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The Chinua Achebe Foundation Interview Series #22

Nigeria:
A Meeting of the Minds
(Professor Dora Akunyili in Conversation with Adeze Ojukwu)

by
The Chinua Achebe Foundation

                             PROFILE

PROFESSOR DORA AKUNYILI: A LIFE OF INTEGRITY

Professor Akunyili was appointed

Chinua Achebe

Prof. Chinua Achebe

 

Professor Dora Akunyili

Professor Dora Akunyili

the
Zonal Secretary of the Petroleum Special Trust Fund (PTF), 1996-2000, and in that position, coordinated projects in the five South Eastern States: Abia, Anambra, Ebonyi, Enugu and Imo State. While at the PTF, she was hailed for her honesty and transparency when she returned twelve thousand pounds sterling, the balance of the funds provided to her by the PTF for medical treatment abroad. For such unusual veracity, she received a letter of commendation from the Executive Chairman of the PTF, General Mohammadu Buhari. This clear exhibition of integrity, many believe, led to her NAFDAC appointment where she would become celebrated nationally and internationally.

A CALL TO DUTY               

The National Agency for Food and Drug Administration and Control (NAFDAC), was established by Decree No 15 of 1993 (as amended), to control and regulate the manufacture, importation, exportation, distribution, advertisement, sale and use of food, drugs, cosmetics, chemicals/detergents, medical devices and beverages. The scope of this mandate placed the responsibility of safeguarding public health on the Agency.

In May 1999, NAFDAC was one of several government agencies requiring serious attention, and a discreet search for a new Director General began in earnest. President Obasanjo, apprised of a PTF staff member who had returned the balance -- twelve thousand pounds sterling -- of a medical stipend, placed a telephone call to

Dora Akunyili

Dora Akunyili

Professor Dora Akunyili. She still remembers the occasion: “I was unnerved. For me to receive a call from the President of Nigeria was a breathtaking experience...” That phone call was the beginning of her journey to NAFDAC, and her appointment as the Director General of NAFDAC marked the beginning of a revolution that would have impact beyond Nigerian shores. In 2001, Professor Akunyili assumed office without fanfare, and immediately immersed herself in work. A new epoch had dawned on the Agency.

Dora Akunyili has recorded an outstanding string of successes as the Director General of NAFDAC. Prior to her assumption of duty, adulterated, fake and substandard foods and drugs were being dumped in Nigeria without regulation, creating fortunes for unscrupulous individuals. Dr. Akunyili ushered in a new culture of excellence and honesty within NAFDAC and the entire establishment of public regulation, scrutiny and investigation. According to a major national newspaper, “The NAFDAC Director General is a revolutionary. She has not only changed NAFDAC, she has also changed the pharmaceutical industry in the country.”

 

Improvement in the Health and Pharmaceutical Sub-Sector

 

 

Individual manufacturers as well

Drug Examples

as the Pharmaceutical Manufacturers Group of the Manufacturers Association of Nigeria (PMG-MAN) have reported a tremendous increase in production capacities of our local pharmaceutical industries. The Executive Secretary of PMG-MAN attributes the improved performance of the sector to the 100% import inspection policy, and the new impetus from NAFDAC, which has seriously curtailed dumping.

Glaxo SmithKline recorded a 77% growth in sales during the same period. The General Manager, West Africa, attributed this tremendous increase to “NAFDAC living up to its responsibilities of enforcing strict compliance to product regulation.”

Pharma Deko Plc witnessed an increased demand for its products resulting in a 78.5% increase in turnover in 2002. It is noteworthy that the company had not paid dividends since 1999 due to losses but the company declared dividends in 2003. MAY & BAKER’s profit growth rose by 88% for the first half of 2003.

NEIMETH International Pharmaceuticals Plc recorded 105% increase in its profit before tax at the end of its financial year in March 31, 2003.

NAFDAC’s activities have reinforced the confidence of investors in the pharmaceutical industry, as evidenced by the continuous upward movement in the share prices of the pharmaceutical companies quoted in the Nigerian stock exchange.  

Improvement of Government Policies

The following new government policies were spearheaded by NAFDAC:

        The return of NAFDAC to the ports in October 2001. This has yielded an exponential increase in the number and level of seizures and sanctions.

        Release of Shipping and Cargo Manifests by the Nigerian Ports Authority (NPA), Shipping Lines and Airlines to NAFDAC inspectors.

        Outright ban of the importation of drugs and other regulated products (food, cosmetics, chemicals/detergents, medical devices, and all drinks) through all land borders.

        The designation of specific Seaports and airports as exclusive ports of entry for the importation of drugs and pharmaceutical raw materials.

Improvement of Infrastructure

The creation of functional NAFDAC offices in all 36 states of the Federation and Abuja, zonal offices in the six geopolitical zones, and three special zonal offices, brought NAFDAC closer to the regulated industries and the consumers.

The acquisition of a new corporate headquarters in Abuja was a monumental achievement. This edifice not only lifted the Agency’s corporate image, but boosted staff morale.

NAFDAC constructed two gigantic warehouses for thermo-labile and thermo-stable products. Prior to the construction of these warehouses, the Agency was faced with a situation whereby seized products were stored in the owners’ warehouse with its attendant risks.

Four of NAFDAC laboratories have been upgraded to International standards while three new laboratories are under construction. Construction of offices and staff residential apartments at land border posts provided the necessary infrastructure for carrying out the arduous task of enforcing the ban on importation of regulated products through land borders.

Computerization of the Agency’s regulatory activities, creation of the NAFDAC website as well as provision of adequate office equipment, enhanced information flow within and outside the Agency. Provision of functional utility vehicles greatly enhanced transportation of staff for regulatory assignments.

Improvement in health indices

NAFDAC’s monitoring of

Dora Akunyili

Dora Akunyili

salt iodization in
Nigeria has earned Nigeria UNICEF’s nod for attaining universal salt iodization. Nigeria has achieved 100% compliance at the manufacturer’s level, 98% and 88% at distribution and household levels respectively. We have also currently achieved 85% factory level compliance in Vitamin A fortification of vegetable oil.

According to Baseline surveys conducted in 2002 and 2003 (twice), there were positive results indicating a drop in the prevalence of unregistered drug products in Nigeria. The prevalence was almost 70% in 2001 but dropped by 68% in 2003, and according to the current reports received Monday 26th of April 2004, it had dropped by over 80%.

 

Courtesy  www.time.com

RESPONSIBILITY, RISKS AND REWARDS 

Combating fake, counterfeit and substandard drugs has been a major focus for Akunyili. As a Pharmacist, she has always been aware of the devastating effects of fake/counterfeit products on the pubic.

 Professor Akunyili has had to resist a vicious and entrenched cabal that has made increasing and monumental gains

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through fraudulence and duplicity. Spearheading clean up attempts within the ‘industry’ that has generated billions of Naira for the “fake drug mafia,” generated a vicious backlash against her. Two years ago, a gang of armed men broke into her house in
Abuja, disconnected her telephone lines and electricity and laid siege on her house for over two hours. Mercifully, she had traveled to Lagos, on an urgent assignment, and was saved by Providence from the evil consequences that could have resulted.

 In December 2003, an assassination attempt was made on her life. Gunmen fired at the vehicle she was traveling in. The bullet pierced her headgear without any significant wound. Her brother (who was in the same car with her), her children, their foreign visitor, staff and security details in the convoy were thankfully, unharmed.

On March 7th, 2004, NAFDAC offices at the Federal Secretariat, Ikoyi, Lagos, were set ablaze. The fire destroyed the offices of the Director General, Establishment Inspector, Port Inspection and Registration and Regulatory Affairs Directorates. Office equipment including computers, photocopies, fax machines, etc were all destroyed

Three days after this incident, the Agency’s Kaduna laboratory, which serves the Northern part of the country, was set ablaze. Sensitive laboratory equipment including HPLC, Atomic Absorption Spectrometers and GC’s Chemicals were completely destroyed. Most of the equipment was recently purchased and were at the cutting edge of world-class technology in the field. Then criminals broke into the premises of NAFDAC Maiduguri laboratory, but fortunately were prevented by security agents from causing any harm.

Threats of physical harm, abusive telephone calls, and hate mail, have become commonplace in the life of Professor Akunyili. Oddly, insidious methods that the cabal adopted to threaten her include the use of mysterious items and live animals such as a tortoise placed in her office to threaten her. Her family and staff have not been spared either. They too received threatening letters and calls. In the midst of all these threats Professor Akunyili has persevered. Her strength derives from her strong belief in God. She believes firmly that God is in full control, and this belief has made her fearless.

 A GROUNDSWELL OF SUPPORT

Despite the threats, she has had a tremendous groundswell of support and appreciation from millions of Nigerians, governments, institutions, (locally and internationally), and the mass media. She enjoys an amazing relationship with the media. It is no exaggeration to claim that she enjoys the best press coverage of any public officer in Nigeria today. Indeed, journalists have become voluntary soldiers at the forefront of the NAFDAC army.

 

Recognition/Awards  

Professor Akunyili has received

Dora Akunyili

Dora Akunyili

over one hundred and seventy five awards and other accolades from organisations and governments in
Africa, Europe and America. Some of the latest honours include Recognition as an icon of hope for Nigerians (2002) by President Olusegun Obasanjo; conferment with the National Order of the Federal Republic (OFR), (2002), by the Federal Republic of Nigeria; and the Honourary Merit Award (2002), Nutrition College Park MD, USA. Last May, she became the first African ever to win the Transparency International (TI) Integrity award (2003). Prior to this, she had won the International EMRC Euro Market Award (2003); the Total quality leadership award (2003) by the African Institute for Democracy and Good Governance .

Perhaps the greatest honour that Akunyili has received is the gratitude of millions of Nigerians of various walks of life. By excelling in her work, Prof Akunyili has brought honour to her country and people, and has been at the vanguard of a movement of exceptional individuals that are helping to shape a new image of Nigeria, nay Africa, throughout the world. She has served her country diligently and honestly in the past years. In the process, she has saved millions of lives and brought sanity to an abused food and drug regulatory environment. The Chinua Achebe Foundation joins the nation in celebrating Dora Akunyili.

 

 

THE INTERVIEW

Nigeria’s history

Dora Akunyili

Dora Akunyili

of political ineptitude is often blamed on poor leadership. What is your assertion?

Historically, political ineptitude in Nigeria has been fueled by the absence of leadership by example. In The Trouble with Nigeria, Chinua Achebe pushes this point home:

The trouble with Nigeria is simply and squarely a failure of leadership. There is nothing basically wrong with the Nigerian character. There is nothing wrong with the Nigerian land or climate or water or air or anything else. The Nigerian problem is the unwillingness or inability of its leaders to rise to the responsibility, to the challenge of personal example which are the hallmarks of true leadership.

 

When one does not lead by example, one cannot command respect or the confidence of followers. That is the crux of the matter. When we talk about leadership, we mean leadership at all levels. The Head Cleaner is the leader of the janitorial staff in an office. The Director-General (DG) is the leader in an organization. So leadership, accountability, uprightedness, honesty are virtues that should be celebrated and practiced at all levels through out our society.

 

Corruption has long been the bane of the country. What steps do you prescribe for the situation?

 

I think the government should be given credit for appointing the right people to our nation’s parastatals, departments and ministries. For the first time in a very long time, we are witnessing a courageous and concerted crusade against corruption, in this country. Some very highly placed individuals in the country have been persecuted for corruption and jailed; this hasn’t happen in a very long time. And we expect that more corrupt individuals will be persecuted. 

 

There are several subterranean effects produced by the war against corruption that people overlook – the polity will, hopefully, eventually, be adequately sensitized to the fact that corrupt practices can be severely sanctioned with antecedent as well as descendant consequences for the individual, community and nation at large. The problem with corruption is that it thrives when it is not adequately sanctioned. It is human to want to cut corners. Corruption is not only about theft. It includes a myriad of inappropriate behaviour. You may not be guilty of embezzling funds, yet be deemed corrupt. For instance, if I register somebody’s product, because the person is my brother, it is nepotism, which is corruption, even if no money is involved. So, cutting corners and dishonesty are all part of it.

 

Nigerians appear cynical about the war on corruption. There is a great deal of rhetoric, yet a seeming absence of commitment

           

 

I understand the need

Dora Akunyili

Dora Akunyili and Colleague

for people to want the government to move mountains after years of decay; but these things take time. You see, historically in Nigeria, public servants in power have not practiced what they have preached, and the public has become used to that...hence the cynicism around the government’s efforts to rid the country of corruption.

 

After attending numerous government sponsored workshops on corruption, I will confirm that even criminals in this country talk about the importance of combating corruption! Most of the time people “talk the talk, but don’t walk the walk.”

 

Generally, in public places when corruption is discussed, it is condemned. However, it is not so much what people say as much what they practice. The government is doing its part. The important questions that Nigerians should be asking are: Are we, as a nation, taking active part in the crusade? Has it been made clear to the employees in every work environment that their agency or institution abhors corruption? Have we ensured that people working under us are well supervised, and that we do not look away when they are involved in corrupt practices? My point is that there is individual, community, state and then federal responsibility in the fight against corruption. After all, ‘We are the government!’

 

Nigeria’s educational system is in crisis. What factors, in your opinion, are responsible for the decline, and how can they be addressed?

 

Our educational system is a disaster. However, fixing the education sector can be done quite easily. I don’t want to sound as if I have all the answers to every problem, because I don’t. Neither do I want to run anybody down, or create bad blood. But believe me, we can emulate the excellent educational systems abroad, and then adapt them with great success to this country.

 

My contention is that our educational system today has stifled creativity and hampered the emergence of excellence. Over the years, there has been a general leveling of our universities, secondary schools and primary schools, and our teachers, as well. In other words, every school, teacher, professor, is paid the same as their peers, irrespective of individual talent, dedication or excellence in the field. There is an absence of rewards or incentives to stimulate and buttress excellence. There is also no competition, and no rigorous ranking system at all levels of the sector. As long as there is no competition, no incentive to excel, there will be no vested interest in producing excellence. Stakeholders in the educational system will perceive themselves as “under appreciated assembly line workers.”

 

In Europe, for example, a principal of what is regarded as a “magnet school” [number one school in the district or state] could very well earn a salary that is greater than that of the country’s president….

 

(Interrupting) How is it possible for Nigeria to develop the culture of excellence in schools that you allude to?

 

We need to overhaul the educational system, re-evaluate our incentive and salary packages for teachers and lecturers, and do away with flat or level salaries. I mentioned that in Europe teachers and principals work hard to elevate their schools’ position in the league. There are rigorous criteria used in determining how well school systems are performing. These criteria examine teacher quality, student achievement, and quality of facilities, principal effectiveness etc. Fierce competition between schools is encouraged, because a great deal is at stake -- for principals, teachers, as well as the students. So, the fact of one’s school achieving number one, number two or the lowest position in the country depends on many parameters that are used in assessment. A school teacher in a number one or number two school in Britain may earn a higher salary than a university professor! This is because the school is highly rated by a joint commission, and the stakeholders are appropriately rewarded for their excellence. 

 

In the system I am alluding to, ranking is paramount. Ranking should affect both salary and prestige of the principal and teachers, and of the students proceeding to tertiary institutions, and eventually to the job market. So it is not just the principal working extraordinarily hard, teachers will work hard to remain in the school, and make sure their students become the best, so that their school continues to advance within the league.

 

Are you suggesting that Nigeria adapt “best practice” methodologies from the business world to our school systems?

 

For any establishment to succeed, it really must be run like a business, as if it were an enterprise; though without losing sight of educational goals for academic excellence. Thus schools must be run as a business, and not as a private enterprise. However, a principal cannot run a school like a business when there are no incentives in the system to reward his or her hard work. And as long as we don’t have a sophisticated and elaborate rating system for our universities, our secondary schools, our primary schools, we will achieve nothing.

 

How can we effectively marry business and academia in our educational system?

 

The idea is not new; when Americans started raising large sums of money to buttress university endowments, almost a century ago, European schools laughed at the idea, calling the American institutions uncouth. Today, America is having the last laugh. Harvard alone has an endowment of 22 billion dollars…Yale 15 billion dollars. And they are repeatedly ranked in the top echelon of the world’s institutions!

 

So what I am suggesting is that our schools need to be run with clear and keen business tenets, without losing our focus on the ideals of educational excellence.

An example: If we link certain academic, extracurricular attainments to principal and teacher incentives, we will find that principals will work harder to improve the standards in their schools, because they now have a vested interest in school improvement.

In primary schools, the same principle applies. In Europe, there are some primary schools that are very highly rated, and which enjoy glorious reputations. They are considered even as if they were tertiary institutions! For the principal of such a primary school, the salary is often in six figures. The same is true for the teachers. And underperformers are instantly removed.

 

Doesn’t this idea create an avenue for corruption in the educational sector?

 

Corruption is a sore point, and already in the system. We have to root it out where it exists presently, and then clearly, from the planning stages of any new initiatives in education, put in place checks and balances to prevent the abuse of the system in the future.

If a principal and teachers are not corrupt, they will administer whatever money they have in ensuring that the students get the best possible education. But today, when money is given for food and dormitories it is often not used for such purposes. Principals don’t care what is expected from them. I know schools where children have been killed in boarding houses, and things just go on as if nothing happened. If that kind of thing happens overseas, there will be hell to pay! The principal is often fired, and that school goes to zero in the ranking league. Such a principal may never be able to get a job in any other school in Britain or USA. The teachers’ careers will be destroyed as well.

You have mentioned establishing incentive packages for teachers and professors to stimulate and reward excellence. Can you explore this a little more?

Of course! Is it not scandalous that if I studied literature, and become a professor of Literature, that after a few years I will be paid exactly what Wole Soyinka is being paid, granted that he works in the same Nigerian university under our present compensation package system? How can the university grow in such a situation? But in America, lecturers negotiate their salaries. And because national and international reputation, as well as academic output and performance dictates what one earns and is valued by schools, university professors work extremely hard to become rated highly.

Such high rating dictate one’s compensation package, so that Professor Woke Soyinka would be on an endowed salary of one million pounds, and a different Literature professor, even if qualified on the same day with him will be receiving 50,000 pounds. There is no grumbling about it. The rating cannot be on an equal level. If at the University of Ife, every professor of Literature earns the same as Professor Wole Soyinka, where then is the incentive to excel?

 

What about the role of the government in providing facilities and infrastructure?

The government definitely has a role to play...but so does the private sector. The oil industry, the banks etc can support existing schools and establish excellent new schools with large endowments that will sustain these institutions into the future. The teachers play a salient role as I have mentioned previously. Do you accept that you can produce an excellent student if he or she has a dedicated teacher that is valued and compensated appropriately even if all they have to teach with is a rickety old black board and little bits of chalk under a mango tree? What I am suggesting is that we need to go back to the planning stages and facilitate the seamless interplay of government, public and private sector responsibility and roles in producing a unified product – academic excellence.

 

Can you identify specific strategies that are capable of moving the country’s pharmaceutical sector forward?

The pharmaceutical industry can move forward in incremental steps. Let us begin by examining the education of pharmacists.

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My contention is that producing excellent pharmacist will require great commitment from lecturers of Pharmacy. We must establish and maintain excellence by encouraging competition, and revamping the Pharmacy curriculum. We also need to provide more funding to this important sector for facilities and improved compensation packages.

 

We need to establish the culture where students assess lecturers. In some schools of Pharmacy, lecturers become professors, just because they have published books, or have articles placed in journals, and some of them don’t even teach on a regularly basis. Now publications are very important, but a lecturer should also be evaluated based on his/her teaching ability. Some professors really don’t teach very well or care about updating their curricular content. They provide the same lecture every year without any updates. One can see that the lecture notes have turned brown with age, because they were prepared in the seventies with no new ideas reworked into them. This is, frankly, irresponsible, and a gross disservice to students who pay to receive new and current, even cutting edge information. Some lecturers in Nigerian universities are still teaching with pre-historic notes. And students complain that they don’t understand what some of their lecturers are teaching. These are serious complaints, yet do not affect lecturers’ promotions, salaries and status. Unfortunately the students suffer, and ultimately the nation suffers, because the environment has not been set up for excellence.

 

Nigeria is witnessing an upsurge in the visibility of women in public office. Some applaud this development as a long overdue empowerment of women; others believe it is tantamount to affirmative action that erodes the tenets of merit, hard work and excellence. What is your opinion?

My views on the empowerment of women are complex. Let me start this way: all my life, I have always had equal opportunities with my male counterparts. But in some parts of Nigeria, women are not as lucky. In general, women are faced with deep cultural, political, social, economic and historic problems. We have to honestly accept this premise in order to address it squarely!

 

The foundation of this problem is often laid with the attitudes towards females in the home. In certain households, especially homes with limited education and exposure, one often finds that the male child is treated better than the female child. In fact, some pregnancies are terminated, because the fetus is female; and this is in Asian countries, as well, not just in Nigeria. Male-child preference is a problem. And right from the home, the female child is forced to take care of household chores while the boy is regarded as someone who should read and spend more time developing himself. So, right from infancy, most women begin on a level of disadvantage.

 

Does poverty play a role in the oppression of women?

 

Yes, in many ways. One example is the case of childhood marriages. The poorer the background, the worse the situation gets. Poverty is a terrible thing; you find impoverished parents allowing their daughters to be married off at 10, 12 years old, so they can get their hands on her dowry. Once the family is rid of the girls, they will have enough money to train the boys who will inherit the family property and family name. The idea is to keep the family name going. And one problem leads to another: In some cases, these girls get involved in early pregnancy. And of course early pregnancy has its own complications and setbacks.

 

What other ways are women kept back from flourishing in our society?

 

Well, one horrendous example of the oppression of women is genital mutilation. We find this embarrassing, and do not want to talk about it in polite society. However, there are still many areas where young girls are put through this horrific practice! Even before they know what is happening, they are mutilated --preventing them from leading a normal sexual life. In these communities where this terrible practice exists, the practitioners claim that the mutilations are to prevent the women from becoming promiscuous. The practice presents not only physical, but psychological effects for many women. Many circumcised women have marital problems, and develop psychiatric illnesses like depression and suicidal ideation.

 

We also have low school enrolment, and high school drop-out among females in many parts of this country. Again poverty is implicated here. If the family doesn’t have enough resources, they prefer to train the boys.

 

You paint a dire and gloomy tapestry of the state of women in Nigeria

 

I have only touched the surface. You see, we don’t have equal rights in certain parts of the country. In the Southeast, we are not allowed a part in the inheritance of property. In most families, the men inherit the houses, the money, and it is only very seldomly that women are included. They might be remembered when things are plentiful. Now, if there are two houses, and six males with large families, nothing will be shared among the girls. The boys get the property, and the ladies will rarely challenge the status quo. Again, in some other parts of the country, women are denied their right to vote.

 

Such discriminatory and stigmatizing practices are problematic, not just for women, but for our whole country. The situation is even worse for widows…. many of them go through various forms of dehumanizing treatments from families, friends, and in-laws. Poor treatment of widows by relations of the deceased husband, and violent attacks on them and their children, as well as forceful take-over of their properties and rights is abhorrent!

 

Wife battering is a shameful hidden secret in many homes throughout this country! This form of denigration makes women lose their self-confidence. And when you lose your self-confidence, you have lost everything. Women in addition, face different forms of religious discrimination and political repression.

 

Did you go out to redress some of the disadvantages women face in Nigeria by hiring a significant number of women in NAFDAC?

 

Yes. As a matter of fact, in NAFDAC, I like to make sure that women get an equal chance of employment…and I’ll tell you something; people are feeling more comfortable about it. One of my advisors at NAFDAC, a man, encouraged me to hire more women…He said Madam: ‘please don’t send male staff to ports and registration units. These places are too tempting for someone who wants to make N20 or N30 million a day. Please don’t send men to these two areas; we have had enough casualties.’ And that says everything.

 

So I am not saying that women are saints, but women are more cautious. I will go as far as making this bold statement -- that women are generally more honest than men. It does not mean that dishonest women do not exist. We had one such dishonest employee in Onitsha, and we fired her. However, the point is that women are more amenable to correction, and they generally like to play by the rules of the game. They are very strict on regulations. And we need strictness for success. Women are not as prone to corruption as men, and as a consequence, it is my contention that Nigeria should employ more women, especially in very sensitive areas.

 

Now to health care: what is your vision for improving the Nigeria’s health care delivery system?

 

First of all, we need to develop a true health care system. What we have now is not desirable. We have to decide whether we are going the capitalist route like America, the socialist route like Scandinavia, a mixed system like NHP in Canada and the UK, or whether we are going to develop our own unique system. Whichever strategy…we must just do it! The integration of business tenets into the health care system will be a novel approach that is likely to provide this sector with sustainability, stimulate innovation and reward excellence. Much like what I suggested for education, we should develop a ranking system, create incentive packages, and encourage competition to stimulate excellence. Hospitals and clinics should develop performance parameters. Different doctors may be on different salary packages based on skill and experience.  

 

In the system that I envision, if we go by ranking, which is based on various parameters, the chief medical director will work extraordinarily hard, because he or she wants an exceptional ranking for the hospital. S/he will struggle to raise money through the patient’s fees without using extortion. Again, monitors will continue checking to see whether there are cases of over-charging. There will be monitoring units that constantly audit, and make sure that standards are maintained, and that patients are not overcharged.

 

How can health care providers strike the balance between the need to make money for health centers and the need to achieve quality medical care for patients?

 

We can achieve this by making the happiness of patients our top priority. If your focus is the happiness of your patients, you

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will spend time to make sure that they receive the best possible care at the most reasonable prices, or they will go somewhere else in the competitive system that I have described. One’s policy will be to make patients happy, so that they want to return. In Nigeria today, this certainly, is not happening. This is because the medical workers feel they have nothing to lose. But if there is competition, there is something to lose. And you have something to gain when your hospital is generating large amounts of money as a result of high patient numbers. The successful hospitals will generate more referrals, receive more complicated cases or referrals, record more successes, and record lower death rates.

 

With rankings of hospitals, doctors and health centers, health care providers will discover that somebody working in a general hospital ranked No. 1 in the league earns 10 times more than another working in a different general hospital ranked much lower. The result is that from the doctors, to the nurses, to the pharmacists, and then to the Chief Medical Officers, everybody will be working hard to make the establishment a success, because it will be clear to the stakeholders that ultimately, their salary, well being, and success are tied to the growth and success of the hospital. Such a system will encourage excellence, hard work, as well as commitment to the common goals of the organization.

 

Your preference for revamping the Health Care sector appears to be a shift to an American style Managed Care System model where there is competition

 

I believe that if we run a competitive system and a ranking system where every worker in the hospital, right up to the Chief Medical Director, has a stake in the system, and if the system rewards excellence by making sure that successful hospital managers are catapulted to the highest rank, they will work hard to move themselves up. Those who don’t work hard enough will be moved down. In Nigeria, the question is -- are people working hard to move up? Is the entire medical team, including the CMD, doctors, pharmacists, nurses, lab technologists and other staff, working hard enough to move up?

 

(Interrupting…) In our present system there are no incentives to work hard…

 

My point exactly! Everybody is getting subvention. You go to work when you like. You leave when you like. Nobody is actually monitoring staff, and it doesn’t matter what anyone is doing. Nobody’s salary is ever threatened. After four to five years, people are promoted. So where is the incentive for hard work? Human beings are the same all over the world; if they don’t have incentives for competition overseas they will behave exactly as we do here in Nigeria. So if these hospitals are given certain amounts of money, you can say to each hospital: establish a small monitoring unit with a portion of your allocation. After one year we can send joint commissions to audit the books to find out what they have done in terms of patients, hospital visits, mortality rate, and accounts status etc. The parameters in the United Kingdom and America, for instance, are very clear, that there is no room for inefficiency.

 

In America, Health Care providers – Doctors, Nurses - keep their licenses by accumulating yearly compulsory CME [Continued Medical Education credits]. These credits are often earned from clinical trainings, seminars, workshops, research and presentations. Should a similar exposure to continuing education for our health care workers be required in Nigeria?

 

I believe so. Continuing medical education will keep our health care providers up to date on the latest technologies, procedures, research and therapies. The Teaching Hospitals would naturally be the places for such credits to be accumulated through clinical trainings, seminars, workshops, research and presentations, for without research why should they be referred to as teaching hospitals? What gives a hospital academic status? Is it just reading textbooks written by other people? No. Such hospitals must be conducting research and at the forefront of cutting edge technology and advancements. As I said, writing up a lecture and teaching the same content to students for 20 years is not the answer. Some of these lecturer’s notes, as I’ve said, have turned brown with age. They have been in the same condition for 20 years or more. Students are also aware that the lecturer is not doing any research, or updating relevant information and knowledge base.

 

Information Technology plays an important role in the attainment of high quality health care throughout the world. How can Nigeria effectively institute computerization in this sector?

 

Computerization is very

Dora Akunyili

Dora Akunyili

important, and has been found to improve efficiency in a myriad of departments in the health sector – accounting, finance, research. In the United States, most hospitals and clinics have done away with paper charts, and have what is called Electronic Medical Record [EMR] systems on computers! In Nigeria, computers are not accessible to many…not everybody can afford to own a computer or access the Internet due to several competing factors. Children from rich homes easily access the Internet, so computerization is not something that is over the heads of the majority; it’s simply a matter of economics.

 

So there’s a challenge, not just in health care, but in most sectors of the economy that lack access to computer technology. Come to think about it…there are no computers in any of our secondary schools in the villages. These seem to be reserved for the elite; those who can afford computer hardware and software. We are talking about something that should be widely available to all citizens. By the way, we often do not have electricity in some villages for three to six months! In the town, power supply is also unsteady. As long as we have epileptic power supply, the computer technology will not catch on the way it should. Our children are working very hard to become computer literate, but they are terribly handicapped by the lack of computers, and intermittent power supply.

 

 

Madam, you are a household name due to the enormous impact of NAFDAC in the country under your able leadership. Where do you draw your inspiration?

 

Quite frankly, the things that happen in NAFDAC are divinely inspired. That is why I often say that I am not responsible, but our God is. He is using me as a vessel. So I give God all the glory for the success and achievements associated with NAFDAC today, nationally and internationally. The things I initiate or accomplish in NAFDAC have often come to me in a flash. When I remember something, even at midnight, I get up and immediately scribble it on a piece of paper. In the morning, I can begin to implement it. But I know fundamentally that there is no way one can effect a change without leading by example!

 

Thank you Professor Akunyili

 

You are welcome!

Disclaimer: The views expressed in the interview are not necessarily those of the Chinua Achebe Foundation. The Chinua Achebe Foundation, an intellectual and cultural organization, believes in the right of every Nigerian to express their opinion.

Chinua Achebe Foundation Interview Series: Prof. Dora Akunyili in Conversation with Adeze Ojukwu