How would describe your time in Nigeria?
It’s been exciting. In August it will be four years I have worked in Nigeria and, like they say, time flies when you are having fun. The high points of my tenure were the times that you witness the change that you advocated for. It is more gratifying when the change that impacts positively on children is a systemic change, because UNICEF as an organisation desires social change. One area we have made impact is the issue of improving the nutritional status of children in parts of the north. There were children that required special support to grow well and the states were able to provide the support in collaboration with UNICEF. We have established hundreds of centres that helped mothers to get their children healthy again. It’s gladdening because we have the commitment of communities and the government, and when you have such level of cooperation, you are assured that an intervention will work.
As you leave Nigeria, how would you assess the impact of the interventions targeted at reducing infant-maternal mortality?
I have worked in a number of countries and one thing that happens when it come to high infant-maternal mortality rates is that it get to a certain level, then it starts to drop. Nigeria hasn’t gotten to that level where the mortality rates starts to drop. The best way of collating data on infant-maternal mortality rates is by carrying out surveys and surveys are carried within two to three years. This explains why we cannot say Nigeria has reached that point when its high infant-maternal mortality rate will soon come crashing down. It will take several surveys to see if Nigeria has started moving to the right direction. From recent surveys, we can see that though there has been an improvement in making health services available, not all children have been reached with the services. Some children’s homes are too far from health centres; in some cases the children whose homes are close to service providers still don’t get the services. In some instances, the service providers complain about poor response from the communities. Yet, I can say that a lot of things have been put in place to put Nigeria on the right path. The Maternal and Child Health Week (MCHW) is held twice a year in May and in November. The important thing is for the families to keep pushing for these services. The service providers also need to keep pushing for mothers to avail themselves for life saving interventions. The way Nigeria can reduce the deaths of its children is to understand that it will not be done through the hospitals alone. Nigeria should adopt programmes that have been scientifically proven to keep children healthy by taking care of ailments at the stage that they can easily be managed. Four things are key, and they are routine immunisation, de-worming and good nutrition which is largely good Bosom feeding routine and affordable local food. The last thing has to do with providing communities with clean water and a hygienic environment, which largely has to with families having basic amenities like a clean toilet.
How can we scale up interventions on the four interventions you highlighted because we already them in place?
I have been having my farewell meetings with policy makers. I shared my observation with them, which is that Nigeria is such a diverse country and one policy does not work for the entire country. This is because what works in one part of the country might not work elsewhere. I have worked in many countries where you change your method of providing service according to the local realties. For example, there are places where you can provide a small refrigerator where you call store your vaccines so that you can provide immunisation services daily. But in places where you cannot provide a small refrigerator, you can provide immunisation monthly using a cooler with ice to store the vaccines. All you have to do is to inform mothers to come for the vaccination on the set date. There are many countries that have done this with good results. China adopted this approach to reach the rural population in the 90s. So policy makers need to think of ways to design and implement programmes in a way that the differing situations across the country are taken into cognisance.
Another area that UNICEF worked in is the PMTCT (Preventing Mother-To-Child Transmission of HIV). Are you satisfied with the results with the country recording a high incidence of pediatric AIDS?
We have several programmes that we are executing with partners in many states. One thing is sure: we need to take PMTCT services down to the rural areas. We cannot stop at the secondary hospitals; we have to take this service to Primary Health Centres (PHC). States also need to map out the places where they provide PMTCT services so they know which locations to set up new centres. States must monitor and plan for PMTCT in a systemic manner. States need to pay attention to details. It’s not about policies and good intentions, we have to watch what is happening closely and, by this, I mean paying attention to details.
How would rate your collaboration with government agencies?
UNICEF has worked closely with government agencies. We’ve had a good relationship that gives me confidence to speak with policy makers in less formal settings. What is very important about Nigeria is that it’s a federating country where you have to relate with the federal, state and local councils. I have spoken to governors and they are happy to hear scientific evidence that is the foundation of our policies. I don’t burden them with too much scientific evidence but I just explain why, for example, children need Vitamin A. What I have seen is that, in implementing policy, the Federal Ministry of Health has to interact with states and local councils and this makes their job a little more difficult than other ministries.
How would rate the results from the programmes targeted at reducing malnutrition?
I would agree that nutrition needs more attention than it’s given, especially in areas where food production issues affect malnutrition. We have the acute and chronic malnutrition. We have done a lot of work in the area of acute malnutrition. We have established over 300 centres in 11 states where the mothers and children can get therapy in a affordable manner. They don’t even have to be on admission. No doubt it is good news that children can get treatment. But it’s important that we take care of children in a way that they don’t get to that stage where they need treatment. Right now with support from donors like the EU, UK and Japan, we can provide these services. But it is expensive to treat the children so we cannot present the same numbers each year for treatment, and this makes it imperative that we ensure that children don’t get to the stage that they become malnutritioned. Government can monitor grain prices to make them affordable. It can encourage farmers to produce food crops not only cash crops. Government can also ensure that routine immunisation works. Mothers should Bosom feed rightly. What we really need is a multi-sector approach to preventing malnutrition.
Why haven’t we kicked out polio?
When you have an operation that is so wide and needs many people, you have to pay attention to details. You have to plan and monitor the implementation of programmes, especially in the polio eradication drive. We are working on having 2,000 community mobilisers across the country because its difficult bringing in outsiders to explain to a community who don’t understand why they need to immunise their children. These mobilisers will be educating mothers not only on the importance of polio eradication, they will inform mothers about other vaccines. They will educate them on hand washing and other ways their children can stay healthy. We are hoping that the element of mobilising mothers on hygiene, immunisation, nutrition and preventive care would produce results. One important thing about polio is that the disease is found in communities that haven’t been reached with essential infrastructure. And so my call has also been that when you find polio in a community, people can take investments to these places. Polio shouldn’t be treated in isolation because it’s a disease that exposes all of our vulnerabilities.
Are there things you wish you could have done differently?
We are beginning to look at how we can work with local governments. For most of the time, we have worked with communities, not LGAs as a whole. I wish we realised the importance of working with LGAs fast. I would have wished that PMTCT services would have moved faster. I do wish that PMTCT services are integrated into antenatal care in PHC faster.
How would you analyse health sector funding? Is it sufficient?
From recent analysis, development partners have come together to call for a two-pronged approach to health sector funding. The first thing is to properly utilise what you have. Secondly, you need more funding. When we say funds should be efficiently used, what we suggest is that funds should be channeled to high impact programmes, because high impact programmes will give the results that you desire. You do not have health budget in Nigeria in the sense that you have the federal, state and LGAs involved in funding health, and each tier channels funds to programmes it deems important. A Nigerian colleague once said that Nigeria spends more per capita than neighbouring countries but they have better outcomes. This brings us to the position that Nigeria has to direct funding to high impact programmes for better results. It’s hard to choose where to channel funds between preventive and curative care, but it’s important to invest in prevention so that you don’t have to spend money on curative care.
How do you remember the bombings? Did it change your opinion about Nigerians?
It didn’t change my view about Nigeria. For me, what happened that day doesn’t signify what Nigerians. Think about the work we do in the country or what we stand for - we are still enthusiastic about our work here. It was a sad event. The only time after that event that I cried was during the memorial service when I saw the UN flag at half mast. I cried because for too many times that flag has been flown at half mast. I lost friends here and in other similar attacks. And all these people wanted to do was to make life better for the most vulnerable in society. We didn’t just lose our staff; we lost people who came to pick documents for the release of vaccines. What saddened me most are the people who had to suffer because they generally wanted to improve the lives of others. The good thing is that within two days, we were back on our feet. We were attacked on a Friday and by Tuesday we started issuing cheques so that activities would continue. We knew that work had to continue immediately because what we do is important work. In life, we get stronger emotional bonds with people who you went through difficult times with. I know that the attack has created a strong bond between me and my colleagues who I worked with here in Nigeria, especially the Nigerians. I will always carry the memories of my colleagues in Nigeria all through my life. We have colleagues who work in the villages to make sure children get vaccinated, that they get the vitamins or that they are treated for ailments such as malnutrition. They are the real heroes. I really love Nigeria. I hope that soon people will be able to say that this country has reached its full potential.
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