Dr. Jennifer Anyanti is the Chief Strategy and Technical Officer, Society for Family Health (SFH) Nigeria. In this interview with ENE OSANG she laments the non availability of primary healthcare in Nigeria, adding that a lot of health problems would be solved if there are standard primary healthcare centers.
How do you manage this big office?
I started working at SFH in 1999 so this is my 15th year. I started as a coordinator in the research department, I am very interested in research so over time I have grown through the systems in SFH to end up as the Chief Strategy and Technical Officer so I think my experiences in life both working with SFH have put me in good role to manage the offic.
Was working in the health sector your childhood dream?
I have always wanted to be a Doctor from my childhood, around age 8 or 9 when I always get a doll and pull it to pieces because I was always interested in what causes things and that was why I did medicine. As soon as I finished secondary school I went to Dallah orthopedic hospital we were living in Kano then and I did voluntary work their for about 2-3 months.
Also, my Dad encouraged me in medicine, he had an accident while I was small so I always wondered how they managed his care so it increased my interest. I went to medical school at the then University of Ife which is now Obafemi Awolowo university and first of all did medicine. When I graduated, I did my house job in Kano but in the south I found out that medical care was so different from what we saw in the north because people had a little bit of education and so they understood some basic norm of healthcare but in the north things were a bit different.
At Muritala hospital where I did my house job, you could see women you felt you could have done something about but, the woman gets to the hospital and probably needs a Cesarian Section (CS) like two days ago but because she lives so far from the hospital and there was no Primary Healthcare Centre (PHC) near her, she gets to the hospital late and by then the baby is dead and she becomes extremely sick and we do this operation we called ‘destructive operations’ in those days where, we have to cut the baby into pieces and remove it so we don’t have to do the CS because she is unable to deliver.
So, overtime I found my interest in medicine but I realised there was something we could do earlier that could prevent somany bad cases in the hospital and that was when my interest in public health began. There is the element to health; the health promotion and prevention aspects that could solve so many things in a low resource country like Nigeria on healthcare because it could prevent those small problems before they become big.
How was it like studying a male dominated course at school?
Yes there were more men than women when I was in university but I think I read a research somewhere that says women tend to do better in certain courses in school because women get less distracted when it comes to school work provided we are focused on it and also, we have a skill to do some analysis. Recently, the three best students in WAEC were girls I think for every woman the key is to be focused on what you are doing as a student because it is easy to get distracted by so many happenings in school either by guys or pressure from home but the important thing is to be focused.
Do you think the number of girls studying sciences has increased?
Yes I do think so, I was reading the WAEC results and the girl that came first was an art student but the second person did sciences. I think there are more girls in sciences today, there are a lot of girls in medicine but there are more men in engineering or ICT than girls so its getting better and we should continue to attain higher. We are gradually overcoming the stereotype that some courses are just meant for males, I think medicine, pharmacy and a lot of the healthcare courses has been taken over but in engineering, ICT, technology communication, we are coming up.
Tell us about your educational?
I started primary school abroad and then when we got back to Nigeria I did school in Kano state so my first school in Nigeria was Kano Capital School. It was a Corrona Trust but Kano state government took it over and named it Kano Capital School. From there I went to a Catholic School; Saint Louis Secondary School also in Kano. I like the school now because it gives you a very good background and gave everybody a level playing ground no matter the religion, we all dressed thesame and muslims and christians have there worship places and that helped the country to come together and understand ourselves because some of the challenges we have now are because we don’t understand ourselves, and we don’t talk to each other. From there I wrote jamb and then went to the University of Ife where I spent six years and graduated in 1989, after that I did my masters degree in Public Health in the University of Lagos from 1998-99 so since then its been mainly courses and I have attended a number of courses, and trainings overtime to build my capacity in other areas which I must credit SFH for.
How do you manage work and home front?
The key to a successful women is a very understanding husband, if a husband is not understanding she cannot be successful because the tension is everywhere. I usually tell younger ladies here in the office that ‘you have an oga in the office and oga at home’. I must credit my husband for being very understanding, I live in Abuja now while my husband lives in Lagos with the children one in the university and two are in boarding houses in secondary school so my husband manages more of the homef ront. Any success I have in life I must give credit to him and to the upbringing from my parents.
How do you spend your leisure?
I travel fairly often like every 2-3 weeks I try to get to Lagos and I especially try to coincide it with the children’s midterm breaks or when they are on holidays so I can talk to them. When my daughter was in primary school she was she was with me, we used to go out a lot to the movies, we go for lunch and I also do a lot of church activities. I try to exercise mainly by walking in the mornings or evenings sometimes with the work that tends to be difficult but most women should realize that if they don’t exercise various forms of heart diseases could be waiting for them in the future. Also within the office I try to use the staircase often atleast that is a form of exercise but what is important is 30 minutes of exercise everyday.
Do you have any regrets in life?
Not really, I would have liked to have specialized in pathology rather public health because like I said I like to know the underpinning of everything in other words, if I see someone who is sick, I like to know exactly what causes that sickness. But then I think also doing public health gives me the ability to know the determinants of disease that, it is not just that ailment you find in the person but there is a lot of other things around that person for example it could be the person’s lifestyle, home upbringing, society, or his genetic makeup so if I see a sickler, it has nothing to do with the sickle cell disease but because the parents didn’t care to check themselves before marriage.
What challenges do you face at work?
I think the challenge most women would face can be helped by understanding husbands if you are married, or organization of time. Sometimes it gets very busy here, we are an NGO we have about 12 projects and I try to provide support to all of them so it can be challenging but I think organizing time is important and then always realizing that you have only 24 hours in the day, you can’t use all the hours working because you must sleep, rest, eat and so on but I think really the main challenge sometimes is keeping to time. Like I said having an understanding spouse for me really made the difference of who I am.
What are your hubbies?
I love reading, I like google because one thing about me is if you say something that I don’t really know much about I will go and google to find out what that means. I like playing badminton but my husband likes playing table tennis but because I can’t play tennis I thought him badminton. I also like sleeping but I don’t have enough time but mainly, I like reading and badminton and I even played for my school while at university. I like encouraging people and people ask if that is really a hubby but I don’t like people looking sad or downcast so I like asking what is wrong and encourage you. I also believe that women and the ballot box are the future so everybody should register and vote because if you don’t register don’t complain when things are going bad in the country.
Talking about politics, do you think women stand better chances in the coming elections?
I think a lot of women will probably go out for this election but women tend to hold back a bit because of the way elections are in Nigeria, they feel like do I have to have the money? But a lot of people think that women could be honest and they should not be afraid of contesting because 50% of voters are women and they would likely get supporters if you come on the platform of going to support women but, they should not forget when they get there.
Do you agree that women don’t support each other?
I had this discussion with one of our board members and she said a lot of people say that but it is not really true. One thing about me is that I don’t like using family or children or being pregnant as an excuse for not working hard. If you know you can’t do something because of your family don’t wait until it becomes a problem. When you know your child suddenly fell sick at night send a text to your boss in the morning that you had to take the child to hospital and seek his understanding and assure him you will make up the time you were away, and you are seen as responsible. If you go do whatever you want to do which is important and then get back to office without any explanation or you don’t look bothered. Then if you have a female boss and she talks people would say women are their own enemies but if a male boss talks they would say well he is just correcting me so we have to watch out attitudes as women and know that we do the best we can within the work place. I am a woman and I have risen quite high within this sector and I feel that putting the effort into our work is so key because there are so many women who are high up now and are doing well.
Do you think healthcare has improved in the areas you knew were lagging behind?
When I was in Benue and Taraba, I noticed there were very few Doctors and Nurses and most of the healthcare providers were either community health extension workers or some people who we called ward attendants who had been trained under the missionaries and some could even do some form of operations and you would be surprised they could do CS because there was nobody else to do it and the woman needs care and cannot afford to go to Gboko or Jalingo were she would get care though some go all the way to Yola to get care. Those ward attendants could do operations for hyena, CS, etc but if there was something wrong they didn’t know what to do next because they were not medically trained but only trained to do operations.
Overtime, though slowly but surely things have begin to improve in the country, for example a place like Gombe state over the past 4 or 5 years more women are delivering in health facilities like we had 17% in 2008 now it is about 35%, HIV prevalence is dropping slowly but surely, there is also a drop in some statistics of maternal mortality. Some other indices are not rising very fast like the use of contraceptive method surprisingly have not gone up though government is giving a lot of funds into it, and I also feel there is a new epidemics ahead for example there is the cancer epidemic. Every time I hear someone say my parents or brother or an adult close to 50-60 died, I realized it is due to a form of cancer so, our health system currently is not quite prepared for that new range of diseases. We have increased our knowledge on communicable diseases but the non- communicable diseases like diabetes, cardiovascular diseases, stroke, hypertension, cancer etc the health system is not quite ready, as the country is getting richer, more of those lifestyle type disease are coming up and it is important that government and NGO’s like the one I work in and even people begin to prepare themselves for how to prevent this.
How can these diseases be prevented?
In SFH we are currently implementing a project called cervical cancer screening and preventative therapy funded by the guild’s foundation. That project for example is encouraging women between age 30-39 to come for screening, if every woman in Nigeria screens herself in a hospital or facility for cervical cancer every two years, any cervical cancer cells that may want to become a terrible disease would be found early, she can receive treatment so it doesn’t prolong to cervical cancer, thesame thing with breast cancer if women do mammograms regularly like every 2 or 5 years depending on whether there is a family history of it in the person then it can be found early and be removed before it becomes the terrible breast cancer that we see on women these days.
If government also decides that every girl child between 9 and 13 is immunized against cervical cancer like is done in other countries there would be almost no cervical cancer at all for us to scream for so, you see there are certain things that the health system can put in place to prevent a lot of these problems from occurring in the future and we definitely need to invest into those areas.
Why is government not taking these preventive measures?
I think the problem sometimes I see is that there are a lot of competing priorities, in Nigeria we are just getting a grasp of our HIV epidemic, we have just managed to eradicate guineaworm, we are trying to eradicate polio so we have all those communicable diseases we are trying to address through immunization, though putting the right health systems to place yet, the other diseases are upon us so unless we act wholistically and build up health systems that can manage any form of illness or can manage health promotion then we will have these problems. So, it is not that the government doesn’t know but the priorities are so many that they find themselves working in many areas. Government has to develop the health system wholistically so that thesame primary healthcare centre can immunize a child, can screen women and men for cancer, can manage both communicable and non communicable diseases, can manage hypertension before it becomes a stroke because the burden of managing someone who is just hypertensive is more than someone who has stroke, amongst others. So unless we build the primary healthcare system correctly, there is no way we can manage the challenges ahead of the country in the area of health.
Do you think Nigerian health based NGO’s are meeting expectations?
I think it has mainly been the NGO’s over the last few years and certain Foundations or Professional groups like doctors, that has been talking about hypertension or cardiac disease or for example the Kanu heart foundation and I also hear that the first lady takes children with heart problems to india for treatment so, it has been only the NGO’s foundations, etc that has done something around non-communicable diseases in the country.
The challenges with the federal ministry includes probably financing so for example screening and catching these cancers early is something that should be done at the primary healthcare level and doesn’t necessarily have to jump to the federal ministry of health but I noticed that everybody expects it from the federal level but a lot more can be done at the local government and state levels where people are closer to the government. I feel the NGO’s have been trying as much as they can and they are only there to support where government is not supporting yet, an NGO cannot do so much as they would like to without a supportive government structure.
Is the call for 50% affirmative action achievable?
Like I said, women are 50% of the population why shouldn’t we have 50% of electoral and appointive offices because that forms 50%. Before I can understand why it was difficult was because less women were educated but now many women go to school, even in some part of the country less men go to school than women and of course even in the north where women were less like to go to school than men so I don’t see why we can’t get 50%. Now that we are close to getting 35% if we stop at 35 we will never attain 50 so its just we set targets for ourselves in the NG0 atimes you get close to the target but unless you move it you won’t go close.
How would you describe the level of maternal mortality?
I think its unacceptable and I think its something that can be addressed with easy quick interventions if government and NG0’s wants to do them. There are certain things that can be done to reduce maternal mortality at the local government level for example, if emergency transport schemes are arranged to take women from their home to the health facility without them having to search around for transportation that would solve a lot of the problems that are around what we called the ‘second delay’. The second delay is that which takes place from when people say they need to get to the hospital and when they can get to the hospital. A lot of the northern states are trying to put that in place but we need to make it go round the whole local government and I think that is a key role that local governments can play. Providing midwives at local government primary healthcare centres would solve a lot of the problems we have with unskilled people taking deliveries which makes mothers end up with bleeding.
Also training Traditional Birth Attendants (TBA’s) that if you have a mother because they know who is pregnant in their communities, they can escort those women from there homes to the health facility when she is close to delivery rather than them taking the deliveries, they can escort those women to the hospitals and then local government pays them transport for bringing the women to the hospital. There are some basic provisions that can be provided within the health facility for the staffing and of course basic drugs that can prevent women from bleeding and dying of heamorage during labour is cheap and if is is available in the facility and given to TBA’s as well, those TBA’s can give the woman instead of allowing her bleed to death.
Again at the community levels, every woman should deliver in the hospital at her first pregnancy because first deliveries always has problem. If there is a law backing this and traditional rulers are involved in this, maternal mortality will drastically reduce.
Since local governments complain of not having autonomy, can these issues you raised be solved by them?
The health bill was recently signed by the senate and is going to the house of reps, what I believe is that is this bill is accented to by the President, there is going to be reasonable funds within the system a lot can be achieved. It is not about having autonomy, it’s about providing the funds to the local government for them to work and with that there is no way pregnant women from local government will end up in state facility, or SURE-P funded facility because there are too many women and this also applies to immunization, so the key is primary healthcare.
