that money continues to go into this Fund. But as I said earlier on, we intend to invest it in reasonable ventures, and above all to make it a health trust rather than an endowment, because when you start spending money, and money is not coming in, it can finish, and we intend to make sure that this Fund does not finish but last as long as there are human beings who need health care services in Oyo State.


What actually led to the creation of the also recently launched Oyo State Health Insurance Scheme?
We realised that all over the world, health care is capital intensive. Because of the paucity of funds from the Federal Government due to the gloomy oil revenue, Oyo State, like many other states in the country, are not getting enough funds for the health sector. Health insurance is a way to help both the rich and poor, and to limit the amount of money the government has to commit into the health sector. The scheme was forced not forced on us; it is an instrument that Governor Ajimobi believes can reduce the expenses, which were hitherto spent on the treatment of certain ailments by the government, when citizens visit the government hospitals. The Health Insurance Scheme started in May 15, 2017 and, of course, with a very small amount of money of N650 monthly and N7,800 per year, any patient, regardless of where you come from, who subscribes to the scheme, will be treated if he or she visits the registered hospitals. That is the global health practice; it is done even in the advanced countries of the world. This enables the government to fund the health sector within its normal means. We simply bought into this.

What kind of model is it anchored on? Is it’s a PPP?
The Federal Government has a health insurance scheme (the National Health Insurance Scheme – NHIS), and what we have done is to domesticate it in Oyo State. We have health management organisation (HMO) partners, and it is not the government that is running it. You can call it a PPP arrangement of sort, because it is the HMO partners who take capitation fees from patients, and render services, as it is being done all over the world. But it is being regulated and controlled at the federal level by the National Health Insurance Scheme. We have domesticated it in Oyo State to make sure that low-income earners can have good access to health care.

From your projection sir, how many people do you see coming on board for the Oyo State Health Insurance Scheme?
We are targeting a million people in its first year of introduction. And so far since May, we have already had about four thousand people registering, and Governor Ajimobi has made it very clear that the scheme will be made compulsory for the civil servants and residents in Oyo State because we don’t want this scheme to collapse. Nobody wants to pay for health unless they are forced to do so. Even in United States, health insurance is mandatory and if you do not have health insurance, you would be sanctioned. And we intend to make sure that at least for now, civil servants and people that are working for the government buy into this, and we believe that before the terminal days of this administration, we will make it compulsory for every resident in Oyo State. It is such a nominal amount of money, and recharge cards even costs more than that at N650 per month, that even a poor woman can afford to pay for it. Even if she cannot afford it, the Health Endowment Fund is there to pay for people who do not have money.

In walking you backwards a bit, what could be said to be the most prevalent diseases on the ground in Oyo State today?
The most common disease in Nigeria today is malaria, followed by typhoid and infectious diseases of various etiologies. Only recently about twelve Oyo State residents had cholera. There is the sickle cell disease and its complications, pneumonia, bronchitis, surgical problems including hernia, hydrocelectomy, goitre, etc. In terms of the most preponderant, there are various diseases of different types in the State, but we are glad that with the intervention of Governor Abiola Ajimobi, childhood diseases like measles, polio, pneumonia and tuberculosis (TB) are on the decline in Oyo State.

Could you tell us briefly about your professional background?
I was born here in Ibadan, and after my medical training at the then University of Ife, I proceeded to United States of America, US, where I became a Cardio-vascular Surgeon in 1995. I attended Colombia University in New York and later Harvard University Medical School in Boston, Massachusetts. I was appointed a Commissioner here in Oyo State about a year ago, on July 24th, 2016, through divine providence and the kindness of my brother, His Excellency, Governor Abiola Ajimobi.

At the time of my appointment, I was in United States where I was President and Chief Executive Officer of Victory Vascular and General Surgery of Georgia, in Atlanta, Georgia. I have been practicing since 1995, and as I did tell you earlier, my sojourn in medicine began in Nigeria after which I proceeded to Colombia University in New York for General Surgery and later Harvard Medical School for Cardio-vascular training, before becoming a Professor of Surgery at Morehouse School of Medicine in Atlanta. I began private practice in 1995 because I didn’t want to be a paper tiger, and there are two branches of my medical practices in the United States, one in Atlanta and the other Athens, Georgia.

What actually informed your decision to leave a lucrative private practice in a place like United States to take up an appointment in the country on the level of healthcare administration?
My decision was borne out of the desire to make a difference. No matter how smart you think you can be, public service is the best; it is only in public service that you can be immortalised. If you die as a surgeon now, the only people who would be aware of your efforts are members of your family. But take for instance if, God forbids, our president dies now, the whole world will know. Above all, the sole motivation was to make a difference here in the country, and on the global stage. Also, to stop the influx of medical brains abroad; to stop untimely death in Nigeria; to contribute my own quota to the country that sent me to the medical school: I was once a federal government scholar in University of Ife. In a nutshell, my reason for returning to the country is to give back.

What was the experience like during the initial stage of working in the country, considering the fact that you were coming from a more organised and sophisticated society? Did you experience any culture shock?
Not really, the reason being that I trained here. I went to medical school here and I was also a medical officer here at Adeoyo hospital between 1982 and 1983. Having said that, my major reason for coming back to the country is to effect positive change. I have also been coming to Nigeria, at least, annually. I did not really experience any cultural shock in Nigeria because I had always known that there have been cases of premature deaths in Nigeria. The operating rooms, the emergency rooms that I am used to in US are no longer here in Nigeria and I strongly believe that by coming back to work in the country, I will be able to assist the Governor by stopping medical tourism, and by providing quality medical services to the people. That is why I don’t fancy people criticising the government in Nigeria on social media, or on the pages of newspapers. Ask these critics what they have done to make a difference in the country. In America where our people run to, the people of that country stayed back to help make their country what it is today. Like I said before, I believe in making a difference by ensuring that our people are prevented from dying from sicknesses that are curable and preventable, as it is done in other developed nations of the world.

Generally, what would you actually consider as the highest disease burden in our society?
The highest disease burden, apart from infectious diseases of different types, is the issue of sudden heart attacks. The disease is common among middle-aged people between the ages of forty and fifty year, on the basis of the statistical analysis carried out on the data that we derived from different hospitals across the length and breadth of the State. The most common cause of death in the middle-aged group in Nigeria today is sudden heart attack due to uncontrolled high blood pressure. It is uncontrolled because a lot of people who have the disease do not even know that they have it until they die prematurely.

It pains me to know that a lot of middle-aged people die in this country, unlike in the advanced countries where people reach eighty years before they die, and it pains me to know that our people die from a disease that can be controlled. The disease is uncontrolled because the people who have it do not recognise that they do so. This is what pushed me to come back and that was why I prevailed on Governor Ajimobi to ensure that before the end of his tenure, he launches an Health Care Endowment Fund that will allow the state to establish a cardio-vascular centre in Ring-Road hospital with a view to treating heart related diseases, kidney diseases and, of course, cancer. With this, we would be able to stop brain drain and medical tourism.

What are the factors that are responsible for this high incidence of heart diseases? Does it have to do with our life-style; our food intake?
Stress is a major factor and this is in connection with the state of the Nigerian economy, which is quite vulnerable at this point. The majority of our people live on a dollar per day; and our per capita income is very low. Our people encounter stress in every sphere of their lives – in the place of work, on the road, and so on. Stressful conditions can lead to high blood pressure. But the more common type that we see in people is Essential Hypertension, the cause of which we don’t know yet; this is more common among blacks. But like I said, the social factors are the ones caused by the struggles of a man in a poor economy, to provide for his family. Or if you are a man and you cannot satisfy your wife or family, this can lead to high blood pressure. Based on our findings, 30 per cent to 40 per cent of men between the ages of forty-five and sixty are hypertensive.

Is it a uniquely Nigerian thing?
It is a Black thing that is not only affecting Nigerians, but Blacks all over the world. We don’t know why, at least yet. Probably it is in the DNA of Blacks generally. What we know is that Blacks anywhere in the world experience high blood pressure in comparison to their white counterparts. Whites have their own diseases as well. Cancer, as an example, is more common in Whites than in Blacks. But high blood pressure is a Black disease across the globe.

What would be the difference between the Cardiovascular Centre being set up at Ring Road Hospital and the other ones around the country?
There would be a difference. Any cardiovascular centre anywhere should be able treat any heart related disease, including offering medical and surgical care. For instance, people who have the coronary heart disease, kidney problems, and dialysis problems, will be treated in that centre.

Apart from the sophisticated equipment that will be in the Centre (it would be nice if you can mention some of these), what other required levels of competency would be available to its proper functioning?
One of the main reasons for launching the Endowment Fund – through which we have been able to get some money – is to be able to bring in competent hands from the US and the UK to work in the Centre. These are Nigerians who have distinguished themselves out there. It is not only about the money they are going to earn; it is also about the facilities and infrastructure that they will be working with. Recently, Governor Ajimobi and I spoke with the Chief Medical Director of University College Hospital (UCH), Professor Alonge, as well as the CMD of Ladoke Akintola University (LAUTECH) Teaching Hospital, Ogbomoso and BOWEN University, such that we would be able to have a collaborative consultancy and can share consultants across all levels for that Centre. We want to be able to bring in capable hands that have had like thirty years of medical experience abroad to practice and effectively stop medical tourism, as well as be able to earn foreign exchange for our State. Mind you, bringing in the calibre of people I just mentioned down, from their lucrative jobs abroad, to the Centre will cost fortunes. That is why we had the Endowment Fund.

What are the kinds of equipment we should be looking forward to see in the Cardiovascular Centre?
We are going to bring in an Open-heart machine, dialysis machine, and so on. Besides, we will bring in specialists that will operate the machines. Some of these machines cost some millions of naira. For instance, the Magnetic Resonance Imaging (MRI) machine alone costs about five hundred million naira; as such, all these would cost a fortune. That is why we have approached some people to partner with government with a view to sharing the financial burdens. Likewise the profits will be shared.

How far away are we from the precision medical equipment used in places like the US and other advanced countries?
We are far away. But regarding this centre, people who have heart-related diseases will get medical care there. Heart surgeries would equally be performed there. Although we might not yet be close to the level of medical care abroad that you mentioned, but we have to start from somewhere, and that is what we are doing here in Oyo State.

But beyond taking care of people in terms of heart surgeries, do you also have any plans in terms of training programmes?
The Governor of Oyo State has been highly disposed to elevating our capacity level in the public health sector in the State. The School of Hygiene and some other institutions are there where students are certificated upon the completion of their programmes. There is also the issue of health extension workers. We have teaching hospitals that belong to Oyo and Osun States where people are trained. These are some of the places we shall be getting the capacity for the centre, and like I said earlier on, LAUTECH Teaching Hospital will also benefit from the Endowment Fund.

Can you tell us about some of the other health care programmes in the State since you came into the office?
Before this government came on board, the health sector in Oyo State was in total shambles; hospital operating rooms were non-existent, for instance. But since the governor assumed office, he has done a fantastic job. The number one achievement of this administration has being the treatment of about 1.5 million people through the free health programme of Governor Ajimobi, which started in 2012, and in which people suffering from various ailments such as hernia, diabetes, goitre, high blood pressure, sickle-cell anaemia, among other diseases, have received urgent and life-saving medical attention. In May this year, the Governor got about $2 million worth of equipment from United States, from which the 57 general hospitals in Oyo State have benefited.

Second, in terms of the institutional reform of the health sector, as enacted by the Federal Government, the Oyo State House of Assembly has signed into law the Primary Health Care Centre Bill. Through this effort, the Ministry of Health, as against what we used to experience whereby there was always conflict between the Ministry of Health and the Local Government Service Commission, is now controlling primary health care centres in the state. The majority of the funds that come directly from the Federal Government to Primary Health Centres (PHCs) in the country will now go straight to the Ministry of Health.

Above all, the Federal Government, through the Minister of Health, in a collaborative effort with the state government has chosen Oyo State as one of the centres for VVF (Vesico Vaginal Fistula) care. It is a centre that would treat young women who have leakages from their urinary bladder during child delivery. The Southwest’s six States and the Federal Government have decided that Ibadan will be the centre for the repair of these VVF cases. This will reduce the morbidity and mortality that come about as a result of such cases.

Polio has been eradicated in Oyo State; malaria case is now at forty-three percent in terms of incidence. Oyo State has distributed about 3. 4 million treated mosquito nets in the past one-year, and about 8.4 million since 2013. We now have a reduction in the malaria rate by forty-three percent. Measles that used to kill our people is now less than 10 per cent. It used to be 30 per cent before Governor Abiola Ajimobi assumed office.

There is the contraceptive prevalence rate (CPR), which is calculated to know the number of women who are using birth control. The reason why birth control is very important is that we want death through birth deliveries to be drastically reduced in Nigeria. The incidence used to be about 526 deaths per hundred thousand births, but it has now been reduced to 256 per hundred thousand. Oyo State has built four maternal and child health hospitals in the last one year; we have three in Ibadan and one in Saki. We want to ensure that we become a State of Excellence that can treats infants and women at childbirth. We have done a lot.

To cap it up, what state do you hope to leave healthcare delivery in Oyo State by the time your present tour of duty is over?
By the grace of God, before the terminal date of the administration in 2019, we would have brought Oyo State hospitals and healthcare delivery centres into international best standards, meaning that when patients come they will get the best care available in any part of the world. That is our ambition. It is the ambition of the Governor and our aspiration. And I am confident in the Almighty God because the Governor doesn’t like excuses, and I the Commissioner for Health do not like excuses, hence we have two firebrand personalities who are interested in moving Oyo State forward. I am glad we have an able Governor who is the leader of a new Oyo State and I am thankful to him that he has brought me in to make a difference, in terms of moving health care delivery forward in Oyo State.

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