Nigeria’s New Health Minister Turned Down Top Gavi Position to Make a Difference At Home
Dr Muhammad Ali Pate

After working in prestigious international positions, Nigeria’s new health minister has returned to rebuild the health system of Africa’s most populous country.

Excitement turned to disappointment in the global health sector when Dr Muhammad Ali Pate was announced as CEO-designate of the global vaccine alliance, Gavi, then withdrew six weeks before assuming the position.

Pate was an ideal candidate with extensive experience in Africa and globally, including as Nigeria’s health minister, World Bank global director of the Health, Nutrition and Population Global Practice, and Professor of Public Health Leadership at Harvard Chan School of Public Health.

On 22 August, a few weeks after withdrawing from the Gavi position, Pate assumed office as Nigeria’s Coordinating Minister of Health and Social Welfare, a super-ministry that encompasses two huge portfolios – unlike back in 2011 when Pate was appointed as health minister.

A medical doctor trained in both internal medicine and infectious diseases as well as an MBA in health sector management, Pate is renowned for his contributions to combating infectious diseases and the field of public health financing.

Pate’s success rests heavily on his ability to reinvigorate the Nigerian system in Africa’s most populous nation with over 225 million people and numerous disease outbreaks.

In mid-2022, former president Muhammadu Buhari signed Nigeria’s National Health Insurance Authority Bill 2022 into law, declaring that it will provide health insurance coverage for all Nigerians. Buhari also signed new legislation to overhaul mental health care. 

In March 2022, The Lancet Nigeria Commission identified key barriers to optimal health in the country as “ineffective use of available resources, a dearth of robust population-level health and mortality data, insufficient financing for health and health care, sub-optimal deployment of available health funding to purchase health services, and large population inequities”.

Pate was one of the listed authors, which also reported that “about 40% of Nigerians live in poverty, in social conditions that create ill health, and with the ever-present risk of catastrophic expenditures from high out-of-pocket spending for health”.

“We propose an ambitious programme of healthcare reform to deliver a centrally determined, locally delivered health system,” the report declared.

“The goal of government should be to provide health insurance coverage for 83 million poor Nigerians who cannot afford to pay premiums. Implementation of a reinvigorated National Strategic Health Development Plan (NSHDP III) should be supported by structured and explicit approaches to ensure that federal, state and local governments deliver and are held accountable for non-delivery. NSHDP III should be supported by a ring-fenced budget and have a longer horizon of at least a decade during which common rules should apply to all parts of the system.”

Meanwhile, the Ibrahim Abubakar, lead author of the report, described consolidated health insurance as a viable option for solving some of Nigeria’s health financing challenges, based on the previous administration’s introduction of a health insurance law.

Immunization and health workforce

During Pate’s screening process by Nigerian lawmakers before being appointed minister, he stressed the need for the country to spend more on health: “Domestic financing represents the prioritization that we give to health. We’re not spending enough. Even with limited revenue, there is room to increase the allocation for health. Without doing it, inadvertently, we are outsourcing the prioritization of health to external actors.”

With many communicable diseases being entirely preventable with simple and inexpensive vaccines that only cost $1 to $2, Pate also said during the screening process that it is unfortunate that some regions in Nigeria have some of the worst immunization coverage in the world.

“Going forward, under the renewal agenda of the president, I’m pleading that we prioritize investments in health, and investments in the things that can prevent diseases that can protect our children who are the future of this country,” Pate told the lawmakers.

Regarding addressing the emigration of health workers, Pate said this would be tackled via a dual approach of improving the conditions of service: “We need to renew that contract within the context of health to make it more conducive to return the health workers that we produce, to deploy them effectively, to train them where needed and to give them the tools where they can work with those tools to serve.” 

He also pledged support for initiatives to attract the country’s health experts abroad to return to contribute their wealth of experience to improve the country’s health sector and health indices.

Outbreak preparedness 

Before Pate’s nomination, Salma Ibrahim Anas was appointed special adviser on health to the president. Anas said the current administration’s renewed hope aims to attain health for all through an efficient and effective universal health care coverage (UHC) system using the continuum model as contained in the sustainable development goals (SDGs) which Nigeria is committed to.

“The overall goal is to move Nigeria closer to universal health care coverage with a key focus on reducing the gap between those that are in need and those that use health services,” she added.

In addition to the UHC goals, Pate highlighted the need to improve Nigeria’s preparedness for future disease outbreaks which he said entails strengthening public health institutions and agencies, laboratory infrastructures, training frontline health workers and building public trust in health authorities. 

The country faces numerous health threats and outbreaks, the most recent being diphtheria outbreaks.

He also raised the need for Nigeria to prioritize building and expanding its strategic national stockpile of tools that could be in short supply or difficult to procure during global epidemics.

He also stressed the need for Nigeria to invest in “medical industrialization” so that local manufacturing of vaccines, drugs, and other pharmaceutical and medical products can grow in the country.

In an earlier interview, Pate told Health Policy Watch that medical industrialization is a policy that needs to be implemented to provide both the commodities needed and to create jobs.

“There’s a whole value chain in health. Health is not just about the commodities that we use, there’s an economic imperative as well, as we see in many other countries. There is the need to harness and unlock the market potential of the private sector in health, to manufacture, to produce and also to deliver services in terms of capital,” he said.

High hopes

Nigerian lawmaker, Senator Abdul Ningi, said that there is wide support for Pate’s appointment: “He is a minister to look out for because of his pedigree. I have no doubt that Prof Pate has come to add value to our nation.” .

Toyin Saraki, founder of the Wellbeing Foundation Africa and Global Health Ambassador for the WHO Foundation, described Pate’s latest position as an exceptional appointment. 

“With a track record of bridging gaps and evidence-driven actions and advocacy for equitable healthcare, Dr Pate is poised to bring about revolutionary changes in Nigeria’s healthcare system,” she said.

She expressed confidence that under Pate’s guidance, Nigeria’s health and social welfare sectors will “once again witness remarkable advancements, improved access to healthcare services, and a renewed focus on the wellbeing of every individual, shaping a brighter healthcare landscape for generations to come”.

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