…says Foundation spends N250m on health, other interventions in Nigeria yearly
Can you imagine the earth without the malaria scourge? Dr Mairo Mandara, Country representative, Bill and Melinda Gates Foundation in Nigeria believes this is achievable. In an interaction with select journalists in Abuja recently, Dr, Mandara disclosed that the Foundation is already working with researchers towards the elimination of malaria and she believes this will happen after polio. Dr. Mandara also disclosed that Nigeria and other countries that depend on ready-to-use therapeutic food, RUTF, to tackle their malnutrition burdens may be running into trouble as the product is currently scarce in global markets Our Abuja Bureau Chief ‘Tayo Albert, brings you other details of the media interaction.
Within the 10 years of Bill and Melinda Gates Foundation interventions in Nigeria, what would you say has been the organization’s biggest success?
Basically, the Bill and Melinda Gates Foundation was established on the premise that all lives have equal value, because we believe all lives have equal value. We believe that every human being is entitled to live a healthy and dignified life. Everybody who is unable to do that, we believe we should try hard, not just Gates Foundation, we all, as human beings, have the responsibility to ensure that everybody live a productive life. It is in this vein that the Gates Foundation looks at itself and said with monies made from Mr. Gates and also endowment from Warren Buffett, we said, where is it that we have comparative advantage? We can actually leapfrog, we can make impact.
Initially, when the Foundation started, we had fantastic researchers, the best in the world. We still have fantastic researchers, the best in the world. We looked at countries that had the biggest challenges in the world through research. We funded a lot of research; we are still funding a lot of research on how to stop malaria. We want to stop malaria from the earth. Can you imagine an earth where there is no malaria? We believe it is doable. When we talked about a world where there is no polio, people thought Mr Gates was joking. But, now, we have only three countries in the world, Afghanistan, Pakistan and Nigeria. And, Nigeria is almost there, but for the insurgency of Boko Haram, where we have pocket of cases of children that were not immunized.
We are going to eradicate polio. After we eradicate polio, we are going after malaria. Can you imagine everybody saying forever no malaria? Those are the kinds of big targets we are putting up. In Nigeria, our biggest investment has been in polio eradication. We’ve strengthened routine immunization. Immunization because we believe that no child should die because of preventable diseases; every disease that we have vaccine for, every child should be immunized. No child should die of meningitis; no child should die of whooping cough. These are diseases that in other parts of the world, they’ve been taken care of. So, we are investing heavily on immunization of children.
We are also investing in ensuring that as many mothers as possible have essential maternal newborn and child health. What has happened is that we ask what are other people doing, for example in child health? Everybody is looking at children one year up to five years. But, a lot of deaths happen in the first 40 days of child’s life. In fact, the most crucial is the first 24 hours. So, we just decided to be best in that to see how we could contain that. So, we look at all the data, the statistics to see where is it we can invest and see high impacts? So, this is what we do.
In addition to maternal child health, we also work to support families to make decisions about the family they want to have. When husbands and wives decide they want to space their children, they should be able to go and get family planning. If they decide they want to have children, they should be free to go and have children. So, we are encouraging responsible parenthood so that women, families have children they can cater for, children that are well-spaced.
We also invest in nutrition in partnership with the Dangote Foundation. We are investing in nutrition to make sure that the most critical portions of a person’s life are taken care of. What is most important in the lives of all of us is the first 1000 days of our lives. That is after our parents gave birth to us; the first 1000 days is when our brain cells develop. That is when we either decide to become a cleaner or a genius. That is when the decision on whether you will become a cleaner or a professor is made. The functions of your brain take place in those first 1000 days. That is where we are investing.
In addition to nutrition, we believe that life is not just health. Life is about livelihood as well. Most of the rural communities in Nigeria depend on agriculture. So, we support agriculture. And, in Agriculture, our focus is the group of people we call small-holder farmers – people who just produce a little to only survive. So, our theory of change is that if you support all these farmers who are in the majority of rural farmers with good seeds, good fertilizer, good understanding of soil, wheat, insecticides, make sure that they have the best yield, and then lead them up to market, you support the whole value chain. Instead of making N20,000 at the end of the season, they will get N100,000. So, they will get value for their work.
The second is that in addition to them getting value for their hard work, you are also teaching them how to cultivate the most appropriate crops. So, we encourage mixed farming.
You have donated so much to various non-governmental organizations and institutions of government in Nigeria for health care services, how have you ensured that your monies are being judiciously spent?
For the grants that we give, we have systems of checks and balances. Actually, some of the people, we use group like KPMG, they are the people that run after NGO that we work with; they audit them and give them reports. If we find any NGO wanting, we ask them to give us our money back straight. If they don’t, we take them to court. We have very stringent systems.
Have you had any case where you requested for your money from recipient MDAs or NGOs over theft or misappropriation?
We proudly say that since our existence in Nigeria, we haven’t seen any case where we have to ask people to give us back our money or even take them to court. I am sure, everybody knows our systems.
How do you determine the funds that go into countries where you work?
The way we work is this: we don’t wake up and say Nigeria should be given $100 million. No. we do baseline. We look at what the needs are. It is the need that determines what the amounts are. For example, this year, we signed a health MoU with Kano. We are doing primary health care in Kaduna, we are doing a lot of agriculture in Ibadan, with IITA. In Lagos, we are doing financial inclusion. So, we know what we are going to do. Amount of money we are going to put on that will be determined by what is needed.
There is no fixed amount. On the average, for all the works we do, when we started about five years, we spent approximately N35 million per year. But, now, we spend about N250 million per year. Every six months, we give a report of how much we have spent to Ministry of Budget and National Planning.
Every six months, I signed, we deliver to them, and we put it in their system, which is open, which you can access from Budget and National Planning (website) You can see all the dollars, how much they have put in the country. and, it has been captured in the system. I recently signed the last one in January. In June, we are going to do another one.
From what you’ve said, it seems the Gates Foundation has no commitment for the nation’s education sector. Is there any support or plan for the enormous challenges facing the sector in the country?
Globally, we do a lot of education in the US. We do education in the US for the underserved communities. We also do what we call college-ready which is a programme where you look at children from underprivileged communities and give them intensive remedial to ensure they are ready to go to college…Before we do anything, we do analysis, we have to analyze, we need to have data. As I talk with you, we are doing a study on education to see whether we are needed there. Even if there is a need, do we have the best people to meet such need?
What are the criteria for selecting the states you work with? It seems most of your interventions in Nigeria occur in the North. Why?
No. May be it is because people see us working on polio. Polio is a northern nuisance. I don’t think anybody wants us to go and work on polio in their states; polio is a menace. Because people see us working on polio, and we are very active with polio, people think we are in the north. How do we select our states? The selection of our states for health, we look at the number of criteria. Three years ago, we were in 25 states and the FCT. We decided that we are all over the place. We don’t have enough money. We need to be focused on a few states and have impacts. While we demonstrate we can make impacts, we can make impacts. Then, we can expand to other states.
So, we went through rigorous analysis. One of the key things that we take care of is that the main thrust of people that we care for are people who live below one or two dollars a day; the poorest of the poor is our constituency. So, what is the highest burden of the poorest of the poor in Nigeria? Where do you have the poorest people? Where do you have the worst health indicator? You can look at your demographic health survey, where do you have the poorest unqualified people? Kano, Lagos, Kaduna, because of the population. We selected those to start with. And, for us, these are the key most populous. If we are able to saturate, we make a big stride in Nigeria.
But, mind you, this is just health. When we look at agriculture, in agriculture, we work along certain value chains. For example, rice; we do a lot of research. We do a lot of work in cassava. A lot of these of these researches are in IITA, Ibadan. It is not true that we only work in northern Nigeria. Once we eradicate polio, then that notion will disappear. Then, we won’t have to focus on polio affected areas.
Q: In what area have you made the greatest investment?
Our greatest investment is stopping children dying unnecessarily because of preventable diseases. Children in America and the UK and in other countries like Ghana and Rwanda don’t die because of meningitis. We invest in the production of those vaccines. We buy those vaccines, we pay for those vaccines to be brought so that these children will be vaccinated and that they don’t die.
In the next five to ten years, especially in the area of family health, where do you want to see Nigeria?
In the next five years, our hope is that we see a Nigeria where the people of Nigeria are taking the bid in sorting out their health systems, and all donors and international communities are supporting them. That is the only thing that is sustainable. We want to see a situation where everybody, regardless of where you live in the country, you are able to get basic health care services. Universal health coverage for all, this is our dream. I am sure that Nigeria can do it.
With the present budgets for health, do you think Nigeria can get to that height?
It all depends on you journalists, quite frankly, and other Nigerians. The Abuja commitment which is a commitment that all countries in Africa made to put at least 15 of their budgets to health was done here. What we hope is that you will be vanguards to push government to make sure that 15 percent of their budget goes to health.
So much is spent on importation of ready-to-use therapeutic food, RUTF, in Nigeria, with the argument that the country’s groundnuts have aflatoxins. Do we continue this way?
This is a question for the business community in Nigeria. I cannot believe, right now, you are understating it. RUTF is actually out of stock; people are looking for it to buy. I also cannot understand why business people in Nigeria will not invest in producing RUTF. I was just in Lagos; I saw one that was being made around Ikeja by one small group. But, their capacity is very small. Dansa is trying to establish one around Calabar. Why will Nigeria business community not invest (in RUTF) We (Bill Gates Foundation) don’t come to Nigeria to make money. But, if there are companies that make good business sense, they could invest. It is a shame that business people are not catching on that.
The second is that the level of aflatoxin can be controlled. Aflatoxins in groundnuts cause cancer of the liver. So, it is very serious. It is a mould. It a product of temperature and wetness, how you store it…Aflatoxins are not like when the groundnuts are coming, it is the process of storage. We have enough groundnuts in this country.