Edo State Ministry of Health is dedicated to providing high-quality healthcare services and implementing effective public health policies. Dr. Samuel Alli, the Edo State Commissioner for Health, in this interview with The Nigerian Observer team comprising EDWARD OSEGHE, BILL OKONEDO and JENNIFER OSADOH, shares insights on the mandate, achievements and challenges of the ministry. Excerpts:

For wellness regarding health, what are your benchmarks and how do you think you have fared?

There are indices to determine wellness and one of them is mortality. The mortality rate could be maternal mortality. We also use infant mortality. These two are critical. We can also look at our emergency response rates. Those are some of the indices we use and the number of people who can access health care. These are some of the indices which you use to assess how good the society is. If the maternal mortality is high, it shows that the care is also poor. It is a sign that we have poor healthcare.

Another point is how old do we get to before we die; life expectancy. Now in developed countries, it is between 75 to 80. I think in Nigeria it is 52 to 58: women 58 and Men 52 or thereabouts. These are indices that you rely on; life expectancy, access to care, maternal mortality rate, infant mortality rate, and our response to emergency care.

If you look at Edo State, you’ll find out that recently, we have been doing very well in that regard, and these indices have improved.

Would you say that you are enjoying a peculiar advantage due to natural endowments because, in this part of Nigeria, we still see some persons living up to 115, 110, 105?

For life expectancy, I think we’ve not had recent data on it. But it’s something we can work on and know what the life expectancy is. Yes, you might see it on a general note that people live long here. But just general visualization or observation is not enough. You have to have the data to say for those dying, this is the age bracket for it.

I was reading the report from UBTH recently and the number of people that died from accidents was high and all those things also contribute. Those are also part of life expectancy because if your emergency response is poor, then you see a lot of people who should not die for what you call avoidable deaths. That’s one of the reasons the governor recently launched the Edo emergency ambulance service.

We also have a command and control center where people can call for anything that has to do with either security or emergency. Call the numbers 112 and 739 because there is always a need for people to have a number they can always call upon and they are sure of immediate response.

When you look at Nigeria, when we say our life expectancy is low, it’s mainly from avoidable deaths. But those who can scale over the avoidable tend to live longer. If our healthcare response is not optimal, then we tend to have more avoidable deaths and tend to now shift that balance up to 52 years of age, because it’s an age where people are active and they move about. Sometimes you just hear somebody just drop dead, and most of those things are part of poor health-seeking behaviour.

From your observations, what are the main challenges, by way of lifestyle or ailments, that constitute or contribute to the low level of life expectancy?

I think a combination of all of these, say malaria, high blood pressure, feeding, diet, and other habits; smoking, drinking, etc. You notice that not many people on visual observation smoke. But our diet is poor. You will find out that because we have very poor diets, the essential minerals that are required to maintain a life balance are lacking. Some like magnesium, zinc, manganese, etc. These are trace elements, they’re very small, but they are very important for the body.

Now because of our weather, because of the kind of food we eat; which has been overcooked and boiled. Also, the transportation system is very poor. People are not thinking of what can nourish them, they’re just thinking of what can fill them. For those people who eat a very balanced diet, you don’t even need to eat three times. Maybe twice a day and you are very okay. What I’m trying to say is the poverty level and some of these other factors. Poor education, poor hygiene, and environment also contribute.

Look at us, malaria is all over the place. There’s Lassa fever, and what are some of the factors causing Lassa fever; poor hygiene, lack of sanitation, lack of good/clean drinking water. All of these tend to be factors that are responsible for Lassa fever. Almost 30 people have died from Lassa fever this year. Even when you have some people that are 80 and then you have young people of 30 dying from Lassa fever, by the time you calculate the average it will be over 50.

Recently in Benin, there was the issue of strikes and treated water, so-called pure water/bottled water, with lots of new brands filling the market space. Do we have the facility to test water?

You could have your water sparkling and looking very clear and that may indicate that it doesn’t have much physical impurity, but it might have chemical impurities. There is something called a water table; where in most compounds you have the effluence disposal system or ‘soak-away’ and then you have the borehole of the well, and people convince themselves that they’ve done right because the “soak-away” is at the east end and the borehole is at the west end opposite each other. There should be a kind of slope. That means there should be a distance that should be between your disposal of your effluence and where your borehole system located. If possible, it should be located higher. I mean higher so that the effluence doesn’t overflow but if they are on the same level or the borehole is even lower, then that means some of these can slip into it.

Generally, what happens is that for you to have a pure water factory or a table water factory, there are certain parameters you must meet. Maybe at the point of the commencement of such a factory, they meet all of these. To test for water I think it is the easiest thing. Water should be neutral.

Another thing is what we call microscopy, just looking at it, do you see any particle in it? If you see, generally it tells you that this water is no longer safe for drinking but beyond that, you can also do what we call microscopic. You can also do a culture of the water and then test for chemicals. Water should not have chemicals because there are certain criteria for good/clean water. Water should be tasteless. Some of these things I have mentioned are ways to detect if water is clean and safe.

I think it is right for us to look at it and see how we can improve water. Some diseases are transmitted through waterborne diseases and people must know about this and see that the water you drink can affect how healthy you look or how healthy you are.

In some developed countries, the insurance scheme sends certain messages on phones to their enrollees when they hit a certain age to come in for certain tests, but we don’t have those advisories here. What can we do?

We are working on it through our Primary Healthcare Agency. The first thing in doing all of those things is to have the data of the people. If I just have your name and you are registered for the Edo State insurance scheme, that’s not enough. I need to know more about you. Are you diabetic? Have you had surgery in the past? Are there current health issues? Are you asthmatic? When we have all of that data, then we can begin to advise people.

Let’s start from the cradle. When a child is born, there are certain immunizations he has to take, what we call the six killer diseases. It is because of those immunizations that all of us could live to this age.

When a child gets between the ages of 9 to 13 she is supposed to take an immunization against what we call the Human Papilloma Virus. But that’s not even common, and it is what every lady should take at the age of 21. For a sexually active lady, she should be having screening from the age of 24 up to the age of 65. If she’s free then that’s it. For men who are 45 years and above, you should do what we call prostate screening.

But generally, every human being, an adult should find time to just do a general check on his/her body; your eyesight, your blood sugar, those basic things but most of us don’t do it.

We have a lot of poor health-seeking behaviours, behaviours that don’t make people seek healthcare.

Now what you have said about texting people, I said it comes from first having the data and knowing who these people are and then you can send it to them.

Our Primary Healthcare Agencies are working on that. It is based on technology, and part of what we’ll be doing is home visits; knowing where people live. We are working towards that. It is part of the plans we have for the citizens of this state.

Pensioners and vigilantes are currently being put on free health insurance by the state government; what informed that move? Does it not entail cost? How are you coping with that? And then what has been the response?

The government has a duty to the people. It’s a way to show governance responsibility and care for the elderly in society and those outside the country. The retirees are people over 60 years old, it’s not about cost but looking at the benefit to the people.

A healthy nation is a wealthy nation. If the government is spending its money in that direction, which will benefit the people directly, then it’s for a good cause.

What would you want to be remembered for?

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That we were able to leave a lasting legacy behind and we have been able to reform healthcare in Edo State; in terms of access, in terms of financing, and in terms of infrastructure.

In terms of access, the Edo Health Insurance is there, just for you to key in. We also make provision for the vulnerable in the Edo Health Insurance. We realized that not everyone will have money to pay if you are saying people should pay. The government pays for the poorest of the poor. Secondly, we are reviewing our Primary Healthcare System which is another type of access but it’s a Gateway.

Before now, when this government came in, there were over 400 Primary Healthcare Centers (PHCS) that no one was caring for or taking responsibility for. What the government has done was to revamp those we can revamp, and made sure that at least we have one PHC in each ward. We have 192 wards in 18 Local Government Areas. This is to make sure that we have one per ward. Currently, we’ve done over 50 of such in the last two years.

Then, I talked about infrastructure. In terms of health infrastructure, look at Edo Specialist Hospital, it had to be rebuilt and then equipped. What you can do is go into the Health Insurance, and with your insurance card, you walk into Edo Specialist Hospital and will be treated. That is the beauty and that is what I said, “We’ve also provided a way of financing it. If everyone gets into health Insurance, you can access it.”

Then we are building the Stella Obasanjo Hospital. We also are making sure that we are building capacity in terms of those to be trained. When you go to our School of Nursing, you know how it was closed for many years, and when the governor came in, he made sure that it was revamped to international standards. We are also revamping the School of Health Technology.

The graduates from all of these places are the ones who will be working in the hospitals. We have touched on all the different aspects of the healthcare system even in technology.

How did you work technology into the healthcare system?

Well, there’s what we call electronic medical records. We are pioneers. In government hospitals, you can apply technology, and even in some of our Primary Healthcare Centres, this same system applies there.

The one we just launched at Federal Government Girls College here in Benin City is the same. Nobody is going to carry any paper or card walking about.

Even primary healthcare is the same technology that is found there. It helps to improve productivity. Technology has a way of increasing productivity, reducing waste, and ultimately improving revenue to the state, and improving efficiency in the system.

We also have inspectors going around the Primary Healthcare; making assessments, giving reports, and coming back to correct human and facility failures or shortcomings. It is part of what we call a Quality Assurance System.

Last year, 16 states were administering HPV medicines to school children, and Edo State was not included in the list. When and how is the implementation going to be?

We are starting in May. Well, it usually starts with advocacy or just educating people and allaying their fears because a lot of people believe that maybe this vaccine is to prevent us from getting pregnant, not giving birth.

You sensitize the people and continuously allay their fears through radio Jingles, TV, etc. It is just generally the same principle; reach out to them through the School, Mosque, Church, Market, or anywhere you can find people.

Speaking on Lassa fever that is still on, recently, Delta State just confirmed some cases and some deaths. Where is Edo State’s stance on this and how are you combating this?

I declared an outbreak on January 9 in the state, and we had to swing into action. We activated our Emergency Response Team and clearly, that has kind of stemmed it.

We’ve trained and we are still training our surveillance officers and also deploying them to ensure that we educate the people.

Currently, we have identified the factors and put up countermeasures to prevent those factors. For instance, we have commenced rat eradication. What we’ve done now is make sure we “De-Ratarize”, that is to kill the rats continuously because if the rat is not there, then we know that Lassa fever will be reduced to a minimum.

We’re not just doing it just because of this outbreak; it is something we want to continue to do until the complete eradication of the rat.

Then we are also improving sanitation through our Local Governments and our environmental officers; educating people on how poor sanitation, lack of hygiene, and poor waste disposal are contributing to the recurrence of Lassa fever.

Then we are also partnering with Edo State Rural Water Agency, to make sure we can provide access to clean drinking water for communities.

These are the measures we are taking. These are not measures that are quick to fix, but they are measures that we should continuously do until we can overcome all of that. We want to eradicate Lassa fever from Edo state within the next five years. That’s the plan.

In the course of your discussion, you mentioned “the gateway”. Can you shed more light?

Health Insurance is an access, more like a key. That’s the primary healthcare, that’s why I say it’s called a Gateway. Everyone should access care through Primary Healthcare. What they cannot treat, they refer to Edo Specialist Hospital.

Ideally, people should not just be walking into Edo Specialists especially if it’s not an emergency or even if it’s an emergency.

People think Primary Healthcare is for poor people, those that live in the village, and that’s why the government said, if we make it good enough, people will come and when they come, they will see that it is fine. People will be calm and they would like to come again.

One thing we are doing in Edo State which no state in this country is doing in Primary Healthcare is the Telemedicine option. Telemedicine is also technology. It is a form of technology where a patient can come in and interact with a doctor who sees on the screen.

We do have it in Oredo and the doctor is based in the US and he does it every Saturday and twice a month, and we also have it in Oluku, we now have it in Okpenu.

What is the sustainability of the Emergency Operations Centre?

Sustainability is also through healthcare financing. This first year is financed and that’s why I say it’s a pilot. We are trying to do it and see how it goes. But after that, we’re expecting that during this one year, we’re able to enroll more people into health insurance with the emergency cover. So with your health insurance, you have emergency coverage.

The good thing about insurance is that the amount you’re paying relative to the cost is small. What if the unknown happens? It’s always good to have health insurance. The plan is to use health insurance as a way to sustain it.