When you heard the news that you have been appointed to head the Agency, what were your reactions?
I felt challenged. For one thing, I was not expecting it. I was busy serving as the Associate Dean of Students Affairs in the University; the very first Associate Dean of Students Affairs in the College of Medicine in the University of Nigeria. I was also working as a consultant Gynecologist with a bias in Public Health where I have my Masters Degree. I have just finished being the Chairman of Nigeria Medical Association (NMA) Enugu State and was now working in the University when out of nowhere, I was directly reached by His Excellency, the Governor of Enugu State Rt. Hon. Ifeanyi Ugwuanyi. I was asked to resume duties as the Secretary of the State Primary Health Agency.
What did you meet on ground when you took over?
I met a Primary Health Agency that was at the rudimentary stage. I noticed that many of the national programmes in the system, the State was not able to pursue them. There were back-longs of programmes and activities. There was this rating of how far the state had gone, in terms of implementing primary health care. The state was poorly rated then as at 2019 when I took over. We were scoring around 43%. But by God’s grace, from that rudimentary level in just two three rooms as offices in the high rising building that you can hardly access, the Primary Health Agency in the state has moved up. That was the state that we met. But His Excellency, the Governor of Enugu State has put in tremendous interest and priority in Primary Health Care in the last 4-5 years. It has been my dream to work with him to re-engineer and revitalize and ensure that Primary Health Care is in top notch. In fact, currently we have good rating among the States, and even in the country.
Recently, we were reconsidered as the 2nd best in Primary Health Care Services across the country (Pointing at Award Plaques, and life-size photo of himself handing a certificate to the Governor.)
So, it has been very challenging, and very engaging too, because the changes we recorded, all the achievements go to the Governor, because he had an idea, he had interest. He first of all came up with a new law. The new law to strengthen the Primary Health Care system in the state. From that new law, he established the necessary agencies and offices. He also did the appointments. He appointed me, the very 2nd Executive Secretary.
He also equipped and relocated us from the high rising building to this befitting office in a whole building in GRA where we have our Coordinating Office. You know our work involves a lot of field work in the communities.
What steps did you take to make things fall in place with your vision and mandate in the Agency?
Some of these things I told you about you have to conceive them, discuss them with the authorities and get a nod. We have been consistent in planning, we sit down and plan. We also have to establish the Agency according to the rule; giving life to the various units and directorates within the agency. So, that the staff and everybody working in the agency can man his or her responsibilities under the law establishing the agency. We took the steps and formed some relevant committees. We had to set up a committee for all the programmes and began to work on implementing it. So, there were huddles, a number of things that we needed to do; trainings and capacity buildings, etc, in order to qualify to start implementing the Basic Health Programmes in each local government. So the state government, the Governor helped us to follow those steps. So, other things we did was that we made law and the rules in the agency. Then we had to work hard to come to work daily, we have Management Meetings once a week to review our activities and keep our staff on their toes.
Since you came in, what structures have you been able to put in place to enable you have a good tenure?
Yes, you see, it is routed in what I have said before. All the six directorates in this Agency are active and functional. We also have requirements that we should have a Board – a Management Board. We were able to discuss it with the government and the Board was appointed for us. And we also instituted an approach where we have Annual Operational Plan for all our activities. We also have our Management Meetings regularly, we also have our review processes. Every programme or process is reviewed on daily bases. Be it a programme that last for a week or two, every evening we review the activity of that day. This is a standard thing we do in our kind of work following a standard system. We also insist in being in very close linkage and guidance with our National Office. That is where advisory level and decision levels are coordinated. And we are also endorsed with our Supervisory Ministry and our government generally for guidance and oversight.
What is the state and level of primary health institutions in the rural areas of the state currently?
Yes, this is one issue that gladdens our hearts to talk about. The extent of the investment in Primary Health Care is, you know very special and unique. This is the only state that is talking about Type3 Primary Health Centres. And you need to visit one of our Type3 Primary Health Care Centres to understand what the governor and the government of Enugu State are doing about Type3 Primary Health Care, the offices, the coordinating system and others. When you come to infrastructural development, there are a number of things that have been put on the ground. In almost all the Local Government Areas that we have , over seven (7) have been completed, of the Type3 Primary Health Care. Each of the Type3 Centres Primary Health has enough spaces and different Wards for males, for females, and for children. Then, there is also enough space for consulting clinics and all the basic things we need to have in Hospitals. Then we have a residence for Doctors and Nurses. And it has its own source of water. Each of them has a borehole water supply, each of them has an independent source of electricity – a generating set that supply light. And it is also spacious. The environment is neat. We have that special Type3 Primary Health Cares in seven (7) different locations serving different communities and locations. And it is done in such a way that already, two Doctors, 4 Nurses, six other Health Care Workers and other support staff , that is about twenty (20) in all have been employed to work in each of these Type3 Health Cares. It is more or less like a game changer. And that is why His Excellency, having seen how wonderful and how well that idea has been to the communities, he had to add more. This year, about 3 new Type3 Health Care Centres are almost completed. We have an addition one in Adani, in Aninri and Awgu. So in the 3 Senatorial Zones of Enugu State, you see Type3 Primary Health Care Centres doting the areas. Now at the National level, this model is trying to be emulated.
What are the outstanding achievements you recorded since you took over, and recognition in terms of Award?
One thing that stands out in our group coverage is immunization. All these implementation of Basic Health Education Fund, we are using it to recruit more Nurses. Also there is what we call Health Promoters that we are training. We call them chips; chips agents. We are training them, and they are now moving into the villages to talk about health. So, bringing Enugu state fully into implementation of Basic Health Care has helped us a lot. Having the support of the governor that is doing both the infrastructural and manpower renewal in primary health care system has helped us a lot. Meaning, up to date with our programme and health care activities has also helped us a lot. And these are things we can beat our chests and say; “we have done well”. And these are things that give us the good rating that we used to win the awards. This year we have gotten two awards. Late last year, Radio Nigeria in South East recognized this Agency for her Excellent Response to Covid 19 Pandemic. A Coalition of Non-Governmental Organization called ‘One Campaign’ rated the status of Primary Health Care across the country, and Enugu state came 1st among all the states, coming 2nd only to Federal Capital. But among the states, we were the first.
The Association of Resident Doctors and Association of all Health Workers in the state have all come to give recognition awards to the work and activities to this Agency. You can see some of those Awards on the shelf.
Do you have enough qualified personnel in your agency, especially in rural areas to execute your programme? What is their level of cooperation and performance ?
Yes, in the Health Care system, the issue of personnel is a dynamic and challenging thing. It has been a challenge, but we are happy that the government is rising to it. We are one of the few states recruiting health care personnel at the primary level, and also our Basic Health Development Fund, and extended Midwife Service Scheme to supplement. That is why I told you about the Midwives that we have engaged, and another 37 Nurses and Midwives we are planning to engage in Type3 Primary Health Care Centres. But I won’t say that they are enough. We still need more. Now you can see that the health system in this part of the world is challenged by the exit of Medical and Health Personnel. So sometimes, as we are getting them, some are leaving.
What is the role of your governor and the Health Commissioner in making your effort successful?
These are the core people supervising and supporting us. Our Cmmissioner has been quite supportive. The governor is particular about Primary Health. He will not allow us to have any respite. In fact, in one of our programmes, we were wailing for Vaccines and other things we needed to arrive from the National Health Office. The governor was even asking; “Do you have enough? Do you need to buy?” We said “No your Excellency, these things are brought from the Ntional. They have their international practice.” He said; “We are ready to go all along to make sure that the citizens of this state are happy.” That is why I prefer describing him as Health Care loving governor of Enugu State. His attention to Health, investments in health in all ramifications is extraordinary.
Any external contributions that you can give credit to?
A lot of it. You see, Primary Health Care is about the Community. It is not something you do in isolation, maybe you stay in one small environment. Like this our Enugu Office, it is just a coordinating office. We move around to towns and villages. We are doing our work with the Primary Health Agency guidance and operations. They give us the technical guidance. We are also doing it with development partners; WHO, UNICEF. They even have to provide the tools we work with in some instances, supported by the state. So, we give credit to all these people. Then when we come to reach the people, we have to rely on the Community Leaders. We work with Traditional Rulers, we work with Community Leaders, we work with Religious Leaders because you can’t penetrate the community and serve them well, and get numbers without working with their leaders. So, these are the people you cannot stop thanking. I am very grateful working with parents, mothers, care givers who make their children available for us to vaccinate them. And also the Media.
What are the problems you are still facing in this Agency?
We still need more manpower. The Health system needs more manpower. And we are coming up with the idea of how to improve on our supervision and oversight. This is because it is not easy to look after the Primary Health Centres across the entire state. We are now planning to find ways to digitalize our system. We have teams for supervision, but sometimes they get overwhelmed , and we also have challenges sometimes with human attitude, because these things involve coordination of interest and a lot of people. So, some people might be late and do not do things exactly the way you want it. So these are all the things I am battling with, and trying to find newer ways, and newer approaches of doing it and getting it better.