Kayode Fayemi (Governor, Ekiti State)
It
gives me great pleasure to deliver the 8th Annual Olikoye
Ransome-Kuti Lecture a decade after the passage of the (more)
I also thank WHARC for their
thoughtfulness in organizing the annual Olikoye Ransome Kuti lecture and
scientific dialogue to immortalize the name of this great icon who excelled as
a person, as a professional, and as an administrator and a pioneer of primary
health care in Nigeria and in Africa. I
congratulate you for this worthy initiative that aims to draw national
awareness to the ethics and principles that were epitomized by Professor
Olikoye Ransome-Kuti in his life time.
Professor Olikoye Ransome-Kuti was a
legend in the field of good governance in Nigeria and one of Nigeria`s foremost
Health experts. A specialist in paediatrics, he entered the national
consciousness when former military President General Ibrahim Babangida
appointed him as Health Minister in 1985.
He made his mark through the rapid introduction of a comprehensive
National Health Policy and revolutionized the Nigerian Health Sector by placing
great emphasis on preventive medicine, particularly concentrating on primary
health care and focusing on preventable childhood diseases and encouraging
continuous nationwide vaccination programmes.
I cannot lay claim to any knowledge of Professor Olikoye Ransome-Kuti
better than many of you in this distinguished audience, although I consider
myself a protégé of his late brother, Dr Beko Ransome-Kuti in the civil rights
and pro-democracy movement in Nigeria. Indeed it was in this context that I
first met him in the early 1990s on one of his trips to the United Kingdom when
he had to deliver a “contraband material” from Dr. Beko Ransome-Kuti to me,
even though he was Health Minister in the government we were then at war with.
(Don’t ask me what the contraband was).
My second close, and the most profound meeting with him was in far away
Florida, United States at the African Studies Association conference in 1995.
He was no longer the Health Minister then and I was a very young PhD scholar
and radical activist brimming with ideas on how to ‘fix’ Nigeria. I shared his
lunch table on this occasion and engaged him in this typical ‘us and them’
discussion about our beleaguered country and how his generation messed things
up. It was not so much anything he said that touched me to the marrow. It was
how he said it - his simplicity, his humility, his refusal to accept that
Nigeria was ‘unfixable’ and the courage of his conviction. The two hours that I
spent with him that afternoon remained indelible in my memory even till now. In
the course of my return to Nigeria in the post-Abacha era, I have had the
privilege to meet other members of the family, Aunty Sonia, Prof’s lifelong
partner, Dotun, Gboyega and other members of the family who have carried on the
Ransome-Kuti touch.
Professor Olikoye Ransome-Kuti’s
achievements in the health sector continue to stand tall even today. Many of his
pioneering initiatives are still regarded as some of the greatest legacies left
behind in the health sector. With Professor Ransome Kuti, many now believe that
a tree can indeed make a forest. Many who also believed that you cannot do good
in the midst of evil and see this as an excuse for in-action now refer to
Professor Olikoye Ransome-Kuti as one person who made a fundamental difference
in spite of the insincerity of the government he served. Apart from his giant
strides in primary health, he broke the silence surrounding AIDS in Nigeria
when he announced in 1997 that his brother – legendary musician, Fela died of
complications arising from HIV. This was at a time when many Nigerians believed
that HIV/AIDS was either a tool of western propaganda or a white man`s disease
to which blacks were immune. Professor Kuti was unique in his integrity. He has been described as a superb clinician
who devoted himself to his patients, always as a salaried professional, never for
private gain. His intelligence, compassion, wisdom, exceptional honesty and
exemplary leadership earned him widespread respect. Evidence of this abound
everywhere and the award of the prestigious Leon Bernard Foundation Prize of
the WHO in 1986 and the Maurice Pate Award for his contributions to children’s
health and welfare are just two examples. He remains a model in public service
for those who genuinely want to serve their people and that is why I consider
delivering this lecture a rare privilege indeed.
Health Care
Delivery in Nigeria
To
put matters bluntly, Nigeria’s national health indices are uninspiring and it
is worrisome that Nigeria’s healthcare delivery performance index is still
struggling with those of war torn and less endowed countries even after 52
years of independence. The maternal
morbidity and mortality figures are the second worst globally. Peri-natal
mortality is at equally astronomical levels with a high incidence of diseases,
particularly the emerging pandemic episodes of HIV/AIDS, cancers of all kinds
and rising cases of hypertension and diabetes with their attendant
complications. Coupled with all these is
the very low life expectancy of 52 years for males and 54 for females. Many factors and challenges have conspired
against the realization of the laudable objective of the Walter – Harkness
ten-year development plan and the enunciation of the first National Health
Development Plan in 1960.
Before the 21st century,
Nigeria would have achieved universal health coverage with all her citizens
having access to quality healthcare, if there had been good governance at all
levels of government. The problems militating against healthcare delivery in
Nigeria range from policy inconsistency, lack of political commitment, and
corruption to infrastructural decay, the undue politicization of the health
sector and declining professionalism. To these we can also add the lack of an
adequate constitutional and legal framework for healthcare delivery and absence
of a National health act that clearly defines the roles and responsibilities of
government in the management of the three levels of healthcare.
Other
obstacles are weak co-ordination, integration and implementation of health
policies and programmes; inadequate budgetary provisions for health,
inequitable distribution of the health workforce and weak primary and secondary
levels of care with a weak referral system. The challenges are literally
legion.
The
table below shows the veracity of the current health indices in Nigeria.
Table 1: Nigeria
Health Indices
|
S/No.
|
Index
|
Nigeria’s
Figures
|
Ranking Among
Countries
|
|
1
|
Access
to sanitation
|
33%
|
115th of 129
|
|
2
|
Birth
rate, crude per 1000 people
|
40.51
|
20th of 195
|
|
3
|
Children
underweight rate
|
11%
|
14th of 95
|
|
4
|
Contraception
|
15%
|
77th of 89
|
|
5
|
Dependency
ratio per 100
|
90
|
20th of 166
|
|
6
|
Drug
access
|
1%
|
141st of 163
|
|
7
|
Expenditure per capital
|
$23
|
155th of 186
|
|
8
|
Hospital
beds/1000 people
|
1.67%
|
98th of 149
|
|
9
|
Infant
mortality rate
|
70.49%
|
33rd of 149
|
|
10
|
Life
expectancy at birth
|
43.83yrs
|
170th of 194
|
|
11
|
Probability
of reaching 65 years
|
42.1%
|
126 of 159
|
|
12
|
Total expenditure on health
|
4.7%
|
135 of 185 as
% of GDP
|
|
13
|
Water
availability
|
2,514 cubic (mtrs)
|
115 of 165
|
Source: World Bank Development indicator database
2012.
Health, Social
Inequities and Universal Access
Like
the age old saying goes, “Health is wealth”.
Healthcare is a social service and is essential for sustainable economic
production. Indeed, good health is a
priceless resource in the economic life of households, communities and nations. The resulting high economic production is
also necessary for sustaining the delivery of qualitative health service. This cycle is so important that health can no
longer be regarded as a social service alone but rather as a developmental
programme with economic implications.
The role of healthcare as a vehicle for human and social development has
long been understood and countries with functional heath systems, particularly
the OECD nations, are known to have made giant strides in the developmental
arena.
This
conception of healthcare allied with empirically-derived policies and best
practices in healthcare delivery has enabled developed economies of the world
to sustain high levels of economic productivity which in turn has led to the
continuous evolution of their societies into secure, responsive, prosperous and
egalitarian examples of the modern nation state.
The yawning gap in development between
the First World and the Third World – which is obvious in most African
countries and indeed in the developing world – stems in part from our
collective inability to offer high-quality, affordable and accessible
preventive, curative and rehabilitative health solutions to the people who our
hopes of building resilient and prosperous societies depend upon.
Developing nations require bold and
imaginative healthcare policies to accelerate the attainment of optimum
socio-economic development with the people at the centre of policy
planning. In as much as a nation cannot
rise beyond the collective capacity of its people, creative thinking and
necessary investments in health care remains a top requirement for the
emergence of development in Africa and provide real validation for the axiom, “Health is Wealth”.
Having established the primacy of
healthcare in the broader spectrum of development, let me state here that
achieving universal access to qualitative health care services has remained one
of the major challenges of developing nations like ours. Without prejudice to previous attempts to
expand healthcare coverage for our constantly growing population, it remains a
fact that the intentions and goals captured in those developmental agendas have
not translated to results, particularly for the most vulnerable. In most parts of our nation, there remains a
chain of considerable cultural, socio-economic and systemic factors that constrain
access to quality health care for a sizeable proportion of Nigerians.
As clearly stated by WHO in an
assessment of health systems contained in the World Health Report of 2000
“Better health is unquestionably the primary goal of a health system”. Further to this, the same report notes that
because health care can be costly and the need for them unpredictable,
mechanisms for sharing risk and providing financial protections are
important. Another goal of adequate
healthcare policy is therefore “fairness in financial contribution”’ A third goal, “responsiveness to people`s
expectations in regards to non-health matters”, reflects the importance of
respecting people`s expectations in regards to non-health matters”, reflects
the importance of respecting people`s dignity, autonomy and the confidentiality
of information. It also burdens stewards of public trust with the
responsibility of marshalling public assets across all sectors-education,
agriculture, water and sanitation, infrastructure development etc in a manner
that achieves meaningful synergies for the improvement of the health outcomes
of the population.
However, inequities still exist in our
health system making the rich and educated access better health care services
than the poorly educated and poverty stricken that need it most. This has continued to bedevil the legitimacy
of our health system and remains the most important factor for our not being on
course to achieving health Millennium Development Goals (MDGs) by 2015.
The World Development Report (2006)
defines equity broadly as “equality of opportunities and potentials” and “the
avoidance of extreme deprivation in outcomes”.
It must be noted that while equality and equity are not the same by
technical definition, a country with high inequality is less likely to be
equitable compared with a society with low inequality. Though a lot of meaning can be made from
considering inequality in financial or economic terms, inequality is now being
assessed beyond its financial measure.
The majority of inequalities found in developing societies are not
“income-expenditure” measures of inequality.
Rather, they are mostly related to the “opportunities” dimensions of
equity. In other words, how equally are the opportunities for a healthy life
distributed among citizens?
The inequalities in poor countries also
tend to be mutually reinforcing and when the various dimensions of inequality
reinforce one another, individuals who fall into the disadvantaged group may be
caught in an “inequality trap”, a situation in which they experience barriers
to access and participation that may persist for generations.
A very good measurement for determining
the development of a society is by assessing how its poorest and most
vulnerable groups live. According to the
Nigeria Human Development Report 2008-2009 published by the UNDP, Nigeria seems
to have a systemic structure of inequity where just 20 per cent of the
population owns 65 per cent of national assets while as much as 70 percent are
peasant rural workers and artisans.
Inequality in Nigeria means that opportunities for upward mobility are
very limited; it means a few decent jobs, poor income and low purchasing power
for the employed; it also means poor infrastructure and institutional failure
in not only the health sector, but also in education, transportation and other
social services.
The report titled Achieving Growth with Equity also notes that between 1985 and 2004,
inequality in Nigeria worsened, - increasing from 0.43 to 0.49 on the Gini
coefficient scale – thus placing the country among those with the highest
inequality levels in the world. This
assertion is corroborated by several studies and publications which affirm that
despite its vast resources, Nigeria ranks among the countries with the widest
gap between their poorest and richest citizens.
A major dimension of inequality in the
UNDP report is in the areas of access to health services and health
outcomes. The percentage that has access
to healthcare consultation services and actually takes advantage of it
increases by quintile, from 3.5 per cent from the bottom or first quintile to
12.47 per cent for the top or fifth quintile.
In terms of Maternal Health, findings of
the 2008 National Demographic and Health Survey shows that the proportion of
women residing in urban areas who
obtained Antenatal Care services from a skilled health worker is 84%, higher
than among women residing in rural areas where only 46% get these
services. Educational status, another
important socio-economic population factor also seems to influence the uptake
of Antenatal care services among women as 97 percent of women with more than
secondary education received antenatal care services from a skilled health
worker, compared with 31 percent of women with no education. Similarly, women in the higher wealth
quintiles were found to be more likely than women in the lower wealth quintiles
to deliver in a health facility as the survey revealed that about 79% of women
in the upper wealth quintile delivered in a health facility compared to 7.3% of
those in the lowest wealth quintile.
These figures aptly demonstrate the “wealth of social imbalance” among
our population and how it further accentuates iniquities in health access.
The Ekiti State
Health story before 2010
Before
2010, a lot of the initiatives had been designed and implemented for the
improvement of the health of the population.
However, the structural inequity that is the main bane of many health
initiatives still persists. A sizeable
proportion of our people still live below the poverty line while access to
qualitative health care services in rural areas is still far from ideal.
As far as Maternal Health services – a
top priority of the MDGs – goes, the NDHS (2008), also reported that in Ekiti
State:
§ Fertility rate
in Ekiti as 5 children per woman
§ Only 20% of
these women deliver in Public Health Facilities
§ 15% in Private
Facilities and
§ 62% at home
§ 56% of mothers
in Ekiti had no Post Natal check up within 41 days of delivery
§ Only 45% of our
women had 4 or more antenatal care visits from pregnancy to delivery and out of
which 87% of them had access to skilled care.
2010 October
till Date: Eight Point Agenda to the
Rescue
As
part of my administration’s agenda, the 5th item of my 8-point agenda represents the
Health component of this all-important document and is focused on “Provision of Free medical services for
children under 5, all pregnant women, the physically challenged and senior
citizens; establishment of health centres in all localities, increased
immunization coverage”.
The agenda is focused on resolving the
issues of equity which have long limited the capacity of our health care system
to impact on the development of the total man and to improve the reproductive
health indices in the State. The Health
component is being vigorously implemented alongside other programmes in other
sectors based on the other seven items on the 8-point Agenda.
Free Health
Programme
The
Ekiti State Government launched the free health programme for the delivery of
high impact quality health services to the targeted groups through a
facility-based model. The programme
ensures the removal of financial barriers to health care and prioritizes the
delivery of services for the vulnerable in a bid to scale-up efforts at
achieving the Health-related MDGs. As at
July 2012, 112,399 people had registered for the programme including 10,787
pregnant women while 3121 normal deliveries and 240 caesarian sections had been
recorded.
Currently, the programme serves pregnant
women, children under five years, elderly citizens above 65 and physically
challenged, including People Living with AIDS.
To access the free health programme, individuals within the defined
groups are required to register at any of the 35 designated health
facilities. The programme provides
essential services to the prioritized groups including free antenatal care and
facility deliveries including assisted deliveries and caesarean sections, free
treatment for ailments like malaria, acute diarrhea and acute respiratory tract
infection with essential drugs for the designated groups.
In the first year of the programme,
indicators of service utilization such as total attendance, total antenatal
clinic attendance and under-5 attendance improved by over 30% when compared to
the baseline year (August 2010 – July 2011) as shown below. Deliveries also recorded marginal improvement
of 2.73%. Referrals however improved
significantly by 12.71%.
Generally there was an improvement in
utilization of services as evidenced by the available data and elderly citizens
are the highest users of the free services accounting for 51.15% of registered clients and 42.40% of total facility attendance in the first year of the
programme. There has also been relative
increase in utilization by pregnant women and under-5 children. The programme has also promoted referrals to
higher levels of care with a 12.7% increase in volume of referrals over a
12-month period. The current maternal
mortality in the State is 135 per 1000,000 compared with 420 per 100,000 reported
in 2010 October (unpublished data). The
total value of drugs dispensed has increased from N11,038,007,77k to
N25,926,398.43k due to increase in demand and utilization.
Free Health
Missions:
We
have embarked on seven Free Health Missions till date, the last of which took
place in April 2013. The Free Health
Mission was designed to consolidate the Free Health Services to all the
citizens of the State through a population-based outreach model. The philosophy of the scheme is to deliver
services to the wider population not protected or covered by the facility-based
burden and improve health outcomes of the general population.
This intervention is being carried out
because:
§ It assures
Greater Equality: Compared with higher
levels of care, free medical missions are more accessible geographically,
financially and culturally to local communities, and provide more personalized
care to the most vulnerable.
§ It reduces the
Disease Burden: By effectively
addressing the most common health needs of the people. Medical missions can bring the greatest
benefits to the health of families and communities, because a predominant share
of the burden of disease is concentrated in children under age 15.
§ It produces
Economic Savings: by improving family
health, free medical missions reduce the economic consequences of
ill-health. It is a known fact that
illnesses lower worker productivity and drain household assets.
The
scope of services include screening for chronic medical conditions and
infections, medical out-patient services, dental services, health promotion,
eye care services, immunization services, simple emergency services and
provision of essential drugs.
Complicated cases are referred for further treatment at secondary and
tertiary facilities.
In 7 editions of the mission implemented
since January, 2011, a total of 720,000 people have been reached with this
intervention amounting to over a quarter of the population of Ekiti State.
Medical
Assistant Schemes
Ekiti
State has a very low resource base being ranked thirty-fifth on the
state-by-state index of resource allocation from the federation account. Thus,
poverty is more entrenched among the people and this informed the free health
programme and the free health mission component of item 5 of our agenda. Because of the level of poverty and the
palpable social inequities, people who cannot afford hospital medical bills are
often assisted to take care of the rising medical bill through the medical
assistance scheme/Board. Between 2010
and October and April 2013, about 125 million naira have been distributed to
the financially limited clients to take care of surgical and chronic medical
illness including cancers within and outside this country. The request for this support continues to be
on the increase.
Unified Drug
Revolving Fund (UDRF)
In
order to make the cost of medication, medicaments and consumables affordable to
the people, we have the most virile unified drug revolving fund which has been
rated the best in the country in recent times.
This UDRF is supported by the World Bank and it ensures that drugs are
delivered to everybody in the State at affordable prices and access made very
easy while avoiding polluting the market with fake drugs. We continue to improve in this area with the
development of the mega depot at our Central Medical Store.
The Health
Facilities/Institutions in Ekiti
The
health institutions are organized into primary, secondary and tertiary
institutions but these lack co-ordination, appropriate linkage and referral
systems, and are faced with human resource challenge and lack of modern
equipment. Besides, there are beset by infrastructural decay with many of them
being what they were about 40 years ago when they were constructed by the
regime of General Adeyinka Adebayo in the 1960s.
We have started the process of
renovating these facilities to make them more responsive to the needs of our
people. We are making these facilities
more environmentally friendly by giving them a new look through general
rehabilitation, rehabilitation with extension of the primary and secondary
hospitals and equipping them with the State of the art equipment with provision
of the needed human resource. These
hospitals are being provided with ambulances to facilitate effective management
of accident and emergency care. Since I
came on board, I have procured 15 ambulances to take care of emergencies across
the State. The ambulances are fully
equipped and handled by trained paramedics.
There are other items on my
administration’s agenda in Ekiti that address the health challenges and the
broader social inequities in the state. We are actively dealing with these
issues. In the areas of education, this administration is underwriting free
education up to the secondary level with the provision of bursaries and
scholarships to the students that are genuinely poor. We have embarked upon
similar activism with regard to women empowerment and gender equity,
agriculture and construction of roads particularly those linking the urban to
the rural areas. We have also put in
place a welfare package that provides a form of social security to the elderly
citizens of Ekiti and has helped in bridging the gaps created by
inequality. We have devoted a greater
proportion of 2013 budget to water development and environmental
sustainability. While the prevalent health challenges in Ekiti are not totally
different from other states in the country, we have learned enough over the
past few years to be able to argue that a proper repositioning of the health
sector in Nigeria and in many developing countries definitely requires
political commitment to healthcare by all levels of government. It calls for
the transparent implementation of poverty reduction schemes, commitment to
universal health coverage by government at all levels, increased budgetary
provision for healthcare to at least 15% of the national and state budgets with
effective utilization of the funds and allied health resources.
Yet, free health programmes and missions
by themselves are not the panacea to the health inequities in our society as
our experience in Ekiti has shown. They may work for a while as a short term
solution but ultimately we must develop an effective insurance scheme that will
sustainably transform our health system. That is junction we have reached now.
The present National health insurance scheme though not perfect and universal
at the moment is noteworthy as a step in the right direction and we have just
entered into a partnership with NHIS. It should be embraced and improved upon
through community-based health insurance which has the tendency to cover both
formal and informal sectors of the economy using the appropriate tools of
performance-based financing and healthcare contracting.
Overall, this administration believes in
and is undertaking a holistic approach to the provision of healthcare. Beyond
constructing supply-side facilities, we have crafted an approach based around
two questions. The first question – how diseases operate – informs the nature
of the remedial intervention. The second question – what conditions give rise
to the disease – help us shape a broader spectrum of policy conception and
execution. We recognize that health itself is an outcome of other
socio-economic indices. Thus, policy design takes note of such factors as how
women empowerment and girl child education impact on early pregnancy and
maternal mortality and how access to clean water and the prevalence of
waterborne diseases impact on child mortality. Development is best seen as a
policy continuum rather than a series of compartmentalized reforms. Within this
framework, sustainable healthcare gains can only be achieved when we address
the social dimensions within which citizens operate. Issues such as good
housing, adequate nutrition and stewardship of the environment among other
variables have to be addressed. Without doing so, health sector programmes by
themselves will yield marginal returns. This is the thinking that has informed
our administration’s drive to improve the life of our people and we are
committed to seeing it through.
Tackling Social Inequality in
Governance
One of the biggest impediments to good governance in
Africa is the absence of strategic planning and strategic thinking by those who
seek power before they start the process of seeking power and before coming
into office. We are lucky that in south-western Nigeria, we are heirs to a
tradition of strategic planning and strategic thinking in public administration
and governance, a tradition that even predated formal political independence.
By the late colonial era, that is in the 1940s and 1950s, when many parts of
Africa were still gripped exclusively by the sloganeering of anti-colonial
activists, our leaders sat down to do a forensic analysis of the political,
economic and social circumstances of our region and the rest of Nigeria. They
came up with practical solutions to the challenges confronting both our region
and the federation of Nigeria. Therefore, by the time they got to power, they
were fully prepared to deliver on the promises made in the areas of education,
social welfare, agriculture and health care.
Therefore, as heirs to this progressive tradition, we
could do no less, despite the violation of this heritage before we came to
office. Long before I announced my bid
for the governorship, myself and my team had spent many months to study the
reality in Ekiti State and to debate the critical areas of intervention that
were needed. This resulted in what we called “A Road Map to Ekiti Recovery.”
This road map was elaborated in the 8-Point Agenda. Our 8-Point Agenda were
fully guided as much by the globally-accepted standards of measuring good
governance as they were by the socio-economic and political realities of Ekiti
State.
There is consensus around the world that good
governance denotes the “political and institutional processes and outcomes that
are deemed necessary to achieve the goals of development.”[1] The key
elements of this, as acknowledged by local and international organisations,
include participation, rule of law, transparency, responsiveness,
consensus-building, equity and inclusiveness, effectiveness and efficiency, and
accountability.
Against this background, our 8-point agenda which
aggregate all aspects of socio-political economy of the state include:
Governance; Infrastructure Development; Modernisation of Agriculture; Education
and Human Capital Development; Health Care Services; Industrial Development;
Tourism development; and Gender Equality and Empowerment. In this 8-point
Agenda, not only are the key elements of good governance evident, we also paid
attention to the UN Millennium Development Goals (MDG). Through the
modernisation of agriculture and human capital development, we have paid
attention to the Millennium Development Goals of ending poverty and hunger; through
our focus on education, we have paid attention to such MDG of ensuring
universal education; through our programmes on health care services, we have
taken care of child and maternal health; through the development of tourism and
infrastructure, we have contributed to environmental sustainability; and
through the attention we have paid to gender equality and empowerment, we are
meeting the Millennium Development Goal of gender equality.
However, I will be remiss if I do not emphasize the
fundamental question of public culture. Given the state of affairs in the eight
years preceding our coming into office, bad governance, corruption, official
violence and brigandage had all led to the erosion of the values that hitherto
defined public culture in the state. Therefore, we needed to also resist the
corrosive practices that had become institutionalised by the time we came into
office. We also needed to resist the culture of anything goes in the
bureaucracy, within government agencies, and sadly, even in the public sphere
and civil society. Another form of resistance was consequently needed to face
the task of governance squarely and ensure that the people had access to the
benefits of egalitarian rule - which we had promised them during the years of
campaign and struggle to reclaim our mandate. Helping to recreate our political
culture had to be the starting point and the guiding principles of rebuilding
infrastructures and ensuring development.
Therefore, an essential first step that we took was to
rechristen the state as ile yi, ile eye
(“The Land of Honour”). Against this backdrop, we redefined governance in Ekiti
State, such that public commentators now acknowledge that there is a renewed
sense of pride and belonging in the citizens of the state, based on the
restoration of the core Ekiti values of passion, courage, integrity,
meritocracy and honour. We have also restored the confidence of both local and
international developments partners and investors, many of which are now back
in the State.
In the area of Governance, our goal was to enhance
participatory governance and accountability, thus motivating the citizens with
ideas for better productivity, and creating an intellectual bank for policy
formulation and implementation. In this bid, we have taken a number of crucial
steps and recorded important achievements. For example, for the first time in
the history of the state we established a regime of legislations to guarantee a
predictable environment of good governance and promote transparency and
accountability. We domesticated the Freedom of Information Law, therefore, in
our state, citizens have the right of access to government documents which are
not classified - the first state to so do and we also enacted into law a Fiscal
Responsibility bill, a Public Procurement Legislation, a Public Private
Partnership Law and a Gender Based Violence Prohibition Law amongst forty new
legislations passed into law. For the first time in the 16 year history of the
state, which was created out of the old Ondo State in 1996, we have replaced
the Edicts and Laws of the old Ondo State with the Laws of Ekiti State.
Second, we adopted a merit-based system of appointment
and promotion of civil servants, including at the highest levels of the
bureaucracy. The chief bureaucrats, including the Head of Service, Permanent
Secretaries, and the Accountant-General, were all selected through an open and
competitive process. In an environment which had been dominated by
patrimonialism and clientelism, this was a transformative step and it has led
to the rejuvenation of the civil service, such that we now have civil servants
who are capable of driving the people-focused policies and programmes of the
government. We also focussed on increasing the revenue base of the State by
reducing our dependence on what comes from the Federation account.
We also instituted a social security benefit scheme -
the first of its type in any state in Nigeria. This is backed by law so as to
ensure continuity. It is therefore now a scheme of the Government of Ekiti
State and not merely the policy of my administration. Based on this scheme, we
give monthly stipends to indigent citizens over the age of 65 years. We
currently cater for over 20, 000 senior citizens in the State. This is in
addition to our Free and Compulsory Education programme up to senior secondary
schools and our free health programme which focuses on the vulnerable segments
of our population – children, the elderly, pregnant women and those with
physical disabilities.
In terms of Infrastructural Development, our goal is
to establish optimum communities that will improve the lives of citizens and
attract investment. Our target is to ensure that every part of the state is
accessible by major roads by the end of our first term - which is in two years.
This has never happened in the history of the state. We are also making water
dams in the state functional so as to increase water supply by eighty per cent
(80%), while using the public-private partnership to increase the generation
and supply of electricity. In this respect, Ekiti has just won a major funding
for the urban and rural water supply scheme from the World Bank and the African
Development Bank. In the last two years, we have focussed on urban renewal
through many projects. We have embarked on massive road construction and
expansion, rural electrification projects in communities that previously had no
electricity; we have established a State Ambulance Service unit which is able
to respond to emergencies; we have provided potable water and water treatment
plants to many communities.
For a population that relies significantly on
Agriculture, modernising agriculture helps with the improvement of yield and
the reduction of inequality in the state. Agriculture employs about
seventy-five (75%) of our population. Therefore, agriculture is at the centre
of our programmes. Nigeria used to be a world leader in cocoa production up to
the early 1970s. In fact, the enlightenment project re-started by the late
colonial era indigenous government in our area of Nigeria was partly based on
the economic resources derived from the sale of cocoa. Ekitiland in
south-western Nigeria was an important part of that cocoa production. That
ended from the late 1970s. We are now reviving cocoa plantations to make Ekiti
a world leader again in this area of production. This will generate employment
for tens of thousands of our citizens, particularly the youth. We are also
focusing on developing the full value chain of cassava, rice and oil-palm
production. We project that 20, 000 of our youths would have been trained and
employed in mechanised agriculture by the end of our first term in office. We
also project that agriculture will contribute fifty per cent (50%) of our
internally-generated revenue in the near future. To achieve this, we have
improved the conditions for farming in the state, thus guaranteeing effective
cultivation, harvesting and processing of agro produce.
We want agro-business to thrive in our state and
change the fortunes of the state as well as those of our citizens. Towards this
end, 15, 000 farmers have been assisted through the supply of agro-chemicals
and fertilisers. This has led to the cultivation of several thousands of
hectares of land. We have funded overseas training for agro-workers in cocoa
rehabilitation in Indonesia and China; we have refurbished the Orin Ekiti
cassava processing plant and upgraded the plant output from 10 tonnes to 60
tonnes per day under a private-public partnership with Vegefresh Agro-Allied
Company. We have also rehabilitated and constructed many kilometres of farm
access roads; cultivated and supplies 500, 000 cocoa seedlings and 60, 000 oil
palm seedling to farmers at highly subsidized rates, and collaborated with
British America Tobacco Nigerian Foundation and FADAMA III project in the
construction of a $1 million cassava cottage industry which has created jobs
for about 3, 000 women and more than 1, 000 youths.
Education is central to reducing social inequality. In
the area of education and human development, our target is to put a computer on
the desk of every secondary student by 2014, while providing free and
compulsory education up to senior secondary school level, including special
initiatives for the physically-challenges students. We have delivered 18, 512
computers to teachers and 33, 000 Samsung solar laptops through the first phase
of the Ekiti State E-School Project. We have invested vast resources in the
last two years on knowledge acquisition and skill development to enable our
citizens to work effectively in a rapidly changing and complex global
environment. Our investments in human capital represent our most critical
intervention in the process of state reconstruction in Ekiti State. Other
accomplishments include the complete refurbishment of all the public primary
and secondary schools in the state; procurement and distribution of furniture
as well as science and sports equipment to all public secondary schools across
the state. We have also sought to improve teacher quality whilst successfully
merging the States’ three universities into a better funded single state
university. Other initiatives focus on
skills based technical and vocational education in the State. [There are
several other initiatives that I can discuss during the question and answer
session]
Human development is not sustainable without massive
investment in healthcare delivery, which include capacity building and
infrastructure and staff welfare and disease control. Therefore, in the area of
Health Care Services, we have been providing, in the last two years, free
medical services for children, pregnant women, the physically-challenged and
senior citizens. We have also established health centres in all localities,
while increasing immunisation coverage. This year, we have embarked on our
‘Operation Renovate all health centres and hospitals. More crucially, we have
embarked upon a strategic re-development of health management information
systems while rehabilitating our health training institutions. We have greatly
improved maternal healthcare, disease control, while also making the regulation
of private health institutions more effective. Through our investment in
medical education, in the specific case of the Ekiti State School of Nursing
and Midwifery, the students in the school achieved a 90% success rate in the
National Nursing Examination. We have constructed a new Accident and Emergency
wing in the Ekiti State University Teaching Hospital, while also creating a
State Health Data Bank. We have renovated and extended the secondary healthcare
facilities in the State, and enacted the Primary Healthcare Development Agency
Act. Our health sector indices vis-à-vis the national average bear testimony to
the significant steps being taken in the health sector. Ekiti has one of the
lowest maternal and child mortality rates in the country, the second lowest HiV
prevalence and the highest life expectancy in Nigeria.
To be able to generate employment, development and
empower the citizens to pay taxes, we have been providing the enabling
atmosphere for industrial development. To jumpstart this, we have create
technology and industrial parks for small and medium scale enterprises,
established micro-credit facilities for promising entrepreneurs, while also
promoting agro-allied and solid minerals sectors. We also plan to make Ekiti
State a most attractive destination for relaxation and holidays by developing
the Efon, Okemesi, Ikogosi and Ipole-Iloro tourism corridor, a heliport, and
world class hotel and accommodation facilities. We are incredibly blessed by
nature in Ekiti State. For instance, we have the Ikogosi spring where both
natural warm and cold water flow from the hills to the valley. I invite you to
Ekiti State to enjoy this most fascinating and unusual blessing of nature.
Our administration is just concluding the
re-development of the first phase of the Ikogosi Warm Spring & Resort as
the flagship of the tourism industry in the state. About 116 hectares of land
was acquired for this new Resort, with plans for theme parks, spas,
high-altitude sports academy, resource centre for women, gold course,
edutainment centres, and sports academy. The hotel part of the Resort will be a
150-room branded international three-star hotel. We plan to spend N1.5 billion
in creating a mini-paradise in the Ikogosi Warm Spring & Resort to which I
invite you all when next you are on vacation. No doubt, it is now a place that
the world will come to and enjoy the beauty of nature. Electric power is very
central to jump-starting the local economy, especially in the area of agro-processing
which is our focus and we are working an the development of independent hydro
and solar power generation in the State.
Finally, in the area of gender equity and empowerment,
we are committed to promoting gender equality and empowering women to maximise
their potentials. In this context, we reserve no less than one third of all
appointments and promotions for women, while mobilising resources to attend to
issues of concern for women from maternal health and child care to employment
and freedom from abuse. Specifically, I signed into law, the Gender-Based
Violence (Prohibition) Bill in November 2011, making Ekiti State, the first
state to domesticate this law in Nigeria. We also domesticated the National
Gender Policy, while providing skills acquisition programme for out-of-school
girls, supporting girl-child education and inaugurating the Family Court for
the implementation and administration of children and family matters. An Equal
Opportunities Bill is now making its way through the Ekiti State House of
Assembly which aims at addressing issues of access to public services as well
as closing the gender gap in our state.
Conclusion
It is
quite fashionable in both lay and academic literature to emphasise how and why
Africa is not being governed well. Much of the evidence adduced in the
literature is, no doubt, not only true, but also troubling.
As a
civil society activist, scholar and even dissident for many years, I am aware
of both the structural and agential bases of the dark prognosis on political
power and what passes for government in Africa. Nigeria is one of the starkest
examples of the consequences of how bad leadership can complicate
colonially-induced structural fatalities. However, I will like to conclude by
making two important points.
One, in
the theorizing social inequality in Africa and in analysing the challenges of
democracy and state-reconstruction in post-Cold War Africa, it is important
that scholars and development experts begin to look beyond the macro-state,
that is the national-state, in understanding the processes of delivering good
governance at the micro-state, that is, sub-national level. Perhaps all the
received cynical theories of African political pathologies can lend themselves
to some instruction concerning a well-articulated agenda for development based
on good governance which are often under the radar of a paradigm that
perpetually expects basket cases to emerge from Africa.
I can say
with confidence that the process of state reconstruction and actually-existing governance in Ekiti
State today is not reflected in any of the pathologies and dark prognosis
popularised and almost romanticised in the literature represented by such works
as Bayart, Ellis and Hibou’s book, The
Criminalization of the State in Africa,[2]
or Chabal and Daloz’s Africa Works:
Disorder as Political Instrument.[3]
Neither is Ekiti State emblematic of “The Politics of the Belly” popularised by
Bayart in his book, The State in Africa.[4]
This is not to say that these theories do not reflect much of the reality of
contemporary Africa, I am only arguing that Western social scientists,
journalists and development analysts should pay as much attention to state
reconstruction, development and governance at the sub-national level in Africa
as they pay to the national level. Just as we can all agree that Professor
Olikoye Ransome-Kuti proved the point beyond debate that not everyone who goes
into public service does so for personal aggrandizement and corruption, I am
proud to say that in Ekiti State, we do not run the kleptocracy that some have
come to associate with our part of the world. We are running a government that
is participatory, transparent, consensus-oriented, inclusive, responsive,
effective, efficient, accountable and one based on the rule of law. Many independent
bodies continue to attest to this and the latest is the Special Report on
Africa in The Economist Magazine of London recently, which states as follows about Ekiti:
Better
governance is creeping beyond the metropolis. When your correspondent emails
the governor of Ekiti State in impoverished central Nigeria, he gets a reply
within minutes, with the entire cabinet copied in…Cabinet members are highly
motivated and have private sector experience. A new employment agency sends out
job advertisements by text message. All secondary school pupils are getting
free laptops with solar panels. All civil servants, including teachers, are
tested annually; those who fail stand to lose their job…To be sure, this sort
of governance is still an exception. [The Economist, March 2nd,
2013]
We are
committed to ensuring sustainable human development. This is also true of our
sister states such as Osun, Lagos, Oyo, Edo and Ogun States and this is why we
are involved in a pioneering the regional development agenda for Western
Nigeria.
However,
having said that, let me now flip the picture. And this brings me to my second
concluding point. What many of the dark prognosis about Africa say is largely
true at the national level. However, in our bid to federalise good governance
in Nigeria, our party and political associates are working hard to ensure that
we build a strong opposition platform which can wrest power from the ruling
party at the centre, so that we can begin the process of humanising the
totality of the Nigerian space. For us in Ekiti State, as well as in the other
states governed by my party, what is left is to federalise good governance in
Nigeria; to ensure that if infant and maternal mortality rates are reduced in
Ekiti and Osun States in the south-west, they must also be reduced in Sokoto
and Zamfara States in the north-west of Nigeria. This is important because we
are not only co-citizens, we also share a common humanity with all our
compatriots in every part of Nigeria. The realisation of this shared citizenship
as well as humanity makes it insufficient for us to ensure good governance in
Ekiti State and not care about Jigawa and Yobe or Borno and Akwa Ibom States.
This is the new phase of resistance that people like us who were formerly at
the barricades have embraced. Indeed, it is the new barricade; the barricade
against bad governance, ignorance, illiteracy, injustice, inequity, incompetent
leadership, want and misery in a nation which has earned over $400 billion over
the last five decades from oil sale alone.
Professor Olikoye Ransome Kuti was a known critic of bad and corrupt
governance and he was not romantic about just focusing on health, he insisted
we must get governance right. He vehemently accused some African governments of
stealing money targeted for medicine. In
2001, he told a WHO conference that only $12 out of every $100 contributed by
donors eventually get to HIV patients in most African countries. Prof once
said: “I have seen $300m presidential palaces and $350 cathedrals in the midst of
ill-health, poverty and destitution in various African countries.”
In the
face of the daunting odds that our compatriots face all over Nigeria, people
like me cannot restrict the struggle for good governance to my state only.
Therefore, I cannot abandon the zone of resistance, even while being in the
veranda of power. With seventy per cent of Nigerians living below poverty line,
the reality of the poverty trap is an unacceptable paradox when measured
against the country’s wealth. It is akin
to what the notable political scientist, Terry Lynn Karl once referred to as
the “paradox of plenty”. As I stated in November 2009 in the paper
I presented at the Panel on “Ten Years of Civilian Rule in Nigeria” at the
African Studies Association Annual Conference in New Orleans, “Bred by unequal power relations, the structural and
systematic allocation of resources among different groups in society and their
differential access to power and the political process, the distorted
distribution of the nation’s wealth has resulted in the enrichment of a
minority at the expense of an impoverished majority, and this minority… now use
the wealth to continue to entrench their power. Inevitably, the chronic nature
of poverty in Nigeria has a link to historical and continuing mismanagement of
resources, persistent and institutional uncertainty, weak rule of law, decrepit
and/or absent infrastructure, weak institutions of state and monumental
corruption.” It is also now responsible for the insecurity that the country is
experiencing.
I added
that the immediate challenge is how to rescue Nigerians from bad
governance, stating that: “There is an urgent need to build coalitions and
platforms in the public sphere that are beyond parties and personalities, but
all embracing enough to those who subscribe to the core values of integrity,
honesty and dedication to the transformation of Nigeria….In my view, the problem is still about the nature and
character of the Nigerian state, and it is not one that election can resolve,
no matter how regular, well organized and untainted they may be. It is clear to
most people in Nigeria, including the political leadership, that the question
of the national structure is the central issue that will not go away in
Nigeria’s quest for democratic development and effective governance.”
I believe that this broader and
strategic approach will bring us closer to the perfect pitch in our engagement
with healthcare challenges. We will be much closer to solving the problems of
social inequity that preoccupied the acute intellect and compassion of Olikoye
Ransome-Kuti all through his life. And
the greatest tribute we can pay to this legend is to ensure that we deepen his
good governance approach to health care and social inequality as well as
continue the campaign for a healthy, wholesome life for all our people.
Thank you
for listening.
[1] “Good Governance and Human Rights” http://www.ohchr.org/EN/Issues/Development/GoodGovernance/Pages/GoodGovernanceIndex.aspx
[2] Jean-Fracois Bayart, Stephen Ellis, and Beatrice
Hibou, The Criminalization of the State
in Africa. Oxford, UK and Bloomington, IN: James Currey and Indiana
University Press, 1999.
[3] Patrick Chabal and Jean-Pascal Daloz. Africa Works. Oxford, UK and
Bloomington, IN: James Currey and Indiana University Press, 1999.
[4] Jean-Fracois Bayart, The State in Africa: The Politics of the Belly, London and New York: Longman, 1993
Posts
0 comments:
Post a Comment