I Stand On Existing Protocols

A lady and I were standing at the foyer of one of Abuja’s architectural masterpieces, Shehu Musa Yardua Centre waiting for a vehicle to convey us back to our respective offices and we both work for donor agencies. Stuck in our arms were copies of the 2008 National Demographic and Health Survey (NDHS) which the National Population Commission had just launched for public dissemination. It is on record that the 2008 edition is the most detailed and painstakingly conducted NDHS Nigeria has ever produced with data disaggregated on state by state basis save for some indices classified according to geopolitical zones.

This lady, a Zambian was in shock and couldn’t sit any longer in the auditorium as different segments of the NDHS results were reeled out by the presenters who ‘stood on existing protocols’ before making their presentations that gave gory pictures of the state of health in Nigeria- poor maternal and infant mortality figures; poor nutritional status of women and children; poor educational and economic status of women in rural and urban areas; gender-based violence and much more. She had enough and the numbers that translated into millions made her heart sick; women and children sent into early graves by sheer negligence of fellow citizens who had the privilege of being responsible for the delivery of services to others.

She was visibly shaken and scandalized that a country as resource-rich as Nigeria unlike her resource-poor Zambia could show this level of irresponsibility towards her over 140 million citizens. With commitment and support from donors, Zambia had used a sector-wide approach to bring reforms in their health system and have progressed to budgetary support for the delivery of health services and have now exceeded some of the MDGs targets in health. Yet Nigeria, the sleeping giant of Africa and its leaders and privileged citizens are still mounting podiums and making speeches and addresses rather than getting our hands dirty by doing what is needful to turn the tide of underdevelopment in our country.

About two weeks earlier, precisely on the 10th of November at the Presidential Villa, the Federal Ministry of Health had through the support of President Yardua held a Presidential Summit with the State Governors where Prof. Babatunde Osotimehin had presented a league table of health indicators for each state of the federation based on the results of the 2008 NDHS. He used the table to paint a graphic picture of the sorry and sordid state of health system and service delivery in Nigeria to the respective Governors. Save for a few states that crossed the bar of average in the ranking, most of the states have little to cheer about the health indicators credited to their respective states. They were expected to sign a compact that will make them accountable to their citizens for the provision of quality health care and deliverables to their state citizens.

Prior to the Presidential Health Summit, a pre-summit meeting was held on the 5th and 6th of November at the International Conference Centre, with public health experts, State Commissioners of Health from the 36 states of Nigeria and other stakeholders in attendance during which, the Federal Ministry of Health presented the dismal picture of the health situation in the country. While premiering a documentary on the state of health in Nigeria produced by the Partnership for Transforming Health Systems (PATHS 2); a programme supported by the UK Department for International Development (DFID), Dr. Mike Egbo its Country Team Leader literally couldn’t hold back tears as he recounted how he lost his mom through child birth. And this had informed his passion to ensure that no woman in Nigeria dies as a result of child birth. As we watched the documentary, we all couldn’t play ostrich as usual; our nation is sick and in need of healing!

Nothing could have been more embarrassing and politically incorrect for such a high ranking health and development expert to break down and cry in such a high profile meeting before public health colleagues, commissioners and members of the donor community. But his tears were not because his mom had died out of preventable causes but because those who have the responsibility of providing quality health services have continually reneged on their responsibilities with no one holding them accountable. A few weeks earlier Mike Egbo, a self appointed ‘militant for health’ was interviewed in a live program on AIT where he had bared his mind on the state of Nigeria’s health. After the programme, a high ranking director from the Ministry of Health who watched him on air had derisively and nonchalantly ‘assured’ Mike Egbo that the health system wasn’t going to improve for sure despite all the efforts being made.

The Chief of Party of a US Government Agency in Nigeria in a speech at one public function had jokingly remarked that one official cliché she had heard too often in Nigeria was ‘I stand on existing protocols’. Yea, we value protocols in Nigeria. We treasure to be addressed properly and with the right titles; Your Excellency, Your Honourable, Your Lord, spiritual and temporal, and the list goes on and we make speeches and gather at functions to sermonize and recount our achievements while smaller countries are making development strides with the little resources they have.

Developmental activities in Nigeria seem to be translated as the preparation of annual budget, followed by its submission and defense at the hallowed chambers of the National Assembly. The new fiscal year comes and after fights between the executive and legislature, the budgets are approved, and the Ministry of Finance releases the monthly subventions to the respective ministries. Each ministry then begins the implementation of the projects and programs in their work plan which mainly include ‘capacity building’ of program staff and workshops for the development of policy documents and implementation strategies.

After the policy documents are developed and approved, funds are allocated for their public dissemination in Abuja with ‘stakeholders’ drawn from the 36 states with mouth-watering DSA and estacodes for their esteemed participation and to make their stay in Abuja worth the while. This is then followed by trips by the ministry officials in Abuja to conduct workshops ostensibly to ‘sensitize and advocate’ to the state government officials on the need to ‘domesticate’ and ‘adapt’ the policies and develop strategies that ‘speak to’ the national guidelines and strategies.

The state ministry officials upon receipt of the baton from the federal fore-runners, they start the state lap for the ‘Step Down” of the policies and to kick-start the planning process for the release of the state budget for the ‘training of trainers’ workshops with participants drawn from the Local Governments. By this time, the DSA would have diminished in size and this is understandable having passed through conduits that needed to be maintained and budgeted for as well. The LGA officials will then invite their cronies at the grassroots (wards and communities) where they call the shots for the ‘micro-level’ planning with the residue of the subvention that trickled in from the state capital.

At the end, the programs are either implemented shoddily and the populace is once again denied their rights to the much promised ‘dividends of democracy’ which the politicians had promised during their campaigns. Another fiscal year passes by and Nigeria recedes and slides further down the ranking of countries on developmental indices, with the citizens being ravaged more and more by avoidable poverty. The political class dismisses the figures as blackmail by enemies of Africa and neocolonialists who denigrate our ‘home-grown’ approach to ‘sustainable development’ that is not ‘evidence- based’ or ‘people-oriented’ to really stand the test of time.

As we stepped out of well-kept lawns at Yardua Centre Abuja, I wondered what other excuse I could give the bothered Zambian lady to calm her

already boiling blood. It was this same shock and anger that gripped the Executive Director of UNICEF when she visited Nigeria earlier in the year. Initially she had doubted the statistics that were attributed to Nigeria until she landed Nigeria and saw things first hand. But each figure on the bar chat or pie chat and each dot on the scatter diagram represented a life that could have been saved if the money allocated in the budget had been translated into a deliverable health service; routine immunization, drugs and supplies etc .It was embarrassing to say the least as the UNICEF wondered why all the millions spent on development work in Nigeria had not bettered the lot of the average Nigeria for decades.

I forgot to remind the Zambian lady that it was actually the US Government that provided the funds and technical support to the National Population Commission for the conduct of the 2008 NDHS so we can have data for planning the delivery of health programs in Nigeria. In the next 5 years, we will yet gather again for the public launch and dissemination of the results of the 2013 NDHS and by then several states of sub-Saharan Africa may have inched closer to the finish line of the MDGs, while we will mount lecture podiums to make speeches preceded by this popular Abuja cliché of ‘I stand on existing protocols’ while majority of Nigerians slip further into avoidable poverty and deaths.