Governor Olusegun Mimiko of Ondo State has achieved unprecedented success in health care since he took office in February 2009. His state was adjudged by the World Bank as having the worst indices in terms of maternal and child care when he took oath of office. However, the hardworking medical practitioner-turned politician has begun reversing the trend and he is fast turning his state into a haven for pregnant women and children under five years. Sitting in his simple but detailed office inside the State Secretariat in Akure, Mimiko speaks about his passion and hopes for expanding the pilot projects of the Abiye (Safe Motherhood) and Mother and Child Hospital that have become important icons for the success of his administration. In this interview with senior assistant editors Stella Sawyerr and Ololade Adewuyi, Mimiko talks about his passion for the poor in the society and how his administration is winning the battle against maternal and child mortality among other issues. Excerpts:
When you took oath of office in 2009, you promised to uphold the laws of the land and to bring the needed improvement into the lives of your people, looking back, how well do you think you have been able to achieve your target?
Looking back, I thank God for where we are. Of course, there have been challenges but on the balance, I think to a very large extent we’ve been able to impact the lives of our people in these past two years in almost every sector: health, education, social infrastructure, job creation. We could do more as there’s opportunity to do more and we’re still running and I feel happy.
You were a successful medical doctor before you moved into full-time politics and you must have had some dreams and expectations about the health sector before you became governor. Now that you are governor, how have you been able to bring your professional calling to bear?
Like I tell people, I’ve seen what it means when people cannot afford to access simple healthcare. We’ve seen cases of mothers who will bring their children to hospital dead but when the doctor is about to examine them the child will twitch, giving the impression that he or she is still alive. I’ve analysed these things over the years, it’s a very complex situation. I think it is the overwhelming guilt feeling that they’ve been unable to do anything about. What I’m saying is that we have seen the complexity of human reaction to poverty, especially when they cannot access healthcare in emergencies. I always decided that if I had the opportunity to tackle equitable access to decent healthcare that I would give it a very, very good shot.
Can we then say that one of your greatest achievements since you came on board has been in the health sector?
Since I came on board, I’ve been able to a large extent make it possible for our people to access healthcare where they work and play. It is that accessibility that for me is the hallmark of our achievements. If you’ve been to our Mother and Child Hospital, there’s been a social integration of sorts. At the hospital, you’ll see the wife of a messenger lying next to the wife of a bank executive or a commissioner because we have created a care centre that does not discriminate, irrespective of their social status, in the ability to access healthcare. The quality is also non-negotiable as it were. The affordability factor has been removed. Tackling the peculiar health needs of the vulnerable people in society and we’ve identified pregnant women and children under five as extremely vulnerable. And we have designed a home grown customised programme to tackle it. Two years on, the results are there and we’ve not only gotten national acclaim, we’ve also gotten international recognition. For me that is very fulfilling.
Of all your interferences in the health sector, so far which one would you say has been dearest to your heart?
The one that has gained everybody’s attention is the Abiye programme which Mother and Child Hospital is an integral part of its referral structure. I’m very proud of the Mother and Child Hospital because when we started the concept as a purpose-built facility, we set out to build a centre that would provide the highest level of care in terms of quality that you can access anywhere in this country either private or public. We also said it must be affordable and accessible to every level in society. And after some debate we said let us make it free of charge. It sounded like a paradox of sorts, the best quality, zero user fee. But two years on we’ve been able to achieve that, it’s a landmark achievement for me. Each time I get into the hospital I feel fulfilled. And with our ability to track every pregnant woman under Abiye programme, from conception to delivery, I can’t exchange it for anything. It gives me inner joy and fulfilment.
You realise that many economic systems are jettisoning welfarism because of trying situations all over the world, how do you justify spending so much money on free health knowing that there are other equally pressing issues?
Because the people that sold that paradigm to us are not honest, they tell us not to subsidise social services yet they do. Look at agriculture for example, which is so central and so fundamental, the high priest of liberal economy will tell us not to subsidise but American agriculture I understand is the most subsidised in the world. For us in the developing world, and I stated this very clearly in my inauguration address, while we believe we need an environment for private sector to thrive and drive the economy but we stick stubbornly to the social democratic paradigm of development that we also have responsibility to intervene in the economy to ensure that the weakest in the society is carried along. We must create an environment of equal opportunity for people. We cannot rule out the fact that we have responsibility to intervene directly in terms of budgetary allocation and government expenditure to ensure that everybody in the society has access to decent care. The other side of it is that we also create an environment to make it possible for the very rich in society to subsidise the very poor using tax regiments and very creative products in the system. The important thing is that at the point that a man needs emergency care in Ondo State, he gets it.
How do you hope to sustain this on the long run looking at the rising cost of health care, rising salaries, education, agriculture, and so on?
Let me tell you something, resources will always be limited. The essence of representative government is to be able to make the appropriate choice for people. The issue of priority is also important. For us, human capital development, that is, education and health are our number one priority. For now we have not even spent up to 15 per cent of budget on it and I tell people I’m ready to expend 25 per cent of budgetary allocation on health and education. We must also develop products that will ensure efficiency. We have achieved almost zero per cent wastage of drugs at the Mother and Child Hospital. We have gone beyond the conjectural realm to actually calculate the cost in part, from pregnancy to six weeks after delivery, what you need is N6,500 in an efficiently run system. A health tax of about N200-400 per annum from a one million tax paying public will be enough to take care of all pregnant women in Ondo State.
How did you develop the concept of giving phones to pregnant women to use in communicating with health rangers?
The idea actually is to remove the pregnant woman from just being statistics and give her flesh and blood. That means being able to track every pregnant woman. That I can sit in my office and monitor any pregnant woman under the Abiye programme. For us, the most available tracking device is the cell phone. So with the cell phone I can call any of the pregnant women, the commissioner can call, any of the health care providers can actually track. In case of any emergency, they can use the phone to call their charges. Beyond that we also have the health rangers that actually track them to the home front. So the whole idea is to be able to have hands-on (experience) in terms of the challenges they may face. In the course of our interface with them, those that will have difficult deliveries are already well-known and we have made adequate arrangements. It is so exciting for these women when all parameters indicate that you will need a caesarian section and an ambulance comes to pick you and drop you because the hospital is waiting for you. This is what we have organised to show that we must pay attention to what matters in our society. These pregnant women that we help are the clear indicators of a caring society.
What other programmes has your administration put in place to help the health sector?
We want to make the existing hospitals more efficient using the Mother and Child Hospital as a model. We are trying to replicate the best practices of Mother and Child in our health facilities and we are trying, in a very integrative manner, to structure our referral system, so that it is predictable and functional. We also recognise the need for investigative intervention in healthcare. That is why we have set up the Gani Fawehinmi Diagnostic Centre, which is top range in terms of diagnostic services. We are also keying in into the National Health Insurance Scheme, one of the areas where health care financing challenges can be addressed because people have always talked of sustainability. There are more than eight factors that we are looking at to ensure sustainability of the projects. The important thing is that people don’t have to pay at the point of the need of care.
How have you been able to fund these projects?
One, budgetary, two, partnership of World Bank, three, partnership with the MDG office of the President, partnership with local governments, all of these in a creative way have driven our programmes in the health sector.
What informed your creation of the Gani Fawehinmi Diagnostic Centre?
That was a commitment we made at the burial of Gani Fawehinmi. He died of lung cancer so the reports had it. It was late diagnoses. We had always had a plan to establish a diagnostic centre in the state and we thought the best way to honour him is to name it after him.
Let us talk about the issue of personnel which is a very tricky one, what incentives are you giving to medical professionals to come and work in the state knowing that half of the country’s graduates end up working abroad?
The first incentive for me, which is perhaps the most important, is the creative challenging environment, a result oriented environment. Part of it is definition of the problem. A lot of our people don’t show commitment because we don’t celebrate outcomes in our system. If you change the orientation of our people towards outcome, what do we hope to achieve? In a measurable way what is our target? You’ll be amazed that it is that commitment that everybody keys into at the Mother and Child Hospital because they have targets and they are working towards it – zero maternal mortality – whatever it takes to achieve. Then pregnancy must not be death sentence, everybody must be on board. Of course it creates an environment that makes work easy and conducive. We also place emphasis on what is important. If you go to our hospitals you realise that the most important tool to keep a woman alive are not those gigantic digital and electronic equipment, they are IV fluids, basic tools to create that functional environment. And of course, appropriate salary also incentives, no question about that. People are coming from abroad to work in Mother and Child Hospital because they can see a system that is geared towards results.
Knowing that a system always needs doctors, what is your shortfall at the moment?
All I can tell you is that we have approved that eight doctors that are critically engaged and focused in terms of engagement can do the work of 60 doctors with the present methodology and workload. It’s not only about the quantum of need but also about efficiency and utilisation and that must be the emphasis.
Ondo people have been noted to be widely pessimistic and suspicious, how have you been able to cope in all these and hoping to get a second nod?
You know I came in with a lot of social capital. I’ve been in and out of government, I’m a known quantity, people know me; they trust me and I’ve not betrayed that trust. I promised them that the disconnect between government and the people will be bridged and I’ve done that to very large extent. We have addressed their basic needs: issues of everyday survival, issues of conducive environment for market women, issues of unemployment which we have identified as the biggest challenge of our generation and we have tackled it heads on using the advantage that we have in agriculture. We have not squandered the social capital we brought on, the trust of the people knowing that we are working for them. We promised to work for them and they can see the result of our work in every sector. We are building markets. We have embarked on urban renewal process and cleaning up our cities, turning street traders into entrepreneurs. We’ve literally impacted every section.