By Bodunrin Kayode, who was in Maiduguri
Reporting the health sector within the web of humanitarian crisis in Northern Nigeria is no mean feat, requiring empathy for the people who are at the mercy of the terrorised health sector in Borno state and North Eastern Nigeria. This sector is so important to humanity that each time the insurgents plunder primary health centres, they cart away the drugs and skilled workers before bringing down the structure by fire, indicating that even the wrong doers in the bush know the value of health.
Prying into the Borno Health Partners Forum
Attending the Borno health partnership forum is not about reporting on what transpires but as a contribution to rebuilding the infrastructure in the sector that has been battered by 14 years of insurgency.
The “risk communications” subsector, where massive enlightenment is given to the people whenever emergencies, like the sickening cholera outbreaks, the diphtheria scourge that claimed 67, choking the medical practitioners, has had its own chaenges.
Sadly, the ” risk communication pillar” is one of the most badly managed pillars because the bankrolling world partners refuse to allow the Borno State Government to lead as it should.
Representatives of the two world health bodies have rather decided to turn themselves into a cabal or a caucus who meet separately and impose their decisions on the rest of the partners regardless of the interest of the state commissioner, who is represented by the incident manager (IM) at any given time. That itself has created a shaky foundation for that pillar and the lingering lacuna strips them bare whenever their own managers are in need of action or solutions in certain ways.
The only pillar which has not existed in the last seven years is that of “security” which will go a long way to act as a liaison between the military, police and the health sector. But with the evolution of the sector over the coming years, we would soon have a sitting security personnel who would be an instant reference point whenever challenges of that nature fall on the table of the IM.
It’s also time to begin to analyse, on a yearly basis, some of the developments in the sector so that the world knows those that are behind the heavy toil for the health sector to be moved from where it was when Boko Haram struck, capturing 22 council areas in the entire state, to the envisaged level of excellence it is being taken to.
There are many non-medical professionals whose contributions to crushing emergency challenges over the years have been invaluable to astounding emergencies like cholera which has harassed health managers and kept them on their toes. Looking back at the sector, there was one year of the cholera scourge that everyone who was a doctor in the ministry had to abandon files, put on coats and gloves and were lined up at the Muna Garage axis ensuring that they helped slow down the scary mortality rate. That is an indication that the medical workers, serving and retired, have also managed to stay above board at the primary health care level.
Pending challenges to be crushed in Borno state
There are many pending challenges before the health partners that need to be dealt with. One is the inability, sometimes, to understand the fact that change is the only permanent phenomenon in life which everyone must prepare to embrace. A lot of partners still do not understand why change from the old order of doing things to the new is important. Some financial partners want to completely adjust the ideal narrative by wrongly taking the drivers seat in almost every pillar including risk communication and sometimes, the good old surveillance.
Two sensitive pillars which are supposed to go together. 90 percent of the time, sitting through meetings, Abdu Mbaya, or Modu Kyari, the deputy head of the communications pillar in the primary health board are hardly carried along. Often, less knowledgeable individuals in the United Nations international children’s fund (UNICEF) and World Health Organization (WHO) will stand up to speak for the entire Borno State which they know nothing about. And most times when they speak, they do not impress the IM or the meeting, because they talk only about what they understand from their own foreign-designed system. They hardly display knowledge on how to solve problems in the 27 Council areas of the state.
One particular young man in the one of the international agencies, said to be a tea boy for a previous disgraced communication expert, never ceases to amaze, because of his obvious limitations of what to do for the good of the state.
They are not to be completely blamed. Its simply because the state has been unable to sit on the drivers seat all these years in some of these pillars, before the advent of Dr Lawi Meshelia. Those who should know are equally to blame because they saw these dysfunctional persons play with the intelligence of the state and did not raise alarm to the Commissioner or the Governor of the State, Professor Babagana Zulum, knowing his disposition towards mediocrity, regardless of who is involved. It is change in the old order that will bring about what will benefit the state, when it comes to enlightening people on how to get, for instance, the best out of the web of complex information needed to make the operations at the primary health care get better.
The management of emergencies at the primary care level have seen many administrators, on and off the forum of partners, and each one, foreign or Nigerian, do his or her best to better the system. It does not mean that they do not have their limitations, it is talking about constraints ranging from management style to low capacity based on background training, and sometimes, downright timidity in assertiveness in getting certain things right based on contemporary practices.
This informs why some partners jump into the drivers seat, without permission from the state, the designated driver for the building of the health sector. The state government is responsible for crushing emergencies like the on and off Polio, monkey pox, COVID-19 or Diphtheria, as announced from time to time by the state epidemiologists.
The numerous interventions of emergency manager Beatrice Muraguri
Most of the partners have done their best. It’s not just bad news all the way. There have been quite a good number of good managers in the system. For instance, there were the frantic efforts of Dr Collins Ovilli who jumped into the trenches with other doctors, like Mohammed Guluze, then emergency manager, to ensure that the cholera mortality figures do not scream more than it was then. To those poisoned by insurgency in the backyard 50 dead is noise, but 100 is really a screaming figure.
At present, Dr Beatrice Muraguri is one of the good souls of the WHO and has been making her presence felt in all the three states nort-eastern badly plagued by the lingering insurgency. Sitting in theat meeting hall in Damboa Road, watching and listening, her contributions always for the common good of humanity. Sometimes she used to ponder and literally press the state to hurry up and sit tight on the drivers seat to crush these emergency headaches. To her, as a clinical epidemiologist, nothing is impossible if minds and hearts are brought together. Diphtheria, for instance, has reached 67 deaths as at the time of writing this report, do we want to wait until it gets to 100 before we deal with the challenges bedeviling the management of the disease? In as much as people are not perfect, Dr Beatrice is one woman who means well for Borno state. She has been a very transparent professional, who has water tight empathy for the people of the entire Borno, Adamawa and Yobe (BAY) states. She is a distinguished African woman who understands how to serve humanity using the template of the state or council areas accordingly. She is not one of those whose bosses had questionable records before being asked to leave the WHO because of dubious activities aided by a sacked former state commissioner.
We have seen a Theatre Commander (TC) here who shut down the activities of three Non-Governmental organisations NGO’S when they ran foul of the laws of the land, “so none of them will tell us they are better than the people they met on ground” said General Adeniyi, the then TC.
Co-management of the sector with WHO
In spite of all these challenges for instance, since the advent of Dr Lawi Mshelia, a lot of things have changed for the better. Some of them were procedures which had to change even though with difficulty. Lawi drives the system like a taskmaster and some of the partners, used to the old system, do not like him for doing the right thing. But Lawi, a foreign trained public health specialist like Maruguri, is getting tremendous results. Though from his body language sometimes he appears unhappy with the trickles of results he has been having in areas like the risk communication and surveillance pillars.
These pillars have terribly shaky foundations going by what we see from the cholera and now diphtheria torments of the people. Since Lawi arrived as the incident manager, he has succeeded in gradually changing the old ways of doing a lot of things. Obviously this public health specialist understands that emergencies in a system where most of the infrastructure has been destroyed by insurgency you virtually have to be regimented to get results. That means he must step on some toes if he must get results. Emergency is not the “that is how we do it” kind of phenomenon in which obvious mistakes are tolerated as the norm. It must be a near perfect phenomenon and that is what the university of Maiduguri (unimaid) trained Dr. Lawi is tying to achieve. Before his advent, the ministry officials allowed pillar heads to just do what they wanted without proper capacity to back the system. Then came Shafiq Muhammad, a Pakistani, who for the first time between 2017 and 2018 tried to fix a suitable template in which the emergency system could work without forming themselves into a parallel ministry of health that would be dabbling into non-emergencies. That system has stood the test of time till this day because it was a transparent system. But like a disease, it relapsed into the old system with the exit of Dr Shafiq because the very foundation was not properly fixed in such a way that pillar heads who are ministry officials will own the system and drive the steering and change gears at their convenience. It was literally in disarray because nobody had dug the right hole for the pillars to be firmly rooted. Safiq learnt very fast from Martinez Jorge and drove the system from 2017 to 2018. By the time Jorge left, Safiq was running at a speed faster than he met on the ground but there was a lot to be defined properly. When Safiq left, we have had several other managers including Dr Kida who had to act as IM even at retirement. His style was actually different because he tolerated most of the excesses of the partners. He was always smiling and not wanting to step on toes. With the advent of Dr Lawi, pillar heads and deputies meet regularly with him to state what they had achieved and he freely directs if he thinks they are driving down the wrong way. This kind of proactive professional on the drivers seat has come at a time when he is most needed. He is trusted by his permanent secretary, Mohammad Guluze, and Commissioner, Professor Baba Mallam Gana, a consultant Oncologist. Lawi has an almost regimented managerial style which most of them are yet to come to terms with, but it is hoped they will surely get used to his style and we would wake up one day to discover that all the emergencies are gone with the dry wind of the sahel savannah.
Ex Raying the background of the current IM Lawi Meshelia
Dr Lawi Meshelia is one of those medical practitioners who benefitted from the extension of service years by five years by Governor Babagana Zulum which is why he is still in service. He was equally the arrowhead in charge of the primary health care agency when Borno won the best primary health care agency prize money of $1.2m, in a competition created to bring primary health care under one roof in Nigeria.
He holds a Masters Degree in Public Health (MPH) from Royal Tropical Institute, KIT in Amsterdam, Netherlands; and an MBBS from the University of Maiduguri. His exposure and broad-mindedness to tolerate people stems from the fact that he did his secondary school at the Federal Government College Odogbolu in Ogun State, travelling to almost all the states of the Federation, and Dr Mshelia has attended courses in public health in Europe, East Africa, West Africa and South-Central Africa.
He has actually brought a semblance of stability and order since he took charge as IM.
Battling the red tapes in the system
Lawi’s background makes so suited for the job and some may call him a slave driver because he insists on rectitude. If at the end of the day the results are topnotch, he shies away from taking the glory, preferring to lay the crown of his superiors in the ministry, where he worked all his days as a medical doctor.
He is ever ready for emergencies and working towards solving any red tape standing in his way as long as it is not financial. By the way, it is this finance that makes some NGOs misbehave and tend to want to take the steering wheel from state health managers.
The Commissioner’s visit
When the Commissioner of Health paid his first visit to the emergency operation centre (EOC) recently, it was excitement galore. He obviously never anticipated that so many partners will be lined up one by one introducing themselves and taking it upon themselves to uplift the health sector of Borno State, badly battered by insurgency. He came across as a very lively and friendly medical practitioner shaking hands with partners and thanking them for a job well done.
Professor Baba Gana commended the partners for being very supportive in their contributions to moving the sector from where they found it to where it should be. He assured that the molecular laboratory in Umaru Shehu Hospital will soon become a reference lab for the future of the sector especially in dealing with emerging emergencies.
This, according to him, will relax the delay in going to competent labs outside the state to get results of suspected cases as and when due. On vaccinations, the oncologist said that left to him, the country should begin to develop its own local capacity to produce vaccination which will go a long way in trampling stubborn emergencies like Diphtheria, Cholera and measles so that they do not linger longer than expected. How soon that will happen? Only time will tell.