100 Days in Office: Building a stronger health sector for Ekiti State

When I was asked by His Excellency, Governor Kayode Fayemi to join his cabinet as Honourable Commissioner for Health and Human Services in Ekiti State, I saw it as one of the greatest honours possible. Over the last fourteen years, I have worked in various positions, focusing on health systems reform and health financing at national level here in Nigeria, and also in the United Kingdom. The opportunity to bring this know-how home to serve my people in Ekiti State aroused a deep sense of gratitude, and an awareness of the size of the task.

Swearing in ceremony as Honourable Commissioner for Health and Human Services.

As one of the first activities upon my resumption, I visited our health care facilities at all levels, met with Directors in the Ministry of Health, as well as staff. I also met with development partners and civil society organizations. Together, we discussed the challenges faced by our health sector.

Following our joint understanding of the challenges, we held a three-day retreat to develop an implementation plan for the sector. The time was spent reflecting on where we are, and what we will do together to strengthen the health system. Three key issues stood out.

(i) The quality of service delivery — Using available survey and administrative data, we recognized that whilst knowledge and utilization of health services in the state was high, health outcomes were subpar. For instance, despite over 90% of women in the State receiving Ante-Natal Care from a skilled provider and 87% being delivered of babies by skilled attendants, our neonatal and infant mortality rates at 42 and 57 per 1,000 live births respectively were the poorest in the South West, an indication of the quality of care;

(ii) The weakness in our public health security and emergency response; and

(iii) The limited use of data to inform decision making.

His Excellency, Governor Kayode Fayemi, giving the opening remarks at the 3-day retreat.

To address these, we have set clear objectives and indicators, to be reviewed every quarter. Our vision for the next few years focuses on improving quality of service delivered in primary, secondary and tertiary institutions, strengthening health security, and improving routine data collection to support performance management and decision making.

The last 100-days have gone by quickly, but we have begun to take our first steps in this journey of a thousand miles. Firstly, to improve service delivery we have developed the Continuous Quality Improvement (CQI) program to be implemented in health facilities. This program will enable facilities assess and improve their current performance, by generating new ideas and better practices. Embedded within this, is the support for facility infrastructure upgrades, upskilling of human resource and improvements in commodity availability.

In the last 100 days, we have upgraded 20 PHCs of 177 situated in each ward. This was done through support of well meaning Ekiti citizens under the Rapid Response Mobilization Committee supporting our fight against COVID-19. With support from Global Fund, another 24 will be upgraded before the end of the year, bringing to 44 (25% of our facilities) the total number of facilities upgraded. We have enlisted the support of UNICEF to train our healthcare workers using innovative approaches. Recognizing the importance of health care workers to the ecosystem, we have employed 16 additional doctors to augment those currently working across primary and secondary care facilities. To attract more young people to our health sector, we introduced the Ekiti State NYSC Fellowship for Medical Professionals. Through this, we are incorporating leadership training as part of the NYSC year for corps members posted to the Ekiti State Ministry of Health. Our corpers, working alongside other health care workers, will lead the CQI initiative. To improve commodity availability across facilities, we have committed to strengthening our supply chain systems by making available the counterpart fund required to upgrade the central medical store.

Our goal to improve the quality of service delivery is not limited to the primary health care level only. We have undertaken the preliminary work required to invest significantly in our secondary care facilities. By leveraging on private sector expertise, we aim to increase access to laboratory, radiology and theatre services in our facilities. We will also digitize revenue collection in our state specialist hospitals. This immediately helps us with two things: (i) minimizing leakages and wastages by streamlining cash collection (ii) increasing visibility to internally generated revenue — a key metric to showcase how well the health sector could be a net contributor to the State’s GDP. Following visits to some of the facilities, members of the community have also responded warmly to our promise, for instance in Ise and Aramoko, with material support for the General Hospitals.

Secondly, we have strengthened our preparedness and response to infectious disease outbreaks by leveraging on resources from the COVID-19 response. Working with the NCDC, we have finalized plans to establish a public health and molecular laboratory in the State, bringing to two by next year, the number of public health and molecular labs we have. This guarantees swift response to possible outbreaks as we would have the capacity for testing. In one year, we want to have the capacity to diagnose at least three epidemic prone diseases within Ekiti State’s Public Health Laboratory.

To strengthen performance management, we have developed scorecards and begun putting measures in place to improve our ability for better decision making. The necessary tools (tablets and data) to make this work have also been purchased.

The State’s health insurance agency has the potential to spur step changes in how we finance and deliver care; we are therefore exploring collaboration with the NIMC to seamlessly enroll citizens, while we build out the opportunities for revenue mobilization, pooling of funds and a clear approach to strategic purchasing.

Given the scale and scope of this administration’s ambition in the health sector, we are working with the Ministry of Budget and Economic Planning to improve public financial management, and engaged closely with the Ministry of Finance and Economic Development to guarantee timely fund release. I’m grateful to both my colleagues and His Excellency for the support, the outcome of which is an increase in our capital budget to 8% of total capital budget for 2021, up from 3% in 2020.

We have worked with the office of the wife of the Governor, Her Excellency Mrs. Bisi Fayemi to further strengthen advocacy against gender-based violence. Also, together with her office, we hosted the World Mental Health day, to increase awareness around mental health disorders particularly in the time of COVID-19. Given the socio-physical challenges of mental health on the individual and household, we have set up a Committee to develop a mental health policy for the State. We envision a tomorrow where mental health services are integrated into our primary health care service offerings.

Her Excellency Mrs Bisi Fayemi champions the World Mental Health Day event.

We have received and distributed over 12,000 facemasks, 10 ambulances and other personal protective equipment donated to us by the SDG office and other partners.

As we mark our first 100 days in office, I am greatly inspired by the prospects of strengthening various components of our health sector. I look forward with great optimism that the systems we are putting in place will set the state on the right path towards achieving better health coverage and delivery in Ekiti State, ultimately contributing to increased productivity and economic development.

Finally, I would like to thank His Excellency, Governor of Ekiti State, who continues to support us strongly in implementation of the health sector vision. I am also grateful to the staff of Ekiti State Ministry of Health and our partners who work with us.

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Health Systems Reforms and Health Financing Expert

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Oyebanji Filani

Oyebanji Filani

Health Systems Reforms and Health Financing Expert

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