The Wolf Within The System: Dilemma Of A Health Commissioner -By Saifullahi Attahir

There was a story given by one of our lecturer who took us Primary Healthcare under the Community medicine Department. I called him an ‘accomplished lecturer’ because of his vast experience within the academia and the practical world. He studied MBBS and graduated from BUK, where he later did his Consultancy in the department of Community Medicine Aminu Kano teaching Hospital (AKTH).

He went England for another Masters degree in Public Health, was a lecturer in BUK over the past 20 years, a visiting Consultant in FMC Azare, of recent a visiting lecturer in Maitama Sule University, BASUG Gadau, Khadija University Majia, and now the current HOD of Community Medicine Department at the prestigious Federal University Dutse.

This man was not only bookish and idealistic, for his exposure and commitment he also worked as a Director in the Primary healthcare Agency in a neighboring Northeastern state. It was during his period as the Director, unknown to him, was nominated as the State Commissioner of health in 2019.

He spent 2 years as Commissioner before they were reshuffled by the Governor. According to him( the lecturer), his appointment was purely out of meritocracy, for his lack of any relationship to the Governor, in fact he has never met him before.To this lecturer, it was a lifetime opportunity and experience to learn about politics, governance, and healthcare issues in Nigeria.

Our conversation came while he was discussing about the problem of sustainability in primary healthcare policies, problems of healthcare financing, and why Nigeria was yet unable to achieve the universal health coverage (UHC) despite years of advocacy, huge government spending, foreign aids, grants, and all forms of bilateral talks.

As innocent youth, the whole class were full the usual rhetoric of debating, lamenting, and blaming the whole problem as purely a failure of leadership, of inability for Government to do the right thing, and all sort of abuses toward the politicians.
Everybody was drawing a simple ‘A to B’ solution to Healthcare problems. The gentleman allow us all to pour out our ignorances just smiling and listening. He later instruct the class to listen for his views and side of the story.

The strength of his argument was aimed to show us why Government Agencies not only in the health sectors are not functioning to their best. The answer was not a simple one. It was a complex, systematic and nebulae. To fully grasp it, one need to view it from insider’s point. It was not the making of one person alone or a few, it was the work of each and every one of us.

His argument showcase that both the top leaders and the followers were equally a contributing force in this quagmire. As the Hausa adage goes ‘ Idan Bera da sata daddawa ma da wari’….( Rat offence was to steal, but it was the aroma to blame). He told us of his past opinion similar to ours only before he saw it first hand, that change his perspective for ever.

After his appointment, He initiated the establishment of local Government, Ward, and Village Development Committees (LGDC, WDC, &VDC). These Committees were created as one of the strategy to make healthcare easily accessible to people located in the remote areas in the state especially those in the hard to reach.

The LGDC comprises of the LG Chairman, his Secretary, the district heads, LG Medical Officer of Health, representative of religious groups, and Medical Director of the General Hospital or Cottage. The Ward Development Committee also comprises of ; political counselor of the Ward, Health officer in charge of the Primary Health Center, the village head, and the school headmaster.

The role of these Committees were to spearhead management and to help the health personnel in the activities concerning health of their communities. They are meant to do meetings at specific periods in the year, they help implementation of vaccination campaigns, advocacies, manage outbreaks, and other key decision makings.

The WDC under the leadership of the ‘In charge’ are responsible for the remittance of fund from the purchase of drugs and other essential medical wires as DRF (Drug revolving fund) to the State treasury. But what actually happen was that, if the State sells drugs and other medical equipments to those primary health centers at a subsidize price of #100,000 in the hope that those facilities would provide services to the community and make a profit at the end of at least #150,000 so that the government would have a source of revenue.

At the month end, surprisingly those facilities are not even returning a profit gain but a deficit (instead of #150,000 or the exact deposit of #100,000, they remit #70,000 or less)! This example was almost similar in every facility in the state. The same happens for the LGDC.

When he goes down to investigate why this happened, he was surprised. It was not because the clinics were selling the drugs and other services to the locals at a very subsidies price which lead to the deficit, it was actually the reverse.

For example, The state would sell a Malaria drug to the facility at the price of #50, the ‘In charge’ would price it at #100 to the pharmacy store, and behind the door some pharmacist would sell it to the locals at #150. At the end, the pharmacist return #100 to the hospital and the hospital return #50 or less to the State.

The irony of this matter was that, you may think that those surplus money was only for the ‘in -charge’ no! It is spread and shared far and wide among some of his committee members so that this milk cow keeps producing.

One day he received a complain from one General Hospital about inability to repair their water system that may cost over 500,000 so therefore they write to the Ministry requesting urgent intervention. This Commissioner was curious and thinking of where was the money the Ministry pump monthly to this hospital apart from the sells they make from drugs and other services they provided.

He decided to make a surprise visit to this hospital. He went straight in to business with the MD (Medical Director). The Commissioner inquired about the money they generated and what they do with it. He requested about the check balance of the Hospital from the Accountant. To his amazement this Hospital has over #5000,000 ( five Million Naira sitting idle) in their Account.

He was furious, and all sort of explanation were coming out, one.of the excuses was that this money was inaccessible unless the LG Chairman and his Secretary approved for the withdrawal because they were the signatories.

Another Saga happens in one LG, it happens that this town was blessed with one of it’s indigene happens to be the Managing Director of one of the most lucrative Agency in the Federal Government. So as part of his ‘personal contribution’ he decided to build a hospital in his home town.

This Hospital according to the Commissioner was one of the ultra modern health facility he has ever seen. It was well constructed to the standard even in Europe, well equipped with every modern medical gadget you can think of; 2 CT scan Machines, MRI, modern diagnostic and theatre equipments, solar powered water and energy supply.

This facility remains closed for over 1 year still not operating since after it’s inauguration. What even lead to his attention was when he incidentally paid a visit to this town old and dilapidated General Hospital and received several complaints from the management about rising issue of referrals due to lack of man power and equipment.

One talk lead to other he was informed about this new facility, curious enough he went there to see for himself. The only excuse he received for it’s lack of operation was because there are some little equipments the state government need to install costing less than 2 million Naira!
Imagine the lives lost, and this long period of time wasted just for 2 million Naira which stop a Hospital worth 200 million Naira to stop operating.

Another episode happens between this Town and a neighbouring City. They were all Emirates with different Emirs, and there was this foolish tradition old rivalry. It happens the other city has a teaching Hospital (TH) for over 2 decades.
So incidentally, the CT scan machine of this teaching hospital was faulty and inoperable. This force this TH to refer their patients that need urgent brain CT from head injury or Abdominal CT for urgent surgery to another distant TH for management. The only nearby TH was about 200km away.

This Commissioner come to the notice of this tragedy, and out of his wisdom and altruistic nature gave urgent order for the transfer of just one of those two newly installed CT scan machines from that town to it’s neighboring TH as an emergency to help carve out the problem.

Here and then, he was under fire. That town mobilized all it’s force including the Emir and every elite and were at the Governor’s office protesting that this new Commissioner was conniving with their rival Emirate to loot equipments from the newly built hospital. To cut the story short, not an inch of this CT scan machine was move out of this town, to the detriment of the hundreds of people that would die due to inability it access urgent diagnosis.

From the very day of his appointment until end, he was constantly receiving calls and ‘courtesy visits’ by politicians, family and friends, majority of them with ulterior motive.
Every day he received calls from acquaintances asking for job recruitment on behalf of their kit and kins. Some would appear in his office only to ask for relocation to more easier places.

And these are the very people whose request you. can’t turn down for the reason they were your siblings, old friends, political bigwigs, or colleagues at work. Chai!… Things fall apart……No longer at ease..

Saifullahi Attahir, a Medical Student of Federal University Dutse wrote.
saifullahiattahir93@gmai.com