Former Minister of Health and erstwhile vice chancellor of the University of Ibadan, Professor Isaac Folorunso Adewole, speaks with SADE OGUNTOLA on his life and career, including his time as minister of health under former President Muhammadu Bihari.
How does it feel for one to be 70?
Well, I will be 70 on Sunday (tomorrow). I don’t know, honestly. I think 70 is just a number as far as I am concerned, and that number denotes when I will retire, but I am not tired, so I will continue to function, only in a different capacity.
You have come a long way and achieved a lot. What do you think is the greatest achievement you made in the course of your career?
That is a tough question. My greatest achievement is knowing God, and no other achievement can surpass that. But if you are talking about achievement in terms of career, my greatest achievement was the introduction of the basic healthcare provision fund, which I regard as the game changer in terms of funding the healthcare system in Nigeria. The National Basic Healthcare Provision Fund was passed by the president in 2014, but we could not find money. Even Bill Gates decided to give us some support. The World Bank also offered to give us support but God used former Senate President, Dr Bukola Saraki. We had a breakfast meeting and I told him about our problem; that we needed to change the narrative with respect to funding healthcare in Nigeria and he promised to put it in the budget and he did. That, to me, is probably the single most important achievement of my tenure as a minister.
As a consultant obstetric and gynaecologist, what was your greatest achievement?
As an O&G, the greatest achievement is God and that is to those babies who walk around and smile, especially from women who suffered infertility. Nothing can be more satisfying than seeing them. I have lost count of the number of deliveries I was involved in the course of the care of women.
Did you ever think you would be this successful while growing up?
Except one is a prophet, nobody will ever dream of such. When I was growing up, I only dreamt to be a doctor. That, to me, was the achievement I wanted. My horizon was limited. When I became a doctor, I wanted to be in academics and in academics, all I was aspiring to be was a professor. When I became a head of department, I said, ‘oh, wait a minute, I could also be the dean of the faculty’. When I became dean, I saw the possibility of becoming a provost. As a provost, I thought of becoming the vice chancellor. But that was all; I never dreamt for a day that I would be a minister.
What made you want to be a doctor and not an engineer?
I think it was divine, and for two reasons. My family had a close relationship with the workers at Wesley Guild Hospital, Ilesa. They used to visit dad and mum, particularly on Sundays. Then, daddy would fete friends and relations on Sunday afternoon with pounded yam with egusi soup and bushmeat. Once in a while, I also visited them at Wesley Guild Hospital and I think I was fascinated by the beautiful environment of the hospital.
Then, I would come to my father’s shop, lock myself in and pretended to be running a clinic. I would be calling imaginary patients and asking them to come for injection or their cards. One of my uncles said, ‘This boy will probably be a doctor’. He narrated this to me vividly when I enrolled at the University of Ibadan as a medical student. He said they had suspicions that I would end up being a medical doctor because I already practised medicine in baba’s shop when I was young.
How did you feel when you were announced as minister?
Let me be honest; I didn’t expect to be appointed as a minister. It came as a surprise, and it is a pleasant one because someone had earlier told me that the position was not meant for me and that it was earmarked for somebody else. So, my mind was off it. There were myriad of speculations then that I might get a ministerial appointment. I made contact with somebody in the presidency who said that the position was meant for somebody else, so I took my mind off it.
What was it like working as minister under General Muhammadu Buhari who railroaded you into exile in the early 80s?
Well, it was quite interesting. Let me put it in two broad perspectives. When I went into exile, I went simply because I was a unionist and the government of the day which he headed said that they would get us dead or alive. I had to run away through some routes, which I will never tell anybody. It is in my memoirs that I went abroad. I was not too detailed about the description, but I later came back.
I guess time has a way of blotting out memory and when I was appointed to serve as a minister, I had some hesitancy. I had some troubled moments. My interaction with him, however, gave me a vivid picture of a different person. I have a whole chapter in my autobiography, which I’m going to launch on May 5, 2024, where I say he was a misunderstood president. I kept a diary of things I could find about him. I discovered that President Buhari was quite a jocular person in office, very intelligent, strict and punctual to a fault. He is kind and nice. He supported me as Health Minister and I documented that in my autobiography. It is a whole chapter on him.
But one would have thought you would have reservations accepting such an offer from him.
I said so. Yes, initially, I had some troubled moments, but then time is a great healer. You are talking about 1985. I served him almost 30 years later. The wound had healed. I had almost forgotten. Even people that he jailed worked with him because time is the greatest physician.
What was the greatest challenge you faced as a union leader and later as Nigeria’s Minister of Health?
As unionists, we fought over funding. Government said doctors should pay for services they enjoyed in the hospitals and we said hospitals had become a resting place on the way to mortuary because they were poorly funded. As minister, it was still the same chronic underfunding.
In 2001, Nigeria was a signatory to the accord to allocate at least 50 percent of the national budget to health. Our national budgetary allocation to health up to today is still less than five percent.
Why did you not change the situation during your tenure?
We tried but there was also the Nigerian factor. The Nigerian factor is that you have money that can take care of only one or two hospitals but you spread the money across 50 hospitals. That is the main problem. Until we agree to function as a unified country to say look if the money we have can only take care of only one or two hospitals this year, let us face the one or two hospitals. And next year, we will take care of another two. Things will remain the same because we won’t have money to go around at the time.
What we tried to do in office was to reorder the architecture. As of the time we got into office, the Nigerian health system was like a pyramid standing on its tip. Nigerians will walk straight into a teaching hospital. What we tried to do was to re-invert the pyramid so that the pyramid could sit on the base and the base is the Primary Healthcare Centre (PHC). We launched an ambitious programme of revitalising 10,000 PHCs. By the time we left office, we had revitalised over 4,000 PHCs.
Then, as I said earlier, we put in place the National Basic Healthcare Provision Fund that would provide money to fund Primary Healthcare Centres directly from Abuja which, to me, was an innovation. If that was continued over a period of time, we would take care of the Primary Healthcare Centres that would cater for the health of about 80 per cent of Nigerians and then we free the teaching hospitals so that the few, maybe five to 10 per cent, that required teaching hospital care would then come there and enjoy the service. It is not that people with diarrhea, fever and headache would come to teaching hospitals like UCH, Ibadan. They would go to PHCs around them to be treated and that is where they should even get delivered. It is cases that are complicated that should come to teaching hospitals.
Reports say that apart from young doctors and nurses leaving Nigeria, their trainers are leaving, too. What implications do you think this will have for the future of the country’s health sector, and can this brain drain be halted?
But in halting this, we should think beyond the health sector. An advert, a few days ago, said that they were looking for bricklayers and carpenters and artisans from Nigeria. In other words, it has moved beyond the health sector. What we need to do is to balance the pull-and-push factors; we should make jobs attractive, increase pay, provide equipment so that there is job satisfaction and then there should be job security. Some people that are going are not doing so because they don’t have jobs, they’re going because they are not feeling secure. I know of someone who left this country simply because armed robbers invaded his residence. He said he couldn’t stand it any longer and left. So, it is not everybody that is leaving for economic reasons; some are leaving because they are insecure. So, if we improve security and job satisfaction, many people will stay. There is no place like home.
Where do you see Nigeria in years to come if we are not producing enough healthcare professionals?
The word ‘enough’ to me, is hypothetical. No country can ever produce enough healthcare professionals. But what is happening is that there is currently a scheme to increase the number of doctors. But I don’t think that will solve the problem entirely. The Ministry of Health is talking to the teaching hospitals and medical schools to increase the turnover, but that alone will only solve the problem partially. We also need to, as I said earlier, improve job satisfaction, reduce the push and increase the pull factors.
The pull factors are economic, the devaluation of the naira and so on. They make the push factors more attractive and stronger. The push is the job environment, the insecurity, lack of equipment, lack of job satisfaction and so on.
Years ago, we had the VAMED project that refurbished and re-equipped many hospitals. Different governments also tried to refurbish and revitalise these facilities. So, why is it that people continually talk about poor infrastructure as a push factor for health workers?
The VAMED project worked, but it has to be a continuous exercise. You don’t do VAMED project 20 years ago, and then think that is all. No. An equipment of 10 years is even outdated, not to talk of 20 years. I am sure all those VAMED equipment are outdated as of today. So, it has to be a continuous improvement system.
Would the situation have been better than it is now with a functional Public-Private Partnership arrangement to ensure functional and properly equipped hospitals?
The unions did not support that because they thought that they would lose jobs. I think it has to do with proper marketing and education of the unions. The PPP system does not necessary imply loss of job. It only improves efficiency. When you partner with the private sector, you will take on the efficiency of the private sector, the discipline of the private sector which are lacking in the public sector. We need it in the public sector. So, we need adequate education. We need to market it properly before we introduce it. We shouldn’t just rush it or the workers will kick.
A school of thought holds that Nigeria can go the way of health insurance, and once people are enrolled, our hospitals will be better off through capitation. What is your opinion about this?
I think it is the wrong way to look at the funding of the healthcare system. Nigeria has a large informal sector. So, we should ask ourselves who is going to pay the premium for the unemployed because insurance implies that you are using a part of your earning for insurance. There must still be a public expenditure; insurance alone has not been shown to be a good model anywhere in the world. It is complementary to improve public funding. So, we need to improve public funding with insurance. That is what we need, not just insurance alone. Insurance alone will not solve the problem in a country with a large informal sector.
What is your greatest weakness as a man? Could it be money or wine or women? How do you resist it?
It is none of the three. Well, I have been lucky. I don’t drink wine. I don’t take beer. Do I take any form of alcohol? That is a tough question. Let me tell you, I take Amarula or Baileys when I’m on a night flight and it’s time to sleep. When I take it, I sleep off and I wake up when they say, please, prepare for arrival. But routinely, you will not find me with alcohol. My system does not take alcohol.
How did you resist temptations while in office as the provost of the College of Medicine, then a vice chancellor and later the Health Minister?
Well, you must build systems to protect yourself. The first thing you must tell yourself is that as a human being, you are vulnerable. So, you start from the position of being vulnerable, then you protect yourself. When I consult, if you don’t hear me press a bell in five minutes, my nurse will knock on the door and will come in.
So, there is no way I would be left with the lady alone for more than five minutes. My nurse would come in and the doors were open. The keys were outside, not inside. There are simple things you must learn as a doctor when you’re grown up. This is to separate yourself from your affection and be professional. It worked for me. It requires discipline and it will work for even young doctors as long as you don’t allow greed to set in.
Can doctors be greedy?
Human beings can be greedy. Doctors are human beings. We are talking about human beings. The Scripture says let him that thinks he stands… It does not say let him who is standing. It says he who thinks. So, right from the world go, you tell yourself that you are vulnerable and you protect yourself. Don’t think you can withstand it.
You are Yoruba, which food is your favourite?
Well, I grew up to like pounded yam, particularly on Sundays. But for a long time, I stopped because I wanted to control my weight and my calorie intake. I love rice, but then I started protesting with rice because when we were growing up, we ate rice only on Sunday. Now, people take rice three times a day. I’m almost addicted to rice. And I thought once in a while if I can afford taking my eyes off rice, let me do so because there’s nothing so special about it that amala cannot replace.
Yeah. So, don’t kill yourself over rice. I was at Radisson Blu in Norway. I asked for, I think, Salmon. They asked: ‘What about your side dish? And I said rice. They said, ‘Sorry, we don’t have rice in Norway’. I said, ‘Why is this so?’ They said, ‘We don’t grow rice’. They don’t eat what they don’t grow. And I think that Nigeria should also get to that stage that it grows what it eats and eats what it grows. In Ethiopia, it is the same. You cannot import food into Ethiopia.
But with Nigeria’s large population, do you see that working?
God has been kind to us. We have a fertile ground. If you throw a bean or maize grain outside, come back in five days’ time, it is growing.
What is your favourite TV programme?
It is soccer. I belong to Man-U. I started with Chelsea. I left them because they misbehaved. They actually drove their coach, Mourinho, away. I am sure you knew then that one of their players was befriending the physiotherapist and because Mourinho was strict with them, they decided to send Mourinho away by losing matches until they they had to sack Mourinho. So, I left them for indiscipline.
I’m now with Man-U. I’m sticking with Man-U, even though Man-U is seventh on the table. They are not doing too well. Occasionally, I tried to stay away from soccer so that my blood pressure will remain normal. But still, I can’t keep my eyes away. I still watched them perform badly a few days ago.
Can you tell us a little about your parents? Who, between them, had the greatest influence on your life?
I come from a family of traders. Daddy was a trader and mum also a trader. My dad loved education passionately but he passed away when I was in Year Four in medical school. So, it is my mum who now had more contant with me and more influence on me than my dad. But at the early stages, it was my dad. He was my idol.
What were those things that that made you see him as your idol?
He was caring and a firm believer in practical issues such as accountability and transparency. I was his un-certified accountant and he would take stock every month. Every year, he would audit his account. My dad kept a daily record of his expenses. Up to today, I keep a record of my expenditures, too. If you asked me how much I spent last month, I would tell you. I would just pick up my notebook and I would tell you.
Who was your hero in medical practice? And, why did you choose him as your hero?
My hero is different from my mentors. My hero happened to be Professor Olikoye Ransome-Kuti because of his work ethics and his down-to-earth nature. He led a simple life and he was not materialistic. And then he was a workaholic. By 7 am, he was in the office. If he gave you an appointment, he would be there. Another person who followed in the same footsteps was Professor Lambo. He was also a stickler for time. In fact, there was a day Professor Lambo gave me appointment for 7 am. We were going to Igboora. By 7 am, he left his hotel room at Premier and I didn’t catch up with him until we were close to Igboora.
Who were your mentors then?
It is a blend. I have Emeritus Professor Oluwole Akande, Professor Adelusi Babatunde and Professor Oladipo Ladipo. So, it is a blend of the three. They happened to play some critical roles at different times in my life. Emeritus Professor Akande gave me my first international grant. Professor Ladipo gave me my first national grant and brought me back into academia. Professor Adelusi supervised my Part 1 and part 2 fellowship examinations, and during the Buhari crisis, he kept my family for one month in his house and fed us.
What is the best book you have read?
I think it is an amalgam. I am a student of leadership and I have a complete set of biographies of American presidents. And those are my treasures and the best of them is actually the biography of President Bush senior.
What exactly did you see in that biography?
Good. He defined power and what power is all about. And I love a quote there which I have been using since I was provost of the College of Medicine at the University of Ibadan. It says power is not meant to be shown off and that there’s only one use of power, which is to help people. That has been my cardinal philosophy.
Tell us about your autobiography?
I will be launching my autobiography on May 5 at the International Conference Centre, University of Ibadan. I will be launching three books in all. One is the autobiography titled ‘Uncommon Grace’ because I consider myself to be a product of grace. Right from birth up to today, it has been grace. If there’s anything that will describe me and my situation, it is grace. I was born inside a vehicle and I survived because God was my neonatologist. I passed examinations because of grace. Becoming a doctor, it was grace; becoming a provost and later a vice chancellor, it was grace. Health Minister, even when I was not expecting to be a minister, it was grace.
What led to you to believe that everything was a product of grace?
I aspired to be vice chancellor at a point in time when I was provost, but I never dreamt of being the health minister of the Republic of Nigeria and yet I was appointed by an unusual person.
How did you survive the politics and intricacies of the office?
I survived the four years. Even when someone called me and said, ‘Professor Adewole, they are likely to reshuffle and they will drop you’, I survived it all by grace. It is not about what I did, it was all because of grace. Throughout my life, my name ‘Isaac’ has worked for me, and my other name is grace.