Boss Mustapha’s unforced error by Ehi Braimah

The news media made headlines recently when Boss Mustapha, secretary to the government of the federation (SGF) and head of the Presidential Task Force on COVID-19, admitted – honestly, I dare say — that he didn’t know our healthcare system was completely broken and on life support; even the ventilators supplying the much needed oxygen were borrowed. It was like breaking news for the Big Boss who became aware of our unacceptable healthcare system on account of his current national assignment on COVID-19. Mustapha, according to news reports, made this revelation when he met with the leadership of the National Assembly on the global pandemic. “Nigeria needs to improve its healthcare system as developed countries were struggling to contain the global pandemic,” Mustapha counseled during the meeting.

Our amiable SGF shouldn’t worry about the backlash that trailed his comments, especially on Twitter; that was expected from friends and foes alike who do not know Mustapha is a ‘home boy’ like the rest of us. I praise him for having the courage to speak truth to power which is very rare in government circles. As the head of a government bureaucracy in Abuja, his comments appeared like an ‘unforced error’ in tennis – that is when you lose a point by making a mistake in a situation where you should be in full control of the game – or an ‘own goal’ in football. Even in a game of cricket, the fans and players would have screamed ‘caught out’ and ‘howzat sir’ for his revealing comment and then look in the direction of the umpire for affirmation that the striker was out of the game — this situation arises when the batsman hits the ball and the ball is caught by the bowler or fielder before it hits the ground.


When Mustapha said he was misquoted moments later over a harmless statement, I was surprised and amused at the same time, and he let down his numerous admirers. How could he have been misquoted when he hit the nail smack on the head? Mustapha was not saying anything new about the deplorable healthcare system in Nigeria – it is an open secret. The Twitter storm over his comment was understandable and I sympathise with the SGF. He created a negative impression in the minds of the general public and I’m sure that was not his intention. In our kind of society, when you serve in government, especially at his level, such comments are viewed as an attack on the government – a form of culture shock; his close friends and colleagues are likely to wonder if he was out of his mind but context is also important in this matter. On the one hand, Mustapha did the right thing by speaking the truth, and on the other, he was wrong as a government henchman. Mustapha was clearly between a rock and a hard place, and you truly cannot envy him in that situation but I maintain that he did nothing wrong.


What COVID-19 has done is to open our eyes to the existential danger of neglecting our healthcare infrastructure which, unfortunately, gave rise to medical tourism to far flung places such as India, not even to other African countries. This is why we must salute the courage of Nigerian entrepreneurs such as Tony Elumelu and Aliko Dangote who are working round the clock to create wealth and prosperity across the African continent. When there is prosperity across Africa, diseases will be minimized. Strive Masiyiwa is another African entrepreneur from Zimbabwe who believes we can turn COVID-19 into a manufacturing boom in Africa – he’s thinking like a successful entrepreneur that he is and he’s seeing opportunities with multiplier effects.


In his latest Facebook post, Masiyiwa said getting on top of COVID-19 requires millions of essential products like masks, personal protective equipment, disinfectants, chemicals, ventilators and other hospital supplies. In much the same way Mustapha lamented about our poor healthcare system, Masiyiwa said, “African healthcare systems are mostly in a big mess.” His view is that we now have a massive wakeup call from the COVID-19 experience, and he wants African leaders to learn from the experience and turn the crisis into an opportunity by creating a “Marshall Plan” on healthcare.


“We can begin a massive manufacturing capacity building, even now as we build new hospitals for the future. African governments also need to liberalize the health sector and call for private investment,” Masiyiwa noted. He added that he belongs to a group calling for $15 billion to be released by institutions like the World Bank and African Development Bank to support a major investment drive in public health in Africa.


My view is that COVID-19 pandemic will change our worldview in Nigeria and encourage the authorities to pay attention to primary healthcare. The massive investment in public health that Masiyiwa talked about should become a national emergency bearing in mind that ‘health is wealth’. Now that the SGF knows our healthcare system is in bad shape, we must be minded to deploy donations arising from COVID-19 pandemic — it offers us a chance for redemption and I believe he agrees with me — by very generous Nigerians including the support that would come from multi-lateral institutions wisely so that we can re-build our healthcare infrastructure within the shortest possible time. The government must take the additional step of keeping saboteurs and criminally minded elements at bay – these are the people who do not want public healthcare system to work in Nigeria.


I would like to bring Mustapha up to speed by referring him to a recent commentary by Runcie Chidebe, titled “Nigeria’s unhealthy healthcare in the eye of coronavirus”, and published in The Cable, an online newspaper on April 4, 2020. As a Commonwealth scholar based in the UK and efficient healthcare delivery advocate, Chidebe’s research and insights on our broken healthcare system will be helpful as we all join hands to solve the problem. Chidebe’s lamentations and frustration essentially echoed Mustapha’s recent unsatisfactory findings in our healthcare system. “Now is the time for Nigeria to confront its healthcare crisis,” Chidebe advised. “The Nigerian government must accept its failure and our political leaders must brace up to their responsibility and seriously reflect on the problem their greed has brought to Nigeria. This is the time to invest in a result-oriented healthcare system which represents the foundation of any nation,” he added, obviously angry at our flip-flop policy.


Before COVID-19, at least seven medical doctors were leaving Nigeria weekly for jobs in the UK in search of greener pastures. A Recruitment Fair was organised in Lagos last year by a team from Saudi Arabia and their mission was to entice Nigerian healthcare practitioners, especially medical doctors, with the smell of petro-dollars and lure them away to the oil-rich country. Apart from stemming the tide of medical tourism, we must also tackle the problem of brain drain in the healthcare sector.


In a 2019 Healthcare Market Insight report on Nigeria by Medic West Africa, less than 90% of the Nigerian population (about 200 million people) live without health insurance; $1 billion (N380 billion) is spent annually on outbound medical tourism; average life expectancy is 52 years (South Africa is 57 years and Ghana is 61 years); patient-to-doctor ratio is 2,500:1; NCDs (non-communicable diseases) account for 29% of all deaths while spending on healthcare is expected to reach N5,762.061 billion by 2021. The report also stated Nigeria ranks poor on the incidence of tuberculosis (128 out of 138 countries) and the prevalence of HIV (123 out of 138) countries. In child mortality, the statistics are not any better – on under-five child mortality, our record is 89 deaths per 1,000 live births; a level far above the level of 64 deaths per 1,000 live births set in the UN Sustainable Development Goals (SDGs).


The report – which will be a handy companion for the SGF — contains an analysis by the Oxford Business Group (OBG) which indicated that our healthcare challenges include limited public funding; a high communicable diseases burden; rising incidence of non-communicable diseases burden and elevated rates of infant and maternal mortality. In addition, the World Health Organisation (WHO) is concerned that, over the years, there has been high reliance on out-of-pocket (OOP) payments as a means of financing health system in the country. The expectation is that Nigeria will move closer to Universal Health Coverage (UHC) and sustain it when it is achieved.


The federal government, the report further noted, can make healthcare affordable and accessible with improved service delivery through strategies in reversing workforce migration as well as outbound medical tourism costing us a lot of money in foreign exchange. In addition, government should create a framework and policies that would encourage private sector participation in the healthcare sector – similar to Masiyiwa’s recommendation — as well as increasing technology adoption to drive growth and development in the sector.


Braimah is a public relations and marketing strategist based in Lagos