Her Excellency Mrs Toyin Ojora Saraki

Wife of the Senate President of the Federal Republic of Nigeria

Founder-President, Wellbeing Foundation Africa (WBFA)

Inaugural Global Goodwill Ambassador, International Confederation of Midwives (ICM)

Panel Discussion: Incentivising Investment in the Health Care Sector in Nigeria

24th Nigerian Economic Summit – “Poverty to Prosperity: Making Governance and Institutions Work”

Date: October 23th 2018 Time:  2:00pm

Location: Transcorp Hilton Hotel, Abuja

Panel:

H.E. Mrs Toyin Ojora Saraki – Founder-President, Wellbeing Foundation Africa

Professor Isaac Adewole, Honourable Minister for Health

Mr Uche Orji – CEO, Nigeria Sovereign Investments Authority 

Dr. Olumide Okunola – Senior Health Specialist, International Finance Corporation 

Moderator: Mr James McIntyre Brown, Health Practice Director, Global Health, DAI

Timings:

Opening – 5 minutes

Presentation – 15 minutes

Panel Discussion – 40 minutes

Audience Participation – 30 minutes

Wrap-up/Next Steps – 25 minutes 

Closing – 5 minutes 

Speaking Notes:

• Thank you to the Nigerian Economic Summit Group and to DAI for the invitation to join you here today and for co-hosting this roundtable. It is important that we are able to have a productive and frank conversation about the existing barriers to investment; how that investment should be fostered, and the benefits for business, Government and the people of Nigeria. 

• • We are fortunate that Professor Isaac Adewole, Honourable Minister for Health, is here to give the perspective of the Government, along with experts from the private sector. It should be clear to all of us here that promoting investment in healthcare in Nigeria must be a combined effort if we are ever to achieve Universal Health Coverage and the resulting demographic dividend.

  • I hope today to bring a combined perspective – from the experience of an NGO operating on the frontlines of health care training and delivery, as Founder-President of the Wellbeing Foundation Africa; from a legislative viewpoint as Chair of the Forum of Senators’ Wives; and from a technical basis as Special Adviser to the Independent Advisory Group of the World Health Organization Regional Office for Africa. 

  • I must begin by sounding a note of alarm. In 2015, world leaders agreed to 17 goals for a better world by 2030. These Global Goals for sustainable development are intended to end poverty, fight inequality and stop climate change, guiding governments, businesses, civil society and the general public to work together to build a better future for everyone. 

  • At the World Health Summit in Berlin last week, Dr. Tedros, Director-General of the WHO,  warned that we are not on target to meet those goals. We will miss the targets on maternal, child and neonatal mortality; we will miss the targets on HIV, TB and malaria; and we will miss the targets on family planning, child stunting and universal health coverage.

• Here in Nigeria, even the direction of travel should cause serious concern. Some indicators, for instance in water, sanitation and hygiene – known as WASH – have in fact regressed. According to the World Bank, Nigeria’s spending on WASH must at least triple if we are to have any hope of achieving the clean water and sanitation goals. These essential factors must be addressed to foster the kind of investment and confidence Nigeria needs. Investors will ask the same questions as all of us. Are we making sufficient progress towards achieving the WASH Sustainable Development Goals? Is a lack of investment in WASH putting the lives of thousands at risk as the spread of Ebola is made more likely? Are women and infants dying needlessly in labour rooms, with maternal sepsis taking a mother’s life at what should be the most joyous time?

• When we ask these questions of Nigeria, the answers are deeply troubling. It is not just the current situational analysis which is so bleak, but also the systematic failures to bring WASH standards up to an appropriate level for our population.

• Last year the World Bank published its appropriately-named report “A Wake up Call – Nigeria Water Supply, Sanitation, and Hygiene Poverty Diagnostic.”  I met with the water team at the World Bank this summer to discuss and analyse its conclusions, which were devastating. Only 29% of Nigerians have access to improved sanitation, and poor children are about four times more likely to get diarrheal disease than rich children due to poor access to WASH. Is this dire situation being effectively addressed? Well, 15% of completed works on public water infrastructure are considered to be of unsatisfactory quality, and nearly 30% of water points and water schemes fail within their first year of operation. Access to piped water on premises in urban areas has decreased substantially, from a level which was already critical. Across most water-utility indicators, Nigeria underperforms in comparison to African and global averages and needs to invest at least three times more than it does today to achieve the WASH sustainable development goals.

• Nigerians, who have to put up with the daily dangers of poor WASH standards, can therefore have little confidence that future generations will be safer than they are. Can they really expect that their children and grandchildren will be able to bring their own children into the world safely, in a clean labour room? That their communities will not be ripped apart by diseases which could have been prevented with decent WASH conditions? WASH is at the heart of Infection Prevention and Control (IPC) and the fact that outbreaks of diseases have been so severe in Nigeria recently – with the WHO commenting that the Lassa Fever outbreak this year was unprecedented – is no coincidence.

• In truth, Nigeria is struggling to maintain its current infrastructure, inadequate as it is for the current population and entirely unfit for the years ahead. Government must lead the way, achieving economies of scale in densely populated areas by providing piped water and not forcing individual families or streets to rely on their own sources. As the World Bank report rightly highlights, this also allows for the proper regulation of groundwater, essential in the fight against pollution. For all of Nigeria, the tripling of current WASH spending is an absolute imperative.

• There have been very recent encouraging signs from the Ministry of Water Resources in Nigeria, but I would like to take this opportunity to ask us all to acknowledge that water, sanitation and hygiene conditions in Nigeria represent a national emergency – and should be treated as such. 

• The issue of security is one that we can also not shy away from. The on-the-ground reality of frontline healthworkers in Nigeria is now known all around the world. Last week International Committee of the Red Cross aid worker Hauwa Leman was murdered, having been kidnapped in March this year along with two other medical workers in Rann, Borne State. Last month another of those workers, a 25-year-old midwife named Saifura Hussaini Ahmed Khorsa, was also killed – a matter of critical and crucial health worker security which I raised for urgent attention, accountability and action at the United Nations General Assembly. 
• It is not the case that Nigeria is entirely unsafe for investment – of course, Nigeria represents a huge opportunity. But we owe it to healthcare workers and investors to create a Nigeria that is safe. Until that is achieved, universal health coverage will always elude us. 
• We must also recognise the importance of a well-designed civil registration and vital statistics (CRVS) system in order to collect and produce accurate data – and thereby ensure effective delivery, evaluation and monitoring of sustainable, effective public health strategies in Nigeria. 

• At the WBFA we designed the Personal Health Record (PHR), a book in which the medical records of each mother and child are recorded and stored for future reference and analysis. The PHR evolved from a child immunisation and growth record to a comprehensive CRVS tool. Without a centralised health database for many families to rely upon to keep them informed of the necessary health processes in a child’s first thousand days of life, the PHR came as an innovation that placed this knowledge directly into the mother’s hands, and empowered her to provide, analyze and follow-up on her own data. A comprehensive CRVS system in Nigeria will enable us to deliver health for all as a measurable demographic dividend, and provide an attractive basis for investment. 
• I have thus far focused on the challenges we face, which are sizable – of that there is no doubt. My experiences of public-private health partnerships in Nigeria have however been hugely positive. 
• Allow me to give one example: the Emergency Obstetric and Newborn Care (EmONC) programme which the Wellbeing Foundation Africa runs in partnership with the Centre for Maternal and Newborn Health (CMNH) at the Liverpool School of Tropical Medicine, the oldest and most established school of tropical medicine in the world, and Johnson & Johnson, one of the largest global health companies.
•  The model therefore brings together an esteemed higher-education institution, the private sector and a civil society organisation – which is of course us.  Our EmONC training takes place in-house and equips doctors, nurses and midwives, as a collective team, with the skills needed to overcome obstetric emergencies.
• Funding from the Johnson & Johnson Corporate Citizenship Trust allows for a three-pronged model from LSTM and the WBFA: (a) direct, skills-and-drills based method of teaching Emergency Obstetrics and Newborn Care, including newborn resuscitation; (b) Data Management training; and (c) Quality Improvement (QI) training. WBFA’s model is based on community mobilisation, advocacy, and strategic policy advisory. 
• The partnership began in February 2015, with the two first phases being active in 7 of the 16 Local Government areas in Kwara State. In February I took representatives from Johnson & Johnson and the Liverpool School of Tropical Medicine to carry out a ground assessment of the training. The demonstrations witnessed by the team in Kwara were wide-ranging and innovative – we were particularly impressed with the simple inexpensive use of a condom catheter balloon filled with saline to control postpartum haemorrhage, the excessive bleeding after birth which is the leading cause of maternal mortality. As we know, 80% of all maternal deaths result from five complications which can be readily treated by qualified and trained health professionals: haemorrhage, sepsis, eclampsia, complications of abortion and obstructed labour. 
• So far, the EmONC training programme has resulted in a 15% reduction in maternal case fatality rate and a 38% reduction in the still birth rate in health care facilities where the project is implemented. 
• Since that visit, we can as partners proudly report that we have moved to the next stage of the programme, as from August 2018 to August 2020 our EmONC training is set to expand across the whole of Kwara State. 
• Between 2018-2020, EmONC training will be delivered to an additional 27 healthcare facilities in the remaining 9 LGAs. Over 600 healthcare providers will be directly trained and over the 30-month project, an estimated 62,900 women and their newborns will benefit from the interventions implemented.
• I use the example of this partnership to demonstrate that the will is there on the side of the Nigerian people – for training, improved healthcare and partnering to improve health outcomes for all of us. Once the correct conditions are in place, the opportunity to achieve remarkable results is there for us all. 
• Primary healthcare is both a critical challenge and a huge opportunity in Nigeria. I have a vision to strengthen primary healthcare centres to the standards of medical referral centres, to deliver costed, insured, and funded community health to a high quality for all. An ambitious goal but one which I believe is attainable, and certainly crucial if we are to achieve universal health coverage.  DAI will, I trust, be part of making that goal a reality. 

• Inextricably linked to that success will be investment in strengthening health insurance systems – in Nigeria and around the world, too many people are pushed into poverty by health emergencies that they or their families experience.

• There has been some progress in Nigeria towards achieving Universal Health Coverage and fostering the investment we need to provide quality, affordable healthcare – I would for instance point to the Consolidate Revenue Fund and health commitments. However, as we meet today here in Abuja, I would point out that only two countries in Africa have met the Abuja Declaration pledge to devote 15% of their government budgets to health. Nigeria is not one of those two countries – which are, incidentally, Rwanda and South Africa. 
• Let us work together to create the conditions for health investment in Nigeria, provide the resulting boost for the economy, and create a safer, healthier and happier country. The national emergency of water, sanitation and hygiene conditions must be addressed. It can – and must – be done. Thank you.