Sunday, 13 April 2008
Prof Grange: Villain or Victim
by Chikwe Ihekweazu and Ike Anya.
Watching both AIT and the NTA's national network news (beamed around the world) on Friday the 11th of April brought extreme sadness to many in the health profession and to all those interested in the health of Nigerians. Prof. Adenike Grange, accomplished professor of paediatrics, president of the International Paediatrics Association and until recently Nigeria's Minister for Health was led to court to defend herself and 11 others on a 56-count charge of graft involving about N300 million (~$2.5m). She was denied bail and escorted by operatives of the Economics and Financial Crimes Commission (EFCC) back into detention. Face down behind dark glasses she must have been wondering how she got into this mess.
Her appointment in July 2007 brought hope to most of us Nigerians. For the first time in a long while a credible, obviously competent, apparently incorruptible Nigerian was appointed to look after the health of Nigerians. She had risen to the pinnacle of her career and was recognized as such by her peers, a most critical group. Like our president, she had obviously not sought this political position. The story was that a wife of one of the 2nd term Governors who was particularly influential in the emergence of the president had heard her speak at an international conference. Thrilled by the awe in which she was held by the international community, she and her husband eagerly nominated her following the unlikely emergence of President Yar'Adua.
At this point, our health indicators were as low as they have ever been. Nigeria's maternal mortality ratio (death during and around child birth), one of the most important indicators about population health had worsened from 704 to 800 deaths in 100,000 life births between 2000 and 2004, one of the lowest in the world. Epidemics of measles and meningitis have remained recurrent themes in Nigeria despite the existence of vaccines. Nigeria is still the biggest threat to the eradication of Polio. In addition, health services were in dire straits. A sitting vice president was flown abroad for a knee strain and the current president also had to undergo the minor inconvenience of a trip to Germany to treat "catarrh"….a good indication of their confidence in health services in Nigeria. South Africa became the favoured destination of Nigerians that could afford basic health care. What then was the fate of the average Nigerian? We celebrated the arrival of Professor Grange.
Listening to her at the Lancet Annual Lecture in 2007 she articulated her programme to an international audience. She identified her greatest challenges in achieving her goals as the divergence between policy formulation and implementation; the rigidity of the civil service; the challenges of managing a sector where the lines of management are poorly defined between the different tiers of government; a sector where the most crucial arm of health care delivery (primary health care) is in the weakest arm of government (Local Government); and a low consumer awareness of what to expect and demand in terms of their health. So it was a breath of fresh air when the honourable Minister declared that:
How did this dream fall apart? The charges against the minister are mostly in the public domain. A "whistle blower" in the ministry, a civil servant, not satisfied after being "cheated" in the sharing of an unofficial Christmas bonus in the ministry was said to have leaked information to the EFCC. To further complicate matters, the money was part of the funds from the 2007 budget for which there was an explicit presidential order to return all unspent funds to the central treasury. Prof Grange is reported by the press to have admitted signing off on the payments as was submitted to her by civil servants in her ministry, without understanding the implications thereof. She has maintained that she knew nothing about the use to which the funds were put until they appeared on the pages of newspapers and insists that she has not benefited personally from the funds. The matter is in court and it is up to the judiciary to sieve through the evidence and assign blame, but we seek to discuss the wider implications of this to the anti-corruption campaign of the present administration.
Unlike in any previous corruption allegation in Nigeria, the consensus of most Nigerians, individually and in collective bodies has been one of sympathy to the travails of Prof. Grange; sympathy at her apparent naivety in the ultra-corrupt terrain of the Nigerian civil service. Sympathy that she is paying a price for not being good enough at "the game" and trusting her subordinates to be bound by the same principles that she is bound by. This naivety has cost her dearly, and maybe cost us even more.
Part of the disputed funds was allegedly used to fund a retreat by the Committee on Health of the Senate of the Federal Republic. One would wonder the Ministry's rationale in funding this? The senate has been sitting on "The National Health Bill" for close to over three years. The importance of the bill is thus: The most critical aspect of health care delivery; primary health care is left in the arms of the weakest part of governance in Nigeria: the Local Government. Prof. Grange was desperate to get this bill passed and has argued severally that for things to move forward we need to address this legislative dilemma. To quote her;
"....the absence of a National Health Act to back up the National Health Policy has been a fundamental weakness which needed to be tackled frontally. This weakness means that there is no health legislation describing the national health system and defining the roles and responsibilities of the three tiers of government and other stakeholders in the system. This has led to confusion, duplication of functions and sometimes lapses in the performance of essential public health functions"
Now, Grange is in detention, the senate committee is being scrutinised, the health bill is in limbo and the health of Nigerians remains unchanged.
Yes in detention! Her application for bail was rejected. A strange decision, considering that many of our beloved ex-governors who looted the state treasuries with impunity seem to simply appear in court, get bail and go ahead to continue openly displaying the windfall of their time in "service" with effrontery. Of course these ex-governors "have" the resources to rent crowds to come and "express their solidarity". Our chiefs and traditional rulers travel to Abuja to plead their cases. Pages of newspapers are filled by write-ups of "concerned citizens" arguing about their righteousness. The present governors are in the majority their puppets and the state machinery is not spared in protecting their interests. What risks would be posed to the public by releasing Professor Grange?
There is no disguising the fact that Prof Grange made huge errors in judgment. By not giving the activities in her ministry the scrutiny it deserves, by letting these things happen under her watch, by not taking charge of affairs and allowing business-as-usual" she missed a huge opportunity for charting the course of the Ministry of Health. In politics the buck ends on her table. We all read about the authority with which Ngozi Okonjo Iweala changed the culture of both the Ministries of Finance and that of External Affairs, we expected nothing less from Prof. Grange. Her constituencies among Nigerian health care professionals, academics and technocrats and most importantly women will feel particularly sad at this lost opportunity.
However, Prof Grange is definitely not the epitome of corruption she is being made out to be. She is not. While we see and agree with the importance of the statement being made by her trial, we hope that she is not being made a scape-goat, an easy target for the political establishment. It is also pertinent to ask whether the Ministry of Health was the only Ministry that did not return unspent funds to the Treasury. Were others more adept at covering their tracks? While this does not excuse any failings, a thorough investigation should be carried out and the systems of financial control in place in all the ministries will need to be reviewed- if genuine reform and progress is to be made. We watch the trial with one eye on all the other trials.
But ultimately we hope that the vacuum in the leadership of the Ministry of Health does not last too long. This ministry is too crucial to be managed s a secondary department by another minister. It is desperately in need of focused leadership. There is too much at stake.