Dr Paul Manya Dogo, is Kaduna State Commissioner for Health and Human Services. A Consultant Surgeon and Fellow, West African College of Surgeons, Dogo – who began his career as a medical officer after graduation in 1984 – has risen in the service of the Kaduna State health system, to the position of Medical Director, Barau Dikko Teaching Hospital, from where he was appointed a Permanent Secretary in the Ministry of Health in 2012. In 2016, Governor Nasir el Rufai elevated him into the State Executive Council. In this interview with EMMANUEL ADO, Dogo, speaks on the activities of the ministry, his achievement and target. Excerpt

Before the new National Health Policy of 2016, we had the 1988 policy, and now the National Health Act, 2014. Can we now boast a holistic approach, a road-map towards addressing the numerous challenges militating against provision of comprehensive health-care for Nigerians?

This is a pertinent question. Although we’ve had a good national health policy but it was, unfortunately, operated within a vacuum. There was no constitutional or legislative provision that guaranteed the health of Nigerians. The 1959, 1979 and 1999 constitutions were all silent on the health of Nigerians. Let’s take the 1999 Constitution, for example, the Exclusive List has 68 items, health is not one of them. The only mention was on drugs and poisons, on item number 21. The Concurrent List has 30 items: health was not mentioned. The only reference to health was industrial safety. What is the implication of such a vacuum, and lack of either constitutional or legislative provision for the health of Nigerians? There have been no clearly-defined health responsibilities for the three tiers of government leading to poor coordination between them, and absence of referral, linkages and coordination. No clear path of adequate funding for the health system, and no one was held responsible for poor health-care or lack of it.

The National Health Act has filled the void by changing the status quo and guaranteeing the health of Nigerians, and the rights of Nigerians to good health-care. The National Health Act provides a framework for regulation, development and management of the health system, and set standards for rendering health services to Nigerians. It is a tool towards achieving Universal Health coverage by removing barriers to physical and financial access to health-care, ensuring equity and sustainable quality health-care. Yes, with the availability of the National Health Act, we now have a holistic road-map for addressing the challenges that had hitherto prevented a comprehensive health-care for Nigerians. It is a welcome development and its one of the best things that has happened to the health sector – a National Health Act - a legal backing that guarantees Nigerians the right to comprehensive health-care.

Could you, please, interpret the following statement credited to the state Governor, Mallam Nasir el-Rufai: ‘Our programmes are structured to ensure that a pregnant woman does not die due to inability to access quality services during pregnancy and childbirth; that a child is not lost from preventable diseases, that communities are not overburdened with endemic diseases, and that community linkages are harnessed and promoted.’

It’s very obvious to me that the governor’s statement was made from a well-informed and intentioned position. This statement defined the main problem and offered solution in a very pointed manner, as it were, taking the bull by the horn in tackling high diseases burden, maternal mortality of 547 per 100,000 live births, and under-five mortality of 180 per 1,000 live births and, of course, reducing the disease burden. The structured programmes His Excellency talked about, which we’re currently executing, are in two layers. The first are those programmes that are implemented by the health sector and these include the revitalisation of the primary health-care system, Free maternal and child health-care programme, strengthening of routine immunisation, observance of the maternal new-born and child health-care, which is commonly referred to as the Child Health Week, Child Spacing Programme, Control of HIV/AIDS, Control of Tuberculosis and, then tackling of neglected tropical diseases. These are all structured programmes, as mentioned by His Excellency, that we’re currently executing in the Ministry of Health and Human Services.

The second layer of programmes has to do with tackling the social determinants of health. You know there are social determinants that are outside the purview of the health sector, but have very important significant impact on the health of the people. There are programmes that His Excellency has outlined that are being implemented to solve these social determinants of health. For example, water and sanitation: the Ministry of Water Resources is working on that, with the support of UNICEF, the SHAWN II programme. Quite a number of local governments are working on water and sanitation. And that, of course, means the elimination of water-borne diseases like cholera and typhoid fever. Again, this will significantly reduce the disease burden of these infections.

Let’s take education. You’re fully aware of what His Excellency is doing in the sector - a huge investment - school feeding programme, uniforms, books and better learning environment for our pupils and students. Of course, you know poverty is another very important social determinant to health; now parents will no longer pay school fees, they have their children being fed while in school, they’re given uniforms, whatever savings they have, they can now deploy it on any economic venture and that will improve their economic strength thereby bringing down the level of poverty. In agriculture, of course, you know the issue of malnutrition, that it is a problem; we’re going to talk about that later. You’ll agree with me that during the last cropping season, the farmers had it very, very good. Like our governor will say, one of the yardsticks you can use to gauge this is the fact that most of the people that paid fully for the next Hajj come from the rural areas. Those paying piece-meal are from the urban areas. So the intervention of government in the area of agriculture, in removing middle-men, removing the syndrome of allocation of fertilisers, provided a boost to what we witnessed during the last cropping season. Take roads and transport and what the government is doing in that area. When you’re sick you need to get to the hospital, and to get to the hospital, you need transport and road. And so working on roads and transportation is always a very important social determinant of health; government is also working on that.

Let’s take security. Without security, all that I’ve mentioned won’t take place. And government is doing everything possible to ensure security in Kaduna State and that will attract investment. Many national meetings and conferences are taking place in Kaduna, and that means money going down to people. These hotels will buy tomatoes, chickens, eggs, and so money goes down to the people. This is boosting the economy of the state and that’s because of the relative peace that we have in Kaduna. So these are the structured programmes His Excellency is talking about.

You have Kaduna State Sector Implementation Plan (SIP). Your vision is a state where quality health-care services are available, accessible and affordable to citizens in an equitable manner and on a sustainable basis, through active participation of individuals and communities. How far is the implementation going, especially against time line?

The Sector Implementation Plan is drawn from the State Development Plan, which spans 2016 – 2020. Our 2017 budget is drawn from the Sector Implementation Plan. And our 2017 budget in the ministry has further been broken down into implementable and costed activities. There will be quarterly reviews of our performance. What we have done to enhance and ensure performance was to tie every activity to a programme officer by name, so the responsible officer will be held accountable. Because of the seasonal variation we have in the occurrence of malaria, we have included in our annual operational plan chemo-prophylaxis (chemoprevention) for children. It is a drug that will prevent children from having or coming down with severe malaria. Now, who is the responsible officer? He is the Director, Public Health, Dr Ado Mohammed Zakari, and this is a typical example and that is how we’re applying all our activities. So, I’m glad to mention that the SIP is working and is being implemented, and this is what we’re doing. All our SIPs, like I said, were drawn from the 2016 – 2020 Development Plan, and that gives us the time-frame. And this is what is going to be our reference point all the time. Of course, there are other documents that we’ve consulted which were also used in feeding the state development plan, such as the State Strategic Health Development Plan. Even the recently approved National Health policy, some of it got into our SIP.

So against timelines, you’re doing well, your quarterly reviews, the reports…

(Cuts in). Yes, in April, we’re going to conduct the first quarter review.

The challenges facing the health sector ranges mostly from poor infrastructure to service, inadequate human resources and funding. Of all these problems confronting the health sector, the most critical are the quality of service and inadequate human resources. So, in specifics, you don’t have enough nurses. As a way out, are you thinking of re-training graduates of life sciences for instance, to solve the problem, or go the easy way out – Egypt or India?

Still on our SIP, it is meant to address the challenges facing the health sector. You rightly mentioned poor infrastructure, poor quality services and inadequate human resources for health. Although you singled out quality of service and human resources, I must also say that even infrastructure is very critical as far as the provision of quality health-care is concerned and so I will like to start with that. What is Governor Nasir el-Rufai doing in this respect? The expansion and renovation of 255 Primary Health Centres, slightly more than that number because more facilities have been added. Why have we been having poor quality service in our Primary Health Centers? It is because the centres are dilapidated, no drugs and no human resources. So, one of the first things we’ve done was to ensure that these facilities are brought to standard, and that’s why we’ve adopted the one PHC per political ward strategy. Every political ward must have a functional Primary Healthcare Centre. All health clinics in that ward will feed into it and the Ward Primary Health Centre is also going to feed into a Secondary Health-care facility, and we’ve identified one in each of the 23 local government areas. We have 30 Secondary Health facilities; one has been upgraded into a Teaching Hospital. So we have twenty-nine. We have more secondary healthcare facilities than the local governments, but we have deliberately chosen 23 that will serve as the linkage between the primary health-care centres and the secondary health facilities. So, government is working, contracts have been awarded and we’re happy with the progress. Every week, we review the progress in the rehabilitation and expansion of primary health-care centres so that issues and problems that are coming up can be tackled. We’re also carrying out some renovation and expansion work of some general hospitals, specifically Rigasa, Sabon Tasha, Giwa, Kauru, Turunku, Zonkwa, Maigana, Kaura, Ikara and Hunkuyi. We hope to take up additional ones like Kwoi and Gwantu. But these ones are being addressed. Let me also mention that in 2016, MTN launched a Programme. We expressed interest and won. The intervention of MTN had to do with improving maternal health. MTN did upgraded, and equipped maternity wards in five of our hospitals in the state. These are part of the efforts, not to mention other infrastructural development in the Barau Dikko Teaching Hospital, which is still being expanded. The new Intensive Care Unit, which has a Dialysis section, has reached advanced stage. Then, the 300-bed Specialist Hospital in the Millennium City, we’re already in the process of awarding contracts for equipping of the hospital. Contracts have also been awarded for the Doka Trauma Centre along Kaduna –Abuja highway.

Now, let me quickly go to human resources that you mentioned, government has maintained a programme that was started quite awhile ago, through which we harvest medical students from the university. Here, I’m using medical students in generic term, those reading Medicine, B Sc Nursing, Laboratory Science and then Pharmacy. We recruit medical students at 400 level and the others at 300-level. They’re recruited into the Civil Service and placed on salaries every month. This way, we’re able to raise human resources for health sector. Recruitment is just to augment. I’m expecting about 30 doctors who are currently doing their NYSC to return into the system, and that’s a good boost. Of course, you know we have training institutions for the middle-level manpower: Shehu Idris College of Health Sciences, Makarfi; College of Midwifery, Tudun Wada; College of Nursing and Midwifery, Kafanchan; and now the Kaduna University that is training medical students. We’ve just gotten accreditation. Apart from that, we’ve received approval from His Excellency to recruit additional human resources for health in 2017; the process has commenced. Barau Dikko Teaching Hospital has been given the approval to recruit additional 160 nurses; Ministry of Health and Human Services is also recruiting staff of various cadres and professions, the Civil Service Commission is doing that on the ministry’s behalf. Advertisements have been placed: we are recruiting 50 medical officers, 20 consultants in different fields, making it 70 doctors. The ministry is recruiting 1,000 nurses, 10 laboratory scientists and 30 laboratory technicians, 25 pharmacists and 50 pharmacy technicians, 20 nutritionists, 10 physiotherapists, 10 dental care technologists, 10 radiographers and 10 health information officers. These recruitments are ongoing. We are just waiting for the six weeks to elapse, then we will go into the actual process of sieving out, conducting interviews and recruiting.

Are these medical personnel being harvested on bond? If not, how long will they serve the ministry?

Yes! For those we harvest from the university, the bond is for two years. Because we have a robust plan for them - further studies - they will stay after their bond. This is to improve the quality of service the hospitals offer. I went for my post-graduate training as a medical officer in the Ministry of Health. I went back to the Teaching Hospital as a Supernumerary Resident. Quite a number of doctors in Barau Dikko Specialist Hospital went through this same process. I’m glad to inform you that recently a state came to understudy what we are doing in raising human resources in the health sector.

So India, Egypt is out of the question….?

No, when the need arises, we will. I must mention that in medical practice, there are specialties and there are super-specialties. So when the need arises, why not? Because there is always room for that, there is always that need to interact with others from other economies to improve your health-care system.

So how soon are we going to start seeing the dividends. When do you expect the first graduates from the Kaduna State University?

As you would recall, we had severe problems with the accreditation, so the first batch of medical students had to be sent to Uganda to complete their clinical training. Towards the end of last year, they were here on holidays and their officials came to see His Excellency to show their appreciation. And by the grace of God, they’ll graduate when he’s still in office. You can see the number that will be injected into the system. And, do recall that, 30 girls were also sent to Uganda to read medicine, so as to raise female human resources for the health sector, particularly targeted at our women.

So the ministry has about 70 doctors on training?

Yes, outside the shores of the country. Remember that the objective is ensuring that our women deliver in hospitals. So, if we can get female gynecologists, obstetricians managing them, I’m sure the women will feel more comfortable. This is a deliberate policy.

There’s something I want to take you back on, in health it’s called ‘Hard to reach’. You have 225 wards PHCs, but there are still the hard to reach, what’s the ministry’s strategy on such?

Well, we’ve received tremendous support from UNICEF, and we have reached quite a number of communities through a deliberate programme on Hard to reach, where certain interventions have been taken on how to reach them. One thing we have done under the strengthening of routine immunisation is that all the Primary Healthcare Centres providing routine immunisation are adequately funded, and carry out outreach services. This outreach service is what we use in accessing the performances of the PHCs, and they must reach the hard to reach areas. We also have the Community-orientated Resource Persons (CORPs), who are residents within the community. They go through some training and are given basic interventions to administer to the population (and they’re actually supervised) in the area of diarrhea and pneumonia in children. These interventions also include anti-malaria, they have been clearly told what to look out for in children. They have an instrument that can count respiratory rate, and they know when they should refer, and the particular PHC they should refer such cases to. So, these are deliberate interventions to reach these hard to reach areas.

You’ve made progress no doubt about it and I’m also conversant with some of the figures, especially in the areas of major communicable diseases: TB, polio virus. But the same can’t be said for maternal and child mortality rate, it's still very high. You’ve quoted the figure 576 of 100,000 live births; my worry really is for childhood deaths in malaria, pneumonia, which are complicated by malnutrition. So, what is your ministry doing?

Well, I think it is very important for me to mention that our strategy in strengthening routine immunisation is key. It is very, very important because it raises the immunity of the community. So, even when a child comes in contact with infectious diseases he doesn’t get it or even when he gets any infection, it is very mild and will not lead to death. It’s very important that Kaduna State is getting it right in respect to routine immunisation. I did mention to you about the community-oriented resource persons, and their work in tackling pneumonia in children. We use dispersible Amoxicillin, it is now part of our essential drugs list, and we ensure it is available; is very, very effective in tackling Pneumonia. We want to plead with mothers that anytime a child is having fever, they should not hesitate to take the child to the nearest clinic. In respect to malaria, the treatment is free in Kaduna State. We have been distributing anti-malaria drugs to our facilities in order to combat the problem of malaria. We included in our work-plan some outdoor residual spray in order to have environmental control over malaria. We are also distributing insecticide-treated mosquito nets in our ante-natal clinics and during special intervention programmes. People who organise medical mission to their communities come to us, we give them treated nets, and we insist they must give pregnant women and women with children below the age of 5 years. Our plea is that they don't put them to other uses.

Why?

We have seen people taking these nets to the farms to cover their plants’ nursery, and this is quite sad. Some will cut it up and cover their doors and windows with it. That defeats the purpose. We come down with malaria mostly from the bites that occur while we’re asleep. When you’re awake and active, it is difficult for mosquitoes to settle down sufficiently well to bite. This is why we encourage children and pregnant women to sleep under the nets, because malaria fever has consequences for them. On the issue of malnutrition, we did talk about agriculture. The government has a multi-sector approach. It has launched the Kaduna Emergency Nutrition Action Plan to tackle malnutrition. Our development partners have commended Kaduna State for its robust action plan towards tackling malnutrition. So these are some of the things government is doing, not to mention the gains we’ve made in the control of HIV/AIDS, our prevalence rate is falling down and reports show that patient’s viral load are significantly suppressed. For every individual that unfortunately has HIV/AIDS, the level of the virus in the body matters because it means the possibility of transmission to another person is high. But with adequate treatment, if you’re able to suppress the viral load, you would have reduced transmission to a very insignificant level. Not only that, you do know that mothers or pregnant women that have HIV/AIDS can transmit this to their unborn children. We have a robust programme to prevent maternal to child transmission of HIV/AIDS. We have provided this to more than 500 health facilities at the moment, but we’re expanding by the day and whenever we have a woman that has a virus we refer her to such health facilities, where they’re being cared for and given appropriate treatment. And as soon as the child is delivered, there’s also an intervention programme for the child. Now, increasingly, we’re having more and more children born to mothers with HIV/AIDS that do not have the virus. So Kaduna State is moving from prevention of mother-to-child transmission to elimination of mother-to-child transmission. This is the point we are, and so we have deliberately put out our annual work plan to sustain this gain so that we can completely eliminate mother-to-child transmission of HIV virus.

There’s something I wanted to avoid, funding. I’m sure if the governor gives you the whole N200 billion budget, will that take the health-care system to where you want it?

Well, funding, I must say is important. But health-care is not all about funding; attitudes, using the little you have efficiently and effectively. Since this government came in, what we have learnt is to be prudent: managing resources in such a way that we’re able to achieve much; and then coordination, instead of running vertical programmes. What we’re doing more and more is integration; once you integrate you reduce cost. Yes, we would need all the money, but we know we can't get all; it is not available. What has been given to us we thank God; because the health budget is up to 13 per cent of the total health budget in Kaduna.

What is World Health Organisation….?

There’s this Abuja declaration where governments agreed to devote 15 per cent of the total annual budget across board to health.

So you’re almost there in Kaduna State?

(Cuts in). We’re almost there. Thank God for what the governor has been giving for us, and I believe by the time you put the totality of the interventions together, I firmly believe it should be more than 13 per cent.

Next, the governor’s leverage on his contacts, his goodwill, and I’m sure even his political opponents will acknowledge this – DFID, Bill and Melinda Gates Foundation, Dangote Foundation – and the impact of these interventions. What happens if el-Rufai, for instance, serves out his tenure… is your reporting okay? For most of these donor agencies, reporting is key, so that you can continue to enjoy….

Well, first of all the governor is building institutions. When you build institutions they out-last the person who built them. And that is what the governor is doing and this is good for the state. Secondly, nobody just sits down and people will come to you and say, take money......do whatever you want to with it. They must first of all see your efforts, programmes and your sincerity of purpose. One of the things I can proudly talk about is the unprecedented political will that the governor has expressed in terms of revitalizing the health system in Kaduna State. That is what brought the goodwill from partners; you know it’s not just that it is el-Rufai, no. It’s because of what he’s been doing and what they’ve seen him do. Take the example of our programme on strengthening routine immunisation, we’ve signed a tripartite MoU, just like other governments. Now, a basket fund was created. For example, for the 2017 programme, the governor had contributed to the basket since October 2016. What more can someone do to get encouragement from others? So it’s not as if you just sit down and money is given to you to work, no. There are efforts from the government side. For example, if for the three years, we’re going to spend about N1 billion in strengthening routine immunisation; and the governor has paid his counterpart funding into that basket: Is that not a sign of seriousness? In any partnership with development partners, one of the key things we consider right from the beginning is sustainability. Again, let me go back to the MoU we signed for the routine immunisation – the funding progressively is being handled more by Kaduna State Government, and in 2019 it’s going to be fully borne by the state government. Already, the framework for sustainability is there. What do you need for sustainability? You have to create an institutional home for the programme and the State Primary Health-care is the institutional home for routine immunisation and other vital primary health-care programmes. You must have funding, and there’s a budget-line for that; your best bet in sustaining a programme is a budget line. The third, of course, is well-trained human resources for health-care. We are building capacity for staff. So, once you have all these things, you’ve fulfilled the criteria for sustainability. Like I said, the governor is building institutions, partners are supporting us within the framework of sustainability. So, these programmes will outlive the governor, outlive the partners supporting us.

The good thing, as you said, is building institutions; knowing that….

Sure!

Studies have shown and, having been in this ministry for a long time, Honourable, I’m sure you must have also come across these studies. Since your goal is disease-free and productive citizens. When will we have a shift from cure to prevention? I remember my growing up days in Kaduna when we had Sanitary Inspectors going round to fumigate…. Are we likely to have sanitary inspectors back?

You know the whole concept of prevention lies within primary health-care, and that’s why the Kaduna State Government is making huge investment in primary health-care. Immunisation is to prevent vaccine-preventable deaths. Once people have access to health-care very close to them - which is what the primary health-care system is all about - not only will they receive treatment for whatever ailments they have, they will also receive awareness talks. Very simple anti-malaria rules: don’t allow bushes and stagnant water around your homes, sleep under the mosquito nets you’ve been provided with. Infectious diseases like cholera, typhoid fever: again, people must take responsibility for personal cleanliness. How often do they wash hands? We’ve been preaching this very important household practice, which is washing the hands before you do anything; it’s very simple but very important in preventing infections. This is what primary health-care is all about: prevention. For the first time, there’s a huge investment in primary health-care in Kaduna State. Previously, in fact, nationally, we concentrated on teaching hospitals, secondary health-care facilities, and didn’t go down to the grassroots. Even though it is in the National Health Policy - we say that primary health-care is the bedrock, the cornerstone of our health policy - but we only paid lip service. I think this is the only government that has given sufficient attention to primary health-care by moving attention towards it. And so in the context of sanitary inspectors, the Primary Health-care Development Agency in Kaduna State is going to take care of that, and that’s what will be happening. We’re also working on the Village Health Workers Scheme; we will raise people from within their own community, and their work will be in raising awareness so as to improve the health, encourage cleanliness. That’s going to be happening soon. We are hoping that people take responsibility for their health, complement what government is doing.

Do you doubt the governor’s commitment to the SIP goals; and are you getting the kind of support you desire?

Well, I’m sure this question probably shouldn’t have arisen from the tone of my discussion. Having asked, I want to state that we’re receiving unprecedented support from His Excellency. He’s really committed and if you look at APC manifestos, you will see that he’s clearly executing the manifesto.... in respect of health, education, agriculture, etc. I don’t think there’s anyone that will doubt his sincerity and commitment to improving the healthcare of the people of Kaduna State. In fact, we see the governor as a staff of our ministry, because of his commitment and his familiarity and knowledge of the happenings in the health sector.

There’s this talk about the Contributory Health Scheme. Are the poor your target or the civil servants, I know your civil servants already consume a substantial budget of the state.

One of the early concerns of the governor when he came was how to take care of the poor farmer in the village. He met a system where many people are supported to go for treatment abroad …. He asked: how and when can a poor farmer enjoy same from government? I know he made several statements like that and was the motivation for many of his programmes, taking care of the very poor. Already, we have a number of programmes: free maternal and child health programme is one; haemodialysis in the state is as cheap as N5,000 per session, even though we spend more N25,000 on consumables, not talk about other costs like water, electricity, diesel to run the generator, etc. TB, HIV/AIDS treatments are free. These are all programmes government is funding. In addition to these programmes, government is now setting up a contributive health scheme so that all resident in Kaduna State can subscribe. This has been presented to the council, and has been approved. The draft bill establishing the Contributory Pension Authority has been forwarded to the House of Assembly and, by the grace of God, once passed into law, then Kaduna State will commence the Scheme for all citizens, so it’s not targeted at only the civil servants.

Your agreement with General Electric (GE): the proposed co-hosting of facilities. Is it working?

Yes, it is working out. GE is providing us with specialised equipment for all the 255 Primary Health Centres currently being upgraded and reconstructed. I’ll give you a few examples. The whole idea is to promote the well-being of the woman, especially the pregnant woman and her child. So every PHC is going to have a Viscan. Viscan is a small box of a machine that is used to scan and look at the baby in the womb for any problem; the pregnant woman will see her child too. If there’s any problem, it is properly managed and as the case may be, if it’s beyond that level, the woman will be moved to a secondary health care facility, which every PHC is linked to. What we expect, as it happened in other countries like Ghana, the use of Viscan raised ante-natal care attendance four-folds. It also means that more women will come and deliver in our facilities. Again, it therefore means that we’ll be able to catch any complications and manage them; and less women will die. They’re also providing infant warmers for the newborn. Like I mentioned to you, every PHC will be linked to a general hospital, and these general hospitals are also being equipped with facilities that will make Caesarean sections (CS), safer. So, each of them will have anesthetics machine, monitors to be a able to provide quality care to pregnant woman. There's a very big component of training, the midwives will be trained to handle the Viscan; doctors will be trained for anesthesia and in emergencies. We do know that non-communicable diseases are increasing, so we’re providing the equipment to monitor the heart and investigate it at the secondary health level, when patients are referred to them. We’re happy with what GE is doing. Kaduna State is one of the few states that have robust plans that links the primary and secondary health-care.

Finally, you must be a lucky man. You have six Federal Tertiary Health Institutions and the 44 Army Reference Hospitals also; without these institutions, tell me where would Kaduna have been?

We are indeed very happy that we have these federal health institutions in Kaduna. No doubt that they’re contributing greatly to the provision of health-care in the state, and we deeply appreciate their service. We are partnering with the National Eye Hospital for specialised eye surgery for children. This is in conjunction the Yusuf Dantsoho Hospital. We are presently organising a community outreach to Igabi Local Government Area. That, again, we’re doing with the National Eye Centre. Let me also mention that the Federal Neuro-psychiatry Hospital originally belonged to the state government, but was handed over to the Federal Government, when it wanted to create a Regional Psychiatry Hospital. But we have continued to partner with the Federal Neuro-psychiatry Hospital in the area of Community Psychiatry Care. For now, we’ve chosen one hospital in each of the senatorial zones: Birnin Gwari zone, 2; Ikara in zone, 1; Kachia zone, 3. We have also been collaborating with ABU Teaching Hospital. So, there is that collaboration and we appreciate their contributions. However, it is what the state government is doing that will actually improve the health indices of the state, such as the strengthening of routine immunisation and other preventive measures.

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