Paulin Basinga is the Country Director of Bill and Melinda Gates Foundation in Nigeria, a major international donor supporting development in several sectors in the country. In this exclusive interview with Ayodamola Owoseye of PREMIUM TIMES, he speaks on Bill Gates’ speech at a recent meeting with Nigerian leaders at the National Executive Council and on activities the foundation is focusing on in assisting Nigeria tackle its development challenges.
PT – Mr. Bill Gates in his speech at a recent meeting with Nigerian leaders at the National Executive Council (NEC) said Nigeria needs to invest more on primary health care. Your foundation has been increasing its funding in that area. What impact do you hope your intervention will have?
Basinga – Primary health care is the backbone of the health system in Nigeria. When you fix the primary health care, it provides the opportunity for almost 70 to 80 per cent of the burden of diseases to be taken care of. Majority of conditions that the poorest people need services for (preventive and curative) can be taken care of at the primary health care level.
It is the primary health care facility outreaches to the community and community health care workers that are working together. We have being investing in primary healthcare centres for a couple of years in Nigeria and we will continue to partner with both the federal government and some specific states to come out with a comprehensive approach to support the revitalisation of primary health care in Nigeria.
We are doing it in different ways, not only increasing funding. We are also doing more of technical assistance. For instance, we are working with the National Primary Health Care Development Agency (NPHCDA) and Federal Ministry of Health to come up with a strategy that can find a broader financial picture for the National Health Insurance Scheme (NHIS) in primary health care in Nigeria.
We are partnering with the federal government to raise more money for the primary health care to have the appropriate resources to make sure that the primary health care system will be the way Mr. Gates defined it.
This is in line with the Federal Government of Nigeria plan to make sure that specific states have the appropriate financing to have facilities that are rehabilitated and equipped in the right place where people live and to have equal human resources that are productive, pleasant and well paid, and commodities that can be used to generate good performance.
Those are the kinds of issues we are partnering with the government. We have different MoUs. We have MOU with the government of Kaduna on PHC and immunisation.We have an MOU with Niger State, we just signed another five years MoU with Bauchi State where we will be moving our routine immunisation to carve a broader routine services of healthcare. We have done it already in Kano, we have continued to work with Sokoto, Yobe and Borno states. We are also working in Lagos where we have strong partnership with the state government in terms of revitalising their primary health care system and specifically focusing on how to leverage on the private sector on how to improve the family planning services.
PT- From what you just said, most of the places you have been working are in the northern part of the country. Why is this so?
Basinga – That is true that most of where I mentioned are in the north. We work very closely with the federal government. If you look at our funding, significant part goes to the federal level, we work with the Federal Ministry of Health and agencies to make sure that they have structures and policies in place to scale up most of the interventions nationally. This is how we intend to work with the federal government to support any national policies that can touch any of the 36 states plus the FCT.
When we go deep in terms of understanding how we will partner with specific states, we look at where they most need our interventions. When you look at the data, where the kids are dying most, where there is a huge burden of disease, most of those states are in the north.
Then also as you know, we at the Gates Foundation, we are engaging the federal government to support polio eradication; the bulk of the work has been in the north. From Borno, Adamawa, Yobe, Katsina, all those states, we have been there, we have not been able to finish the work on polio, though we are very close. We are trying to move from polio to strengthen immunisation and continue to building PHCs.
We do have a national level of work with the federal government for capacity building through the National Primary health Care Development Agency. NPHCDA, which has six zones, one in each political zone, where they have people to ensure that they can provide technical assistance to every state. And we do some funding to make sure that those people billed to the south as well can benefit from our support.
PT- Gates Foundation has been a major supporter of Nigeria in getting vaccines and you are planning to put more money on routine immunisation. The federal government plans to start manufacturing vaccines locally in three to four years. How good is this news, and what will be the implication of this on immunisation funding and the country as a whole?
Basinga – I have not been following the vaccine production story, but we have been in discussion with the federal government because the Nigerian government wants to start looking in the long term, locally producing key vaccines. It is a discussion which is not only happening in Nigeria but across Africa.
Our experience at the Gates Foundation, because we have been involved in vaccine production for many years, even globally, if you look at new vaccine production, for malaria vaccine for example, we are the biggest funder for all the researches that have been behind producing the potential new vaccine for malaria. But vaccines like HIV. etc, the U.S. government is the biggest funder. We have been following vaccine production very closely, we have worked with several governments, including the government of India, China to look into local capacity to produce vaccines.
Our experience that we shared with some officials of the government is that the human vaccines require a lot to put in place before you can produce it. There are regulation issues, there are quality issues, there are technical issues and our experience is that you need at least 10 to 12 years to set up human vaccine production. So we have offered to share our technical expertise with the government.
I know the government is being in touch with May and Baker to discuss local vaccine production and it is a very good initiative. We see it as a 10 to 12 years project. But on vaccines, as they think about getting local production of vaccines, there is also a need to think about in the short term like three to five years, how they will continue to produce those vaccines. There are about 17 different vaccines that GAVI provides to countries, some of them like pneumonia vaccines, they are only few countries that produce those vaccines for global supply, so it will take some time for Africa to do it.
PT- How have the Nigerian government’s health and agricultural policies assisted your Foundation’s various work with the federal government and the states?
Basinga – There are lots of good policies in Nigeria. We do not have any issue to cut at a policy. Nigerian government is following very closely with our health and agricultural work and with policies that we proposed nationally and locally and they have been doing a good job adapting those policies at the national level and going down to some states.Most of the states also try to adapt those policies and there are very strong policies in place.
We have been doing lot of work in partnership with the government from the federal and state levels to align those policies as we define our strategy, so that we can give a strategy that aligns with the government’s priorities.
The big challenge we see here, unlike some countries, is translating the policies into execution because of the complexity of the Nigerian structure itself. It is a democracy with different layers of responsibility across the federal and states, and even with the states there are several structures that are in charge of different services across agriculture, health etc. It is just to move with the execution to make sure that those policies are put in place.
PT- How do you monitor the progress of grants in many sectors your Foundation has been putting money into? Premium Times has been trying to follow up on the $2 million grant given to the Nigerian Governors Forum. From your Foundation’s point of view, has it been used for what it is meant?
Basinga – We do have at the Gates Foundation our overall strategies for Nigeria; so we know exactly after we have discussed with the government, different development partners to make sure that we leverage their support to make sure that we also complement and put our very scarce resources in places where they are most needed. We develop our strategy and look at the investment and find the appropriate grantee or partner who will deliver. We at the Gates Foundation, we are a funder, we do not implement programmes ourselves.We do a due diligent process to make sure that we pick the grantee that has the knowledge, the technical capacity and the understanding of the Nigerian context and of the state as well.
Most of the time, we also partner with the state or government to choose together who implements the grant and then we start the process of working with the potential grantee to develop a proposal and then agree on very specific milestone of the project and the objective of the project. We put in place very critical milestones. If we say for example, the grant investment would be $2 million for the next two to three years, we have clear milestone on how we are going to release the money. We do not release all the money. It is really conditional to achieving that milestone and those milestones are clearly stated in the agreement and we follow them.
So the Nigerian Governors Forum, for example, we have been working with them since 2013. We started working with them by firstly supporting them in building their capacity to bring together all the governors towards polio eradication. Since then, we moved towards primary health care and then towards domestic resource mobilisation, for example , and the grant is doing pretty well. They are doing exactly what we expect them to do, helping states to develop tools that will track their capacity to generate internal activities.
PT- Mr. Gates in his recent presentation at the NEC meeting challenged the country to invest more in agriculture and human capacity development to boost the economy. Does this mean that the Foundation intends spreading its activities and funding towards these sectors?
Basinga – Those are the sectors that we focus on. For the past 10 years we have been involved in human capital development , specifically on health, agriculture, not in education. We do not fund education here in Nigeria, but education is a very important part of human development. But when you look at the size of our investment, specifically here in Nigeria, it is a very small amount compared to what the government and other partners are putting in.
It is the responsibility of Nigeria to facilitate the development of its people. They have the capacity. What we are doing, we are only accompanying by providing technical assistance and small support to leverage the money that the government is putting there. If the government does not put appropriate budget, it would be very difficult for our money to have any impact.
This is the call from Mr. Gates to commend the government for putting forward an ambitious ERGP (Economic Recovery and Growth Plan) plan, which has three important pillars and one of the pillars is investing in people. As Mr. Gates – and also the Vice President Yemi Osinbajo recognised – said, when you look at the priority of the ERGP in terms of their implementation, the human capital development is not on the top of the priority.
The government is really prioritising infrastructure and physical capital development as it can move the economic development. Mr. Gates’ points was that we also need to invest in human capacity development and the government has launched some very interesting focus slab that helps with the priorities of the ERGP to move forward.
One of the calls from Mr. Gates was to also think about focus slab for the human capital development so that the private sector and public sector if possible can come together to see how they can accelerate investment in human capital.
PT- When we talk about investment in human capital, Nigeria has been investing in health practitioners (doctors, nurses, health workers), who are emigrating out of the country in droves. Don’t you think investing more in human capital at the health level will still translate to the same thing if the right facilities are not in place? With your experience in the health sector, how can we solve this issue?
Basinga – A country like Nigeria with a lot of capital, that poses a question. What we are talking about here is more to look at the people at the bottom of the pyramid. People who live in the states, who need basic primary health care. And for those basic primary health care, they need a nurse who is well trained, well equipped, well supervised and who can provide basic care so that when a mother comes with a kid to a primary health care facility, everything needed is there.
Most of the time it is not an external emigration. They are not leaving Nigeria to work in Benin or Chad, they are leaving the public sector or working partially in the public sector because it is not providing them conducive work environment. It is those kind of human capital that we are trying to trace. Providing good primary healthcare, good education at the primary level so that they can read and catch the kids at the early age so that they can grow up strong.
I as well understand that there is a need to strengthen the other layers of the healthcare system. However, where the most burden is and where we are having the high maternal and child mortality in Nigeria is the local area.
This mortality is high and the way we can tackle that is investing in making sure that in the first 1000 day of life, those kids have appropriate vaccines, they can access care quickly when they are sick, and also mothers who need access to family planning can space their birth, and have access to modern long-lasting methods. Those are the kinds of human capital development we are talking about.
PT- There must have been progress report on what you have been doing in Nigeria and the outcome. What is the data telling us about this progress and what needs to be done to improve it?
Basinga – We are very excited with our partnership with the government of Nigeria on polio eradication. Polio has been a great example of something that can be done in Nigeria. The agriculture sector has also recorded a lot of progress and we have been supporting the government, but the credit needs to go to the government because they put lot of effort to that. Our support was peripheral and providing technical assistance.
Across the states, the government has put in place ambitious plans like the primary health care centre under one roof; to thinking how the PHCs in Nigeria are revived. The federal government, states and local government areas have put in place many policies on how the PHCs under one roof will be realised and today, we are implementing those policies, moving it from the LGAs to the state primary healthcare development agencies so that they can be managed in a more efficient and productive way.
I think there are some good movement, some states are leading the way, and there are still some things that a lot of states can learn from other states. States like Anambra and Lagos, their vaccine rates are almost 80 per cent as compared to some other states which are still struggling. There are pockets of good progress that we can learn from to work with.
PT- As a foundation, what challenges have you been facing in Nigeria and how have you been tackling them?
Basinga – Nigeria is an amazing place to work, it the largest country in Africa, it is a complex country. It is 36 plus one countries within one country. It has been great to see how the unity of the nation is strong. We have been finding our way.
The challenge in Nigeria is when you look at the size of the issues, you just need to think critically and discuss with different partners to find the places were you can put your resources that you will have the maximum impact. There is a lot of needs, but we need to focus and engage in places where we have potential of having maximum impact. We need to continue to do that.
The other challenge is the need to engage at the federal level and same time really engage at the state level. To be at the state level to create strong partnership with governors and with different commissioners and the state legislature to make sure that in the states appropriate laws are passed and have effective execution.
The issue of execution has been a big challenge, you have to go through a lot of paths to get the impact. We have increased our understanding of the process, how we can be effective in engaging the states and at same time keeping the federal government engaged and making sure that we are aligned to have a maximum impact. But we are learning a lot.
We have now created strong partnership with states with MoUs. And with our partnership with the Dangote Foundation and its team, it has helped us understand how to engage the states to partner with us and co-fund some of the projects. It has been a great challenge to overcome some of the challenges, but we will continue to learn and we are here for the long run.