Dr. Mayowa Akanbi Folorunso a seasoned healthcare professional with a passion for driving meaningful change, has recently shared his insights on the current state of Nigeria’s healthcare system and the role of leadership in shaping healthcare policies and outcomes. With an Executive Master’s degree in Global Healthcare Leadership from Oxford University, he has gained valuable knowledge and skills to address complex health challenges, particularly in rural areas. Let’s dive into honorable Adeoye thoughts on healthcare leadership, policy, and innovation.
1. What inspired you to pursue an Executive Master’s degree in Global Healthcare Leadership from Oxford University, and how do you think this qualification will impact your career?
I was looking for new tools and methods to address current complex problems that exist in health and generally, in development. On a broad level, everyone is aware of current policy changes in US and many developed countries on official development assistance (ODAs)- a mechanism through which developed countries contribute in one way or the other to development in developing countries. This has caused a significant shift in the sector, but it didn’t start today. There’s been a trend for five to ten years in what you can call push factors underpinning this- rise in nationalism, interrogation of the benefits or otherwise of globalization, increasing fiscal pressures in developed countries due to variations in economic performance etc.
All these came to a tipping point with the COVID-19 pandemic and the various fallouts between politics or governance and medical science or public health. Add to that the economic and social pressures that the pandemic caused- all resulting in more countries looking inwards and ‘saving their own’ as against ‘saving others’ as well as the demand for more accountability and performance from the global health and development sector. It was obvious to me that it was not going to be business as usual and visionary and collaborative leadership would be more needed, requiring different tools and skills set. The quest to develop these led me to the global healthcare leadership Masters programme at Oxford.
The University of Oxford is a foremost global university and studying there for a postgraduate degree drives home this point- it leaves you with an unquenchable quest to interrogate knowledge, and hone inquisitiveness, to understand the place of scholarship but in integrity, to leverage the power of collaboration to achieve greater impact, and also that of self-reflection to identify personal biases and strengths, so that these could be put in view and/or leveraged. All these would be important in my career.
2. How do you plan to address the healthcare challenges facing Nigeria, particularly in rural areas, using the knowledge and skills gained from your program? If the opportunity to serve come
I have learnt that competitive resources and uncertainties must not necessarily translate to failure and lack of health access to citizens. For this not to be the case, astute leaders that are able to handle multiple paradoxes, lead with empathy but demand results and who can creatively design and deliver multi-sectoral initiatives will succeed. I am immediately applying the learnings to the work I do in support of national health programmes in countries with huge populations such as Nigeria, Pakistan, Bangladesh, Ethiopia and Democratic Republic of Congo but also Uganda, Malawi, Sierra Leone, Gambia and Cabo Verde, to mention a few.
As I have mentioned before, generally, in Nigeria, there’s a chronic and widening urban-rural development (including health) gap. Indeed, healthcare delivery requires significant investments in diverse preventative and curative health needs, and those investments must come from somewhere. Emphatically, there’s no ‘free healthcare’ as this only means what recipients get for free have been paid for by the government, domestic, or foreign partners through resource allocation, taxes, development assistance etc.
Implementing the Abuja declaration on health financing is a great starting point. Government must directly invest in health, at par or beyond that commitment, but also encourage creative healthcare financing by appropriately implemented health insurance schemes, joint partnerships for health, public-private partnerships etc. Government must make policies that prioritize rural communities for health investments, especially as most quality private health investments have predilection for urban areas that have better infrastructure, higher paying customers, and higher potential to recoup profit. In addition to addressing the infrastructure and economic deficit in rural communities; government must envision rural communities’ healthcare initiatives and incentivize willing investors to prioritize these communities.
3. Can you share your thoughts on the role of leadership in shaping healthcare policies and outcomes, in Nigeria?
Policies are the thrust through which healthcare and broader development are introduced and implemented. Leadership is a critical component to designing and implementing these policies and as I mentioned earlier, adaptive and transformative healthcare leadership is even more important in these uncertain and fiscal constrained time. There are many on-going great initiatives to salvage healthcare delivery in Nigeria.
I have a bias towards equitable delivery of healthcare delivery across the country, irrespective of where people live. From a policy perspective, Nigeria must extend some of the creative models it has implemented in road construction (for example interest-free bonds etc. to expanding healthcare. Policy must encourage national and state governments to directly incentivize health workers in rural as well as conflict-prone locations. A central thrust to anchor needed improvements may be the launch of a cohesive Health Services Scheme as an ambitious offering to bring healthcare closer to citizens by partnering with diverse stakeholders to invest in preventative, diagnostic, as well as curative, primary, secondary and tertiary healthcare etc.
As a concrete example, there is a rising incidence of non-communicable diseases including hypertension and diabetes amongst young people now, unlike 20 years ago. Deliberate interventions could be developed to promote the mainstreaming of risk-profiling for all young people at every healthcare touch, with an even higher focus on those with higher risk factors. Related to this, there must be deliberate efforts to reduce unhealthy food imports and their ingestion to the barest minimum, adopt clear food constituents labelling, reduce advertising of unhealthy food/diet to children, and discouragement of sedentary lifestyle. Policies that incentivize States to invest in increased physical activities initiatives, those that discourage excessive intake of alcohol, those that support smoking cessations, that diagnoses and appropriately manage pre-conditions with lifestyle changes will be transformative. This is an example of how something fundamental can be addressed from a holistic perspective, influencing policies but directly translating into outcomes.
4. How do you think healthcare professionals can effectively engage with policymakers to drive meaningful change in the healthcare sector?
Indeed, the level of impact any professional will make is directly proportional to the number of networks they create and maintain, and how much leverage they have with not just policymakers but also political or governance leaders. Thus, the case of health and policymakers or political leaders or if you like, governance, is a clear one. While health leaders oversee direct implementation of healthcare interventions, the ability to elevate the prioritization of healthcare and ensure it’s on the agenda of governments and partners, to demonstrate the benefits of investing in healthcare, often in direct competition with other investment needs and the process of unlocking resources to implement the interventions all depends on governance and political power.
Healthcare leaders must leverage data, be clear on both baselines and reasonable and achievable targets- offering commitments on monitoring and reporting, leverage partnerships and collaborations with other institutions, partners, or sectors, which demonstrate efficiencies and increase champions for health. An experienced team that can support different interventions, effectively communicate successes and address bottlenecks, and most importantly engage the beneficiaries or citizens in a proactive rather than reactive.
One tool that healthcare professionals are not used to is the art of storytelling and communication. There’s hardly anyone who would argue against the importance of healthcare. However, carefully curating and sharing powerful stories of the importance of investing in healthcare, and the unfortunate outcomes in the lives of citizens of not making these investments, will contribute to effective engagement.
5. What are your views on the current state of healthcare infrastructure in Nigeria, and how can it be improved?
Nigeria is a subset of global healthcare systems and even taking a Nigeria- there are multiple healthcare systems realities that exist within the nation such as from one sub-region or state to another, and even within these. Nigeria as a developing country with high fertility rate and correspondingly high population, limited health infrastructure, relatively sub-optimal sustainable healthcare financing, and poor health seeking habits, present with high healthcare delivery needs. These result in high morbidities and mortalities due to preventable diseases, lack of adequate and limited motivation for available health and para-health workers, rising number of non-communicable diseases including in young people.
While several interventions are being carried out, the major pain point is still that a lot of innovation, public-private partnerships are catalyzing world class healthcare delivery in the major cities in Nigeria while there’s limited commensurate investment in an extensive and optimal network of well-equipped primary, secondary, or tertiary healthcare provision centers, country-wide, including in rural communities. This is not a simple or easy problem to address and will take years of consistent prioritization to bend the arc towards progress. It must however start from appropriate health financing and allocation but also budget execution, disbursement, and use for health. For example, the African Union had the Abuja declaration where member states committed to allocating at least 15% of budgets to the health sector, and this could be a starting point.
Of course, Nigeria has a huge developmental deficit, not just healthcare, thus healthcare leaders must use real-life data to justify and advocate for healthcare funding, while demonstrating where efficiencies and sustainability can be gained.
Furthermore, in prioritizing all citizens for health, government must devise a strong rural health initiative that incentivizes- starting with government’s own resources- others to invest in primary and secondary healthcare in non-major cities and collaborate with domestic and international donors on critical public health priorities. As mentioned earlier, there needs to be deliberate creative and sustainable financing of these.
6. As someone with experience in healthcare and an interest in politics, do you think there’s a need for more healthcare professionals in politics? Why or why not?
Laughs. I think all humans are or at least should be interested in politics, even if from a self-preservation and in an insidious way. To me, one of the critical rites of passage for any would be public servant should be verifiable evidence of being successful in a non-politics area of endeavour prior to thinking about governance. Thus, not just healthcare professionals but professionals in general, should be involved in governance. Having a pre-governance background and experience (the so called second address) helps to build trust, demonstrate capacity, and contribute to the narrative of integrity. Thus, if this is followed, the argument of technocrats versus others may thin out since everyone should be one technocrat or the other- in bricklaying, accounting, painting, medicine or as a teacher. What people therefore misconstrue as the opposite of being a technocrat- often called ‘core politician’ refers to a concoction of leadership, being grounded with your people, being relatable and a people person, street credibility, etc. are then not mutually exclusive of being a technocrat but tell-tale signs of an individual that will do well in governance. Of course, there are technocrats that should remain technical or professional people and not be leaders or managers, but the contrary is also true that there are core politicians that should never smell leadership or managerial positions too.
The real test of knowledge, is humility, empathy, compassion, doing good for the greatest good, cutting-edge problem solving, and a thoroughbred healthcare professional, by the virtue of the life-and-death issues they’ve had to deal with- either on a patient by patient basis or from a population perspective, has much of these to give, and as such I’ll say they should be more involved. Again, the same qualities (maybe not as in a life-and-death way as the healthcare professional) can be demonstrated and exploited for the people by a tailor or small business owner.
7. From your response above, it seems you have keen interest in 2027 politics. What should we be looking out for from you?
Hahaha. 2027 is still a long 2 years from now. Laughs. As you saw from commentaries following the President’s mid-term conclave, there’s always a core consideration of the timing and rightness of election positioning- and that is for a sitting president. As our current Akinyele/Lagelu representative, a long-term politician also said at the recent local government meeting- ‘Oke ni signal ti ma n wa. Ma be. Signal ma wa. Ti signal ba ti de, wa mo nkan to ma se’, you and I are waiting for the signal. Laughs
8. How do you plan to leverage your network and connections to drive positive change in the healthcare sector?
Well, scholars define the ‘gown’ and the ‘town’, most times expressing a dichotomy between both. It’s therefore always important that knowledge is effectively deployed and resources directed to where they are needed the most. On a professional level, I’ll continue to contribute to interventions that directly impact the healthcare of Nigerians. There are several on-going initiatives to advance healthcare at national and sub-national levels. Prioritizing underserved and vulnerable population with healthcare investment taking a rights-based approach to healthcare access, is something I’ll always advocate. Initiatives that encourage constituent members to increase their health seeking habits must not be one off or project-based but continually be implemented, reviewed and actioned. Indeed, infrastructure, including all tiers of service delivery and ranging from preventative to curative to life course, must be put in place. On a leadership front, personally, humility, leading with empathy and grace, proactively taking the views of the community through having them as partners and collaborators, and partnering with others on meaningful and transformative interventions to support the community are within scope and to which I am fully committed.
9. What advice would you give to young healthcare professionals looking to make a difference in Nigeria’s healthcare system?
Young healthcare professionals must take a hard stance to invest in themselves. The reality of the state of healthcare could inadvertently be discouraging. Doing the best in one’s setting and responsibilities is important, understanding that these all come together across multiple professionals to represent the outputs of the health sector. Investing in relationships will always be an important resource, as no meaningful change happens without real collaboration.