Good morning. It is a pleasure to join you to present the Goodwill Message of Mrs Toyin Ojora Saraki, Founder-President of the Wellbeing Foundation Africa (WBFA), Global Goodwill Ambassador for the International Confederation of Midwives (ICM) and Special Adviser to the Independent Advisory Group to the World Health Organization Regional Office for Africa.

Thank you to Dr Tunde Segun, Country Director for MamaYe! Evidence for Action, for the kind invitation to join you today on this 7th MamaYe Day, to discuss such an elemental and yet crucial aspect of health care service deliver: accountability. 

According to the Global Strategy For Women and Children’s Health, the tracked indicators in Nigeria are some of the worst in Africa, with one of the fastest growing populations globally: our population is likely to reach 440 million people by 2050. We know the key issues Nigeria faces: from having the second largest number of people living with HIV, the highest burden of malaria globally – which remains the top cause of child illness and death – to having the second highest burden of stunted and malnourished children in the world. 

To achieve accountability in health service delivery, we must be able to accurately assess the demographic need for health: which necessitates a well-designed civil registration and vital statistics (CRVS) system. Only with the collection and dissemination of accurate data can we hope to ensure effective delivery, evaluation and monitoring of sustainable, effective public health strategies. 

In the late 1950s, Professor David Morley developed the ‘Road to Health’ chart in Nigeria for monitoring the growth of infants and young children. This home-based chart was originally designed to monitor growth in resource-poor countries, but developed into a record of a child’s growth and development, kept by parents – it was revolutionary in its time. At the Wellbeing Foundation Africa, we took that concept and 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. 

This forms part of what I call the value of a statistical life. Without a centralised health database for many families to rely upon and 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 mothers’ hands, and empowered her to provide, analyse and follow-up on her own data – to be in control of her own situational analysis. Home-based records have since been successfully deployed in countries like the UK and Japan.

Registering births and linking birth registration to vaccinations is an important part of CRVS and social accountability. Nigeria is currently battling with a situation where only 1 in 4 children, of our population of 198 million citizens, is immunised against preventable diseases. The Global Alliance for Vaccine and Immunisation 
(GAVI) has revealed that despite considerable investment – of about $700 million – we only have total immunization coverage of around 30%. CRVS would allow us to hold Governments accountable for their policy, spending and distribution decisions – including in cases such as this. 

At the United Nations General Assembly in New York last September I attended the launch of the IAP report ‘Private Sector: Who is Accountable.’ That report rightly called on governments, parliaments, private sector partners and multilateral agencies to establish effective accountability systems. As I noted at the time, only two countries in Africa have met the Abuja declaration to pledge 15% of their government budgets to health. Meanwhile, tuberculosis kills more than 4,000 people every single day. This can be avoided – and there are five key interventions which would take us far closer to delivering the 2030 Agenda and achieving universal health coverage:

1. Civil registration and vital statistics systems must be implemented and strengthened to allow Governments to prepare for epidemics and allocate investment where it is needed the most. CRVS is the only way to ensure that we leave no-one behind. 

1. Investment in family, community and primary healthcare – along with hospitals where needed – to bolster healthcare wherever people need it; in rural areas and urban, cities and villages.
2. Government investment in strengthening health insurance systems is also paramount to achieving Universal Health Coverage – in Nigeria and around the world, too many people are plunged into poverty by health emergencies that they or their families experience.

1. Non-communicable diseases kill over 41 million people every year. The Director-General of the WHO, Dr. Tedros, has rightly highlighted the NCD crisis and it must be a core focus of all Government programmes. Strengthening the primary health tier is key to prevention, detection and treatment of NCDs.

1. Finally, and most importantly, the murder of young midwife and mother Saifura Hussaini Ahmed Khorsa in Nigeria last year must spur Governments and global institutions on to strengthen security provisions for frontline health workers, in particular those who work in fragile humanitarian settings. Women and newborns are the most vulnerable in humanitarian and fragile settings where quality midwifery education saves lives by preparing all midwives to prepare for and respond to emergency health situations. 

We know that the road to universal health coverage does not rest upon singular interventions, but rather on a plethora of interconnected  interventions and initiatives; from water, sanitation and hygiene standards in healthcare facilities to breastfeeding education and training for healthcare workers. In a country as large as Nigeria, resilience throughout the whole nation’s system is necessary if we are going to be able to tackle critical health emergencies in fragile settings, for example in the north-east. That is why a strengthened primary health care system is imperative as the foundation and bedrock of achieving health for all and should be a focal point for investment. 

Thank you once again for the kind invitation to join you today, and I look forward to working with all of you for stronger, more accountable, and safer health systems. 

Protocol:

1. E. Aisha Muhammadu Buhari First Lady, Federal Republic of Nigeria

UN Deputy Secretary-General,  H. E. Dr. Amina Mohammed [NB possible video address]

Executive Director, UN Women – Ms. Phumzile Mlambo-Ngcuka [NB possible video address]

Mme. Bineta Diop AU Special Envoy on Women, Peace & Security

Ms. Glory Ohagwu, OAP, Voice of Nigeria

Ms. Comfort Lamptey, AWLN Nigeria Steering Committee by the UN Women Country Representativ

1. E. Bernhard Schlagheck, Ambassador of Germany  Dr. Tunji John Asaolu

Country Representative, African Union Mr. Edward Kallon

UN Resident Coordinator Senior Special Adviser to the President on SDGs  

Honourable Minister of Women Affairs and Social Development

Excellencies, Honourable Ministers, Ladies and Gentlemen:

Thank you to Ambassador Nkoyo Toyo, Chairperson of the Steering Committee of AWLN Nigeria, for your presentation and for your leadership.

Thank you also to the Federal Government of Germany, the African Union, UN Women, and all partners and stakeholders who have made this historic moment possible. 

As we mark the launch of the African Women Leaders’ Network Nigeria Chapter, I urge all of you to look around at the women who have joined us today. We are surrounded by women leaders: role models for women all around the country. As we navigate the way forward, which will sometimes be arduous, I know that we can look to this strong network of sisters to forge onwards together. 

All of us here know, however, that leaders are not bred in a day. Over the next year, and beyond, it will be essential for us to map and demonstrate the talent that we have in this country – superbly talented women leaders – but also to communicate the challenges and barriers faced by women which must be overcome for us to stand shoulder to shoulder with men at every level, in every country, in every region around the world. That is why the national and regional consultations which will be undertaken by AWLN are so important, as part of a wider effort to identify the true demographics of Nigeria. If we can discern the population for the purposes of an election, we must also be able to establish a comprehensive civil registration and vital statistics system, which allows us to allocate resources accordingly for health, community-engagement and infrastructure. 

Only with that understanding can we effectively implement the necessary investments through the life course of a girl and woman. Gender development, if done effectively and led by local communities, will breed women leaders. 

Since 2006, Nigeria’s National Gender Policy has outlined women’s right to equality in economic, social and political life, and seeks to increase women in elected and appointed positions to 35%. We know that we are far from that goal – indeed, going into February’s elections 1668 men and 232 women were vying for 109 senatorial seats, whilst 4,139 men and 560 women were aiming for 360 seats in the House of Representatives.

Political aspirants must be empowered to take part in elections, and as we look to the future, we must also ensure that all citizens can stand and safely vote in elections. In Nigeria today, that is made all the more difficult by displacement and violence. The alarm was rightly sounded by the UN last year regarding the displacement of thousands of Nigerians – 80,000 people were displaced from North East Nigeria between last November and February, in addition to the two million people who had already been displaced by violence or forced across Nigeria’s borders as refugees. All of us here today know the detrimental effect that fragile humanitarian settings have on our citizens, particularly on young people and women, regarding their health, education, chances of realising their potential and ability to engage in the democratic process. 

Given the detrimental effect of conflict and other structural issues on women’s participation in politics, it is no surprise that one of the EU’s seven priority recommendations following its observance of the elections this year was to introduce a legal requirement for political parties to have a minimum representation of women among candidates, and for parties to be required to have policies and provide regular information on the promotion of women’s political participation within parties, as candidates, and more widely. The EU also recommended that INEC publishes a framework for the electoral participation of internally displaced persons before the start of any voter registration exercise and ensure its full and consistent implementation, and that INEC undertakes regular consultation with displaced persons and provide updates on plans for their inclusion.

We have much to be positive about, however. I recently returned from delivering a series of high-level interventions at Women Deliver 2019 in Vancouver, the world’s largest conference on gender equality and the health and rights of girls and women in the 21st century, bringing together thousands of advocates to explore the solutions to achieve a more gender-equal world. I was inspired by my African sisters, from the President of Ethiopia Sahle-Work Zewde to Rwandan Minister of Health Dr Diane Gashumba; to the young female activists from around the world, as we shared our experiences, hopes and determinations for the future. Africa is leading the way – Nigeria must step up and take its rightful place. 

There are also many ways to carve that future and many ways for us to serve. I have, for example, accepted the invitation to serve on the steering committee of the International Conference on Population and Development (ICPD) Programme of Action, which will be held in Nairobi, Kenya, from 12-14 November, 2019. This year marks the 25th anniversary of the ground-breaking International Conference on Population and Development, which took place in Cairo in 1994. We will bring together heads of state and ministers, parliamentarians, thought-leaders, technical experts, civil society organizations, young people and people with disabilities, business and community leaders, faith-based organizations, international financial institutions, academics and thousands of others interested in the pursuit of reproductive health and rights. Our goal is to achieve a world where no woman or girl dies from preventable complications in pregnancy or childbirth:  where no woman has to give birth without the help of a midwife, nurse or doctor. We must forge a world where no one is subjected to violence because of their gender, where no girl is forced to marry, where no girl or woman is subjected to female genital mutilation or other harmful practices.

In conclusion, I will return briefly to politics. This year, despite its challenges, was in many ways unprecedented. Both main parties had very strong, women led campaigns – Her Excellency Aisha Buhari’s 700-women-strong campaign for the APC and the grassroots women for Atiku campaign were historic, and noted for their calls to end election violence. Let us build on that, remove the barriers to women’s leadership, and restore the bridges to Nigeria’s productivity. Thank you.

Distinguished guests, members of the media, Daily Trust Journalists, Ladies and Gentlemen, my fellow Africans: good evening. 

We are here to celebrate and honour the extraordinary endeavours of a group of young Africans this evening, who serve as an inspiration to us all. 

It is auspicious that we do so at the invitation of the Daily Trust. Indeed, this evening serves to remind us of the importance of a free, fair and inquisitive press to a thriving democracy and a healthy society.  

The events of recent weeks have brought to my mind Nelson Mandela’s address to the International Press Institute Congress in Cape Town on 14th February 1994 – and I quote: 

“A critical, independent and investigative press is the lifeblood of any democracy. The press must be free from state interference. It must have the economic strength to stand up to the blandishments of government officials. It must have sufficient independence from vested interests to be bold and inquiring without fear or favour. It must enjoy the protection of the constitution, so that it can protect our rights as citizens.”

“It is only such a free press that can temper the appetite of any government to amass power at the expense of the citizen. It is only such a free press that can be the vigilant watchdog of the public interest against the temptation on the part of those who wield it to abuse that power. It is only such a free press that can have the capacity to relentlessly expose excesses and corruption on the part of government, state officials and other institutions that hold power in society.”

At a pivotal time for democracy and freedom in our country I commend the Daily Trust for hosting us this evening as we celebrate African excellence – and for tempering the appetite of any government for power at the expense of the citizen, for exposing excesses and corruption and holding authority to account. It is not an easy task, nor free of danger, as we have seen so recently. I know that you will continue to be the mirror Mandela spoke of that day in Cape Town. 

The winners of this evening’s award – Stacy Owino, Purity Achieng, Ivy Akinyi, Synthia Otieno and Macrine Atieno from Kisumu, Kenya – have also sought to rebalance power structures for the good of citizens. They have bravely put agency in the hands of women and girls, restoring not only hope but establishing a concrete link to medical and legal assistance. 

We know that FGM has no health benefits for girls and women, and in fact can cause severe bleeding, cysts, infections, as well as complications in childbirth and increased risk of newborn deaths. This human rights violation has affected more than 200 million girls and women alive today. 

I have long been inspired by the work of young women in Kenya, who promote the alternative rite of passage to bring the whole community on board with the health and choices of girls and women. In 2017 I joined Amref Health Africa as it launched its vision to eradicate FGM by 2030. By then the alternative rite of passage method had already saved more than 10,000 girls and women from FGM. Most recently, at the family planning conference in Kigali in November, I met with young Kenyans who, like our award-winners this evening, had a passion to empower their fellow African women, girls and communities. 

Here in Nigeria, we also have talented and passionate young people who can overcome the obstacles faced by our fellow citizens. But they can only do so if we end gender violence and the intimidation which threatens to throttle democracy.

We must raise awareness on the urgent need to stem the apparently rising rate of politically motivated violence that is occurring as the various parties conduct their campaigns across our beloved nation.

In the last week alone, we have seen reports of campaign violence occurring in Lagos State, Imo State, Kogi State, and Kwara State, with many cases of grievous injuries and deaths.

In all these cases, the violence was reportedly wrought by APC supporters, on civilian citizens, and sometimes even on themselves.  

We have heard directly from women in Kwara State, who cried out to the public and religious leaders, that when they were attacked in their homes at the Agbaji, Ilorin West LGA Ancestral Quarters of the Senate President, these attacks were evidently carried out by “supporters” of an APC factional candidate, while the nearby Federal Government security forces simply watched with folded arms.

We have followed with consternation, a similar eye witness account from Kogi State where a supporter of an SDP Senatorial candidate Natasha Akpoti was killed, again allegedly following APC Supporters campaign violence while security officials did nothing.

This gives us great concern for the safety and security, and indeed the human right to democratic suffrage of civilian citizens as an extremely worrying cascade of wilful impunity, which may affect voter turnout particularly for women and youth.

As Nigeria prepares to choose its next leaders, gender-based violence and election violence should be firmly condemned by all, citizens and observers alike.

I therefore call on all to immediately adopt an End Election Violence Advocacy, as a prerequisite to free and fair elections, and to guarantee citizens rights to live and choose their leaders, in dignity, safety and security without fear of intimidation, suppression or retribution from desperate power-seekers. 

Many of those power-seekers have failed Nigeria. Since 2015, 9.9 million Nigerians have lost their jobs. 2 million have been affected by Boko Haram and Herdsmen crises, making us the most terrorised country in the world. 

We now have the highest number of road fatalities in Africa and are the poverty capital of the world. Our direction of travel should cause consternation to anyone who believes in the dignity of human life. On our current path, by 2021 we will overtake India as the world capital for infant deaths. Meanwhile, our electricity supply is the second worst in the world – only Yemen is worse. And what of the future? 13.5 million Nigerian schoolchildren are currently out of school, as investors flee Nigeria, taking $2 billion with them. Our debt has grown by $11.47 billion over the past three years. What a legacy for our children to inherit. It is a legacy we must all work to change. 

My call for an end to election violence comes from the knowledge that we have been cursed quite recently with this plague. More than 800 people were killed in northern Nigeria in three days of rioting, started by supporters of the main opposition candidate at the time. The protests degenerated into violent riots and sectarian killings in the northern states of Adamawa “Land of Beauty, Sunshine and Hospitality”, Bauchi “Pearl of Tourism”, Borno “Home of Peace”, Gombe “Jewel in the Savannah”, Jigawa “The New World”, Kaduna “Centre of Learning”, Kano “Centre of Commerce”, Katsina “Home of Hospitality”, Niger “The Power State”, Sokoto “The Seat of the Caliphate”, Yobe “The Young Shall Grow”, and Zamfara “Home of Agricultural Products”. 

Relief officials estimated that more than 65,000 people were displaced.

One would have thought that the violence would make us all vow to avoid any chance of a repetition of those disgraceful scenes. I fear that that has not been the case, however. Only a year later of that same candidate stated: “If what happened in 2011 should again happen in 2015, by the grace of God, the dog and the baboon would all be soaked in blood.’’ 

Today I say something quite different – if what happened in 2011 should happen again in 2019, Nigeria will need the grace of God to heal the land. 

Regardless of party affiliation, election violence is never acceptable and will never solve the issues we face as a nation. As President Jonathan so rightly said, electoral success is not worth the blood of any Nigerian.

Let us work together for a healthier, safer and freer Nigeria. Congratulations once again to the awardees this evening and thank you for your inspirational work. 

Thank you to the United Nations in Nigeria and to the Federal Ministry of Women Affairs and Social Development for the invitation to join you here today. More importantly, as we reach the end of the 16 Days of Activism to End Violence against Women and Girls, thank you for the work that you do every day of the year to foster better and safer lives for all of us.  

Since 1991, we have marked this period, from 25 November – the International Day for the Elimination of Violence against Women, to 10 December, Human Rights Day. We learn from our sisters around the world and apply those lessons to our own communities and countries. 

All around the world, women and girls are coming together. We come together to share stories – sometimes to say, “Me Too” – and to support each other.

We also come together to say: enough. It is time to end the violence. 

Globally, conversations are changing and women are taking the lead. Just look at the #MeToo, #TimesUp, #Niunamenos, #NotOneMore campaigns – the level of anger and recrimination barely scrapes the surface of the endemic and institutionalised dangers that we face and have always faced. 

In Nigeria, we are blessed with brilliant women who, despite significant hurdles, are entrepreneurs, doctors, teachers, politicians, and care-givers. The midwives of the Wellbeing Foundation Africa, of which I am the Founder-President, constantly inspire me with their dedication and impact. We are also, however, not under any illusions about how far we have to go to ensure that we as women, and our daughters, are safe and free to achieve whatever our potential may be. 

Two days ago at the UN Women Conference in Lagos, Edward Kallon, UN Resident Coordinator in Nigeria, announced that Nigeria ranks 11th among the twenty countries in the world with highest prevalence of child marriage. Mr Kallon pointed out that 700 million women alive today were married as children, of whom 17 per cent of them, or 125 million, live in Africa. Inaction will lead to the number of child bridges in Africa doubling by 2050. 

We know that ending child marriage and investing instead in girls is not only a moral obligation, but benefits all of society. A girl who is married is almost always taken out of education and can never reach her full potential. Better educated women are healthier, earn higher incomes, have fewer children, and enable better health care and education for their own children. In turn, education for girls helps lift families, communities, and nations out of poverty. The UN estimates that gender inequality costs sub-Saharan Africa on average $US95 billion a year. 

Girls’ education goes beyond getting girls into school. It is also about ensuring that girls learn and feel safe while in school; are able to attend schools which have the right water, sanitation and hygiene standards to cater to their needs, and are able to contribute to their communities and the world. 

In 2014 I attended the first Girl Summit, hosted by the United Kingdom, which aimed at mobilising domestic and international efforts to end female genital mutilation (FGM) and child, early and forced marriage within a generation. That first Girl Summit was predicated on the fundamental belief that girls and women have the right to live free from violence and discrimination. That same year, as a recent signatory of the Girl Declaration, I hosted a panel in Lagos entitled ‘Our Future: This is the moment to invest in girls. It has always been clear to me that girls’ education must be a priority for all Governments, NGOs and private partners.

The battle does not stop once a girl reaches adulthood, of course. Close to a third of all Nigerian women have experienced physical violence, which encompasses battery, marital rape and murder, at the hands of their partners. But due to social conditioning, 43% of women believe a husband is justified in beating his wife for a number of reasons, including going out without telling him. Thousands of women and girls who survived the brutal rule of Boko Haram have since been further abused by the Nigerian security forces, as exposed by Amnesty International earlier this year. Midwives and nurses who go to help those most in need have been kidnapped – some have been executed. 

As we reach the end of the year, it is inevitably a time for reflection. If any sorry tale from 2018 has epitomised how vulnerable our girls are and the fragility of our social contract, it is the story of Ochanya Elizabeth Ogbanje.  Ochanya had allegedly been abused by her guardian and his son since she was eight years old. She developed Vesicovaginal Fistula (VVF) and attendant complications. Ochanya died at the age of 13 years old. 

Gathering here today, as we seek to bring about the end of such violence, we have to ask ourselves some tough questions. How many Ochanyas do we have in Nigeria, suffering in open sight, yet unseen, unmet and unprotected? What value do we attach to a standard Nigerian life from birth to age let alone the value of a female life? What is Nigeria’s VSL or value of a statistical life?

The answer to finding and helping our Ochanya’s lies in the full commitment to a comprehensive Civil Registrations and Vital Statistics Framework, from which information and actions could flow, from birth to age.

What are the social safety actions that would flow if an appropriate CRVS protocol was in force? 

If Ochanya had been registered at birth, immunised and recorded as such, registered in school, if the persons appointed as her loco parentis had been registered, wouldn’t her disappearance from formal education have been noticed? If we had an active social service framework rather than the instalment beneficiary system, would a trained social worker not have called on the foster family to check on Ochanya? Would they not have noticed sudden maturation of physical mannerisms that is a marked symptom of sexual molestation of a minor?

When we pray for Ochanya, we do so because her suffering was cruel and because it deprived her of her rights: a happy and safe childhood, the right of a warm family life, the right to become an adult at the appropriate time. The right to be a girl. The right to become a woman.

We also pray for Ochanya because we know that there are countless girls like her across Nigeria. Girls who are not allowed to be children, who are treated not even as second-class citizens. 

I will close today by alluding to the work of the Wellbeing Foundation Africa, whose midwives I mentioned earlier. The health for mothers and infants was the key objective of the Foundation at its inception. Its scope rapidly expanded however, as I soon realised that we cannot confine our actions to our supposed speciality; legislative change, gender equality, maternal health, education and health security are so closely interconnected. To make a sustainable impact and truly open up opportunities for women in Africa, we must reach across borders, knowledge-bases and cultures.

That is exactly what the Foundation achieves through its pioneering ‘MamaCare Classes’ led by our qualified midwives. Some of those classes take place in IDP camps, a frontline for women and their infants. Despite dire mortality rates here in Nigeria – where women face around a one in thirteen risk of maternal mortality in their lifetime – we have not lost even one of our over 250,000 MamaCare mothers during childbirth. Our MamaCare midwives have achieved this not only by providing classes to a global standard – and achieving the new WHO benchmark recommendation of at least 8 antenatal visits – but also because they act as even more than lifesavers. They provide safe spaces and safe conversations: no subject is taboo or off-limits. To unlock the potential for women and girls, our first obligation is to ensure that they are safe and healthy. The Foundation campaigns, advocates and teaches, with global partners, across a wide range of issues which are all essential for women, from water, sanitation and hygiene to accessing STEM subjects and personal development. 

It is by breaking down the sense of a taboo, opening up new conversations and investing in women and girls that we will finally end the violence and create a brighter, safer world for us all. 

Thank you again for the kind invitation to join you here today.

God Bless.  

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. 

Good morning and Happy Handwashing Day!

Before we get down to the very important business of the day, I would like to thank a number of people. Firstly, thank you to our partners at Unilever Lifebuoy, with whom we are committed to reaching 2 million children over the next year, teaching them proper hand hygiene techniques. It is a special partnership, one which is founded on a passion for saving lives through improved water, sanitation and hygiene. Your work all over the world has been an inspiration and I am delighted that you are now here in Nigeria. Together I know that we can not only educate but advocate for the drastic improvements in WASH standards that we know are necessary. Thank you also to Omawumi. Unilever Lifebuoy and this partnership are so very lucky to have you as the brand ambassador. For you to use your star status to get the key messages across to a wider audience is wonderful. You truly are a ‘Wonder Woman’ – thank you. 

Thank you to the staff here at Command Primary School for hosting us today. By doing so you are providing a great service to your students and your community. Handwashing with soap is a highly effective way to prevent the spread of disease and save lives. It will keep your students healthy and make sure that they don’t miss any lessons! 

Most of all I say thank you to the students. Not for being here today: I am a realist and I am quite sure that your teachers have instructed you to attend! However, I would still like to thank you for what I hope that you will do after today. If you pay close attention today, you too can be ambassadors for good handwashing. 

You are about to be taught a very important skill. It may seem a simple one: but it is life-saving. It is a skill you should share with your friends, your parents and your whole family, because it will keep them and you healthy. There are some things that are very dangerous that we cannot see. Washing those things away means that we don’t pass them on to other people or make ourselves sick. I have been told that you are all excellent students so I am confident that I can count on you to all be brilliant handwashing ambassadors – to tell everyone you know how to do it properly, when the key occasions to wash your hands are, and to tell off anyone who does not do it! Am I right?
I certainly hope so. Thank you again and let’s do some handwashing!