Patitos Post

Chairman of Council and Pro Chancellor

Of the University of Lagos

Vice – Chancellor

Provost of the College of Medicine

And Esteem Faculty of College

Very Distinguished Guests

Ladies and Gentlemen.

HEALTH AND THE WEALTH OF NATIONS AND THE CHALLENGE OF NATION BUILDING

I must begin with thanking the organizing Committee of the Professor Felix Dosekun Lecture Series, first for the thoroughness of their effort and then for finding me worthy to join the fraternity of those who have delivered this lecture in honour of an outstanding intellectual and statesman.

I do also want to place on record my appreciation of the College of Medicine for instituting this lecture series to immortalize a great pioneer, intellectual and statesman. I am actively engaged in trying to get people to pause and reflect on what constitutes a meaningful life in the midst of an extant culture of “My Mercedes is bigger than yours” and honour such as this does more to validate a meaningful life than the preaching of a thousand Pastors. With this lecture the College confers immortality on Professor Dosekun.

In a 1991 interview I had said that man’s purpose was the pursuit of immortality. I acknowledged two forms, material immortality – to live in the consciousness of men long after flesh has taken its place as dust like Shakespeare and Einstein do, and spiritual immortality, which for people of faith, is to see God face to face. Most wise people, I suggested, seek both. This lecture certainly helps bring this to Professor Dosekun long after the biggest money bags of his time have faded from even the memories of relatives. We need such to encourage people to seek the meaningful life so l am very pleased that the College has turned to such to honour its best.

Let me also note how pleased I feel that I am the first FOD lecture speaker from outside the discipline of Medicine, and I understand, the first indeed, not to have sat in a class under the spell of this man of knowledge and practice.

I am also pleased that this lecture series is being now used, in addition to remembering a hero passed, to endow scholarships and other purpose of enhanced academic pursuit in his area. I enjoyed the privilege of endowing prices for students in Economics for several years at the Akoka Campus and was pleased to hear that the former Vice – Chancellor Prof Oye Ibidapo – Obe who handed out some of the prizes and the late Deen of Faculty Prof. C. S. Momoh spoke generously of that enterprise. I do hope my friends who are here today try to do me one better at the College of Medicine.

Let me return to the core subject of the day, health care and policy to ensure effective delivery of health care in Nigeria. A few years ago, I was invited to the Teaching Hospital of Bisi Onabanjo University in Shagamu. As speaker, I was preceded by a Professor from the College of Medicine here at the University of Lagos. He had left after the morning session but his comments continued to resonate when I arrived and was called up to the podium. He was said to have described the healthcare system in Nigeria as a “man-made” disaster. Drawing from this I wonder if images of the struggle against a natural disaster, the earthquake in Haiti would be appropriate metaphor for the state of health policy implementation in Nigeria.

If you consider the following you may come to the conclusion that we are dealing with a man-made disaster with worse consequences than Haiti is suffering from the flattening of Port au Prince by the Earthquake of January 2010.

On one evening a few weeks before the earthquake an executive I know was evacuating his mother – in- law to South Africa for a heart ailment. Of his own came the volunteering of the rather scandalous comment that four other air ambulance he knew of left Nigeria that day. The calculations we got that one month cost of these air ambulance services for the benefit of a few, could provide for a quality midsize hospital. I remarked that it was an irony that as we had that discussion the President of Nigeria was lying in a Saudi hospital an irony made more painful by the fact that a few years ago most Saudi hospitals were staffed by doctors from LUTH and other hospitals in Nigeria.

Why does the effect of collapse of health care be compare with the horrific nature of the Haiti disaster. Atrocious health care breeds poverty which is a bigger mass killer than earthquake and Tsunamis. Indeed human progress in these times is predicated significantly on human capital. There are two sides to human capital, education and health care. Until we can build up skills and the capacity to produce and have the skilled well enough to apply their talent and knowledge to development, society stagnates. The consequent deprivation can leave more widespread harm to human beings than the occasional natural disaster causes.

In my work I have offered a framework for understanding economic growth. Among the six critical sets of interdependent variables that result in growth is human capital. The others, Policy Choice, Institutions, Entrepreneurship, Culture, and Leadership share with Human Capital the vital transmission of human progress. In my 2006 book, “WHY NATION’S ARE POOR” I continue the tradition began in my 1998 book: “MANAGING UNCERTIAINTY: COMPETITION AND STRATEGY IN EMERGYING ECONOMIES” regarding the key role of institutions in advancing the goals of development. Sadly, institutions of health care provision have been subject to levels of neglect that made them the subject of coup day speeches in which hospitals were said to have declined to mere “Consulting Clinics”. They have come so far down that there is hardly enough power supply for basic services to be assured at Centres of Excellence such as our leading Teaching hospitals and can therefore be rightly described as a man made disaster.

If Nigeria is to be renewed and we are to go from the country of great promise that became paradise deferred but now on the track to paradise reclaimed we need some new sets of basic ideas that are implementable but fresh and refreshingly different. In the following discussion l offer a few of these ideas.

I do hope my comments will serve both as a source of productive impetus to debate, as well as a signal for policymakers whether in or outside office to encourage. Our public space is unfortunately benefit of quality discussion of such importance. To that end, I will make comments in a number of capacities, whose crossover points may not necessarily be immediately apparent. I will comment as a private citizen, self-interested personal and policy stakeholder, political leader, and finally, as a believer in the idea that entrepreneurial ideas, given sufficient heft by the appropriate business environment, can be a critical partner in solving many a seemingly difficult public policy question.

Given that context, now I believe it is best to start by stating up front that I am in full agreement with the broad theme recently emerging from the leadership of the Federal Ministry of Health. That message is that Nigeria’s healthcare industry is at a cross roads, and that the record of achievement from an outcomes perspective is poor. Thus, I cannot disagree with the Federal Government’s read of the situation. To that end, I will not inundate you with statistics such as how many Nigerians die every year from malaria. We all know the dimensions of the problem, though a number of you might be further jolted should we review the data in its bitter fullness. The Roll back Malaria Summit was one of the first health sector initiatives of the new Civilian Administration in 1999 because the Harvard Professor Jeffery Sach, author of the End of Poverty was on a crusade about how Malaria slows down economic growth in African. That influence remains in the concerns espoused by the Osotimen in Ministry of Health.

Where I part ways with the Honorable Federal Minister, however, is on how to solve the health challenge. It is my view that the current Yar’adua administration is approach is flawed in that it focuses on symptoms of the healthcare challenge, rather than structurally attacking the challenge. That policy logic is a continuation of the failure under the Obasanjo Administration. An illustration of that is the National Malaria control strategy which in my judgment overemphasizes the use of treated bed nets and donor funding, as opposed to seeking ways to use technology to eradicate the breeding grounds of the anopheles mosquito and the mosquito through a radical program of spraying as successfully deployed in South Africa in the past decade. The use of treated bed nets is a palliative that cannot substitute for a real end game strategy in malaria.

I made this point while speaking at a retreat for the Lagos State Ministry of the Environment two weeks ago. The old sanitary inspector role, the wole – wole factor remains the key. Involving the community in ensuring gutters are erected and drains flow is key.

I also hear platitudes about primary health care that is not supported by any clear strategy. As a young man courting a student here in Idi Araba 27 years ago, I recall that primary health care was the buzz of the neighbourhood, thanks to Professor Olukoye Ransome-Kuti. How much has the Federal Ministry of Health upheld the legacy of that former health Minister who was so influential as leading faculty on this campus back in those days?

Thus, today, I want to speak broadly about the healthcare system in Nigeria as opposed to a single therapeutic category or intervention, and my vision for transforming it. I believe that any change agenda in the healthcare space needs to be framed and executed on 2 dimensions: an efficiency and a strategic dimension.

Dimension 1: Pursue Efficiency Improvements to Reduce Cost per User

First, efficiency improvements are necessary to improve the productivity of current assets in the system ranging from skilled medical personnel to MRI machines to inventory of medication. Today, a great deal of waste exists in the system. It is pertinent to ask what percentage of the proposed US$1 billion 2010 federal healthcare budget will actually be spent on improving outcomes. What percentage of the budgets in the past 3, 5 and 10 years was actually spent improving the quality of patient lives for example, or investing in expanding the capability of medical personnel to heal? Was 25% wasted? It is hard to determine because we cannot analyze what we do not measure.

Today, waste comes from a variety of sources ranging from poor scheduling of physicians and pharmacists to poor management of patient records, leading to more benign situations in which the time spent achieving a specified patient outcome is materially higher than it should be. In the worst case, waste and inefficiency have led directly to the death of patients and the attendant destruction of family dreams and aspirations. It is important to underline that waste can also come from medical personnel and resources sitting idle during a strike, and as you all know, we seem to live constantly under the threat of a strike.

As professionals and stakeholders, our goal from an efficiency improvement view is to reduce such waste, and therefore, improve the output of the overall health system. That output can be measured in terms of absolute output e.g. number of patients successfully treated per physician, number of patients per physician man hour, or in terms of quality. In the latter category, we can track levels of patient satisfaction, with the goal being to do more at a lower price point each year i.e. boost overall productivity of the heath system. The overall message nonetheless, is that as a broad logic, we should aim to do more with the little we have. Increasing the productivity of labor, capital and technology assets is a necessity in order to systematically engineer improvements in patient lives.

Dimension 2: Develop and Execute a Strategy That Drives Change

In the longer term, what strategic initiatives will Nigeria need to pursue in order to change its healthcare system? Or put differently, what does Nigeria need to do in order to deliver a competitive healthcare system to her citizens? In my opinion, there are 4 critical strategic themes or organizing principles Nigeria needs to pursue in the coming decade. These are:

1. improving access to healthcare by expanding the healthcare infrastructure in the country

2. changing the funding mix and economics of healthcare by recognizing that a healthy society confers both private and public benefit

3. expanding the pool of healthcare personnel at the skilled and semi-skilled level

4. nurturing and creating a culture of innovation in all aspects of healthcare

Strategic Theme 1: Improve Access to Healthcare

We should work to improve access to healthcare to all our citizens. There are a number of dimensions to improving access. This includes access to primary, specialist and support medical staff. It also includes access to hospital facilities and support equipment on a timely basis. There are a variety of ways in which we can measure access levels and the quality of such access e.g. density of medical services per square kilometer, or distance traveled to reach a physician, or time between arrival and attendance in an emergency room.

With an aspiration to increase the density of medical staff, facilities and equipment, broadly defined on a per patient basis, we can now focus public policy discourse on how to achieve that. For example, the current policy with respect to the National Health Insurance System (NHIS) is designed to improve access for employees in the formal labor markets to healthcare, even though the capitation levels effectively work against access expansion. The recently announced Federal policy of sending physicians to the rural areas is also supposed to improve access to doctors by village communities.

My view is that we have to use a portfolio of incentives and flexible structures to improve access. From tax credits for builders of hospitals to innovation grants to physicians practices who create new treatment protocols to reviving the mobile medical services networks to allowing supermarkets such as Shoprite to place mini-clinics in their stores, we must be open minded about how we extend care and at what price point. Our goal is to keep per patient costs as low as possible and on a steady decline pathway after initial rise to reflect new capital investments, while ensuring that service is broadly available.

That may lead to a situation in which, should I find myself in government again, I would argue for loosening some of the cost restrictions and capitations in the NHIS regulation. We have to make healthcare delivery both financial attractive to certain types of investors, as well as affordable to patients. We should also discuss ways in which macroeconomic policy that reduces the cost of capital due to a shift in long term inflation expectations can spur an expansion in investor willing to invest in the healthcare sector from hospitals to MRI centers to pharmacies.

Strategic Theme 2: Change the Funding Mix

Healthcare is a good with both private and public benefits. A healthy work force benefits the individual as well as society at large. To that extent, we all have a clear stake in transforming the funding of healthcare. Today, what we have is a weak system of funding. At one end are informal sector works such as mechanics enrolled in subsidized health insurance programs, or with no coverage at all. We estimate that about 80 million Nigerians are in this category. At the other end are private employees of formal sector companies who can afford to pay for the services of private networks such as CRI/UNIC and Hygeia. In between are public servants who rely on the new HMO system as well as public and private hospitals. These latter groups make up another 50 - 60 million citizens. What is clear is that the majority of Nigerian’s are not happy about their options and want a policy that comprehensively redesigns the funding and use of healthcare system.

It is my view that the NHIS system regulations need to be revisited in order to spur investment; current cost caps are not working i.e. we cannot ration our way out of the problem. A revised policy whether housed in the NHIS system or another system should seek to create a public health insurance option that exists side by side with competitive private options, with health insurance liberated from employer focused plans. The individual should be able to buy insurance at a competitive price including for pre-existing conditions, with the Federal Government providing a backstop funding support especially for catastrophic cases. That way, the general risk pool is not distorted and insurance costs will remain competitively priced for the majority of Nigerian citizens. I anticipate that as policy and the enabling law is rethought, new financing initiatives will emerge that seek to leverage a broad balance of private capital and focused public funding to make sure Nigeria’s 140 million citizens are covered.

I have on previous occasions proposed a community-based cooperative society health insurance scheme that can broaden access to the poorest of the poor at the bottom of the pyramid on a care for profit basis. What it takes is thinking out of the box like most bottoms of the pyramid schemes

Strategic Theme 3: Expanding Healthcare Personnel

To create broad based access for all citizens in rural and urban areas, it is critical that we develop a rich portfolio of clinics, hospitals, specialized health centers and laboratory services. Achieving that will require a revision of certain existing regulations related to the establishment of hospitals, pharmacies and specialized support services.

We believe that the rules will need to be rewritten to allow all classes of medical and support personnel to maintain within clear ethical guidelines, private practices and offices. Doctors and laboratory technicians, for example will be allowed to maintain their own businesses and practices in addition to their current day jobs as physicians at a teaching hospital. The key word in all of this is incentives. We need to use a new system of incentives to align private profit and public good, while more efficiently managing risk and reward tradeoffs.

It is also important that the thousands of Nigerian healthcare professionals who have left the country return. Even if we are successful in attracting only 25% of the broad pool of medical personnel who left since 1985, the impact would be material for Nigeria. I anticipate that such personnel will return with some capital as well as their wealth of world class experience and insight, and equally as important, relationship networks. That should lead to a blossoming of medical personnel access across the republic. I anticipate that as proposed changes in healthcare financing, insurance and support for entrepreneurial innovation occurs in parallel, access whether through traditional one-to-one visits, or new telemedicine platforms, will improve.

Finally, in parallel, we should review the pre-existing sector reviews and recommendations regarding the training of new healthcare personnel from lab workers to pharmacists to radiologists to surgeons and nurses. Many a federal committee has provided an expert view of the changes and reforms required, but little in the way of implementation has occurred. I recommend we review such counsel with an eye to amending as appropriate given today’s context and the need to use more entrepreneurial incentive mechanism to shift behavior. In addition, it is critical that we create new forecasts of our need for personnel, and redirect public and private funds to prepare for such a future. I commend the Universities Commission for its stance on boosting private university licensing; such a mindset should be more broadly followed as the population requiring care is likely to further expand in the next 20 years.

Strategic Theme 4: Building a Culture of Innovation

Beyond the interventions to solve the basic access, payment and network issues lie the longer term, and ultimately, less structured realm of innovation. It is important to understand that innovation driven by both basic and clever research is what lies at the heart of the global healthcare system.

An initial basic innovation I believe Nigeria needs is creation of electronic patient records and treatment management system. Such records are in many respects an efficiency gain, but given our context may be treated as an innovation. The records should be in a secure database that authorized physicians and other healthcare workers can have access to. Combined with a regulatory ruling requiring only prescriptions for certain categories of medication for example, patient safety and well being will be enhanced irrespective of the patient’s location in Nigeria. Creating the records will also give Nigeria better access to health intelligence as well as create the data to drive innovations in patient management e.g. wellness programs.

In the medium to longer term, our focus should be on encouraging the types of innovation that will create jobs and wealth in Nigeria. A review of most global patent databases show that Nigeria is not considered an innovative nation. The culture of R&D designed to advance the frontiers of knowledge, and create new wealth is sorely lacking. Or where such R&D exists, such as we often find in long forgotten federal institutes and labs, it is simply ignored by the government, nor is it backed by venture capital due to a broad environment that has failed to link ideas and commercialization in our institutions of higher learning. We now need to urgently inspire a generation of scientists and risk takers to once more try to break the code on sickle cell disease, as well as stake their claim in gene based therapies.

We also need to enthusiastically work to own the R&D frontiers on a range of tropical ailments, as well as the process of disease management and patient treatment from computerized patient databases to social support and counseling networks. A critical element of our shared future is the ability to deploy existing knowledge as well as create new knowledge. Much of the diseases and concerns Nigerians have such as cholera, malaria, river blindness etc do not receive sufficient attention. We need to transform our funding of such so called orphan diseases, and profit as a society materially and spiritually from such work.

By championing innovation and the network of innovators whether in small research labs and corporations, or giant medical conglomerates, Nigeria will be helping invent a future for some of her most talented citizen’s, as well as simply keep them alive! I propose that the Federal Government, through a risk based funding system that aligns the national research objectives with the capabilities of Nigerian institutions, should start offering “Health Challenge Grants.” These should be competitive grants that cover both the needs for capital equipment and funding of personnel on specific diseases.

It is important that such funds also be available to research-focused healthcare start-ups and universities as venture funding for well-designed initiatives to commercialize research. American universities from Stanford to Georgia Tech to Chicago have done an excellent job of licensing technology or spinning them off; we should allow Nigerian researchers to have part ownership in their own inventions so that risk and reward are appropriately aligned, with specialized university technology development corporations focused on licensing these technologies, or professors allowed to go and start new ventures to bring new drugs and technologies to market.

I propose the need for a new and creative approach to commercialization of such knowledge. The Federal government should grant the researcher and host university or corporation a right to use the findings of the research for example in drug creation on an exclusive basis for 20 years, provided clear guidelines on investment into commercialization are met. In return, the Federal government will have an irrevocable right to 10%-20% of the profits generated from the sales of any drugs or non-drug innovation emerging from such labs e.g. a new database system for managing patient records using mobile phone systems. Only by unleashing the energies of Nigeria’s most talented and diligent can we start to surmount a number of our public policy challenges.

Conclusion

Today, Nigeria seems unhealthy and frail at many levels. A cursory review of her health statistics from the state, local and federal levels show that much remains to be done. Mortality levels are at unacceptably and morally shameful levels. Yet, the will to act seems missing, despite ever growing budgetary commitments to the sector. I believe that what is missing is an integrated view that places at its heart, a system of ideas anchored around individual themes of improving productivity, and leveraging a willingness to embrace risk as a step towards transformation. Only by bringing new ideas into the public space for healthcare interventions can we address the needs of Nigerians, while using the space as a platform for promoting entrepreneurship, risk taking and double balance scorecard initiatives. I urge all stakeholders to embrace the idea of incentives, ideas and entrepreneurial insight to drive the transformation we all want in the healthcare market. It has been my distinct pleasure to join you today and I do hope that you will join me in pushing for a transformative agenda that rewards solutions not the rhetoric of change.

Thank you.

Patrick Okedinachi Utomi

January 27^th, 2010

I want to seize this opportunity to thank my dear friend Reno Omokri, who organized a relief effort for the people of Haiti as a result of the call I made on my facebook profile. The relief materials were airlifted today and should reach its recipients soon. I also want to thank others who joined this effort. From the bottom of my heart I say thank you!

I wrote this article several months ago to warn those currently in power of the need to be proactive and act on the past reports of the previous probes on the Jos and other ethnic/religious crises. The reason we have these issues is not because we do not know the problem, rather it is because we have not had the political will to fix the known problems. Below is a reproduction of my appeal to the authorities.

PU.

It has been said that those who do not learn from history are condemned to repeat it. This is particularly true of the Nigerian situation. We as a people have been so caught up in the rat race of survival that we have failed to take any notice of the regular recurrence of ethnic and religious crises in the country. Some have even become used to these clashes and have accepted it as a way of life. But the truth is that most if not all of these clashes are avoidable if we will only learn the lessons from the last one. But alas, our attitude is to heave a sigh of relief as soon as the crisis is contained and make some noise in the media, then forget about it after blaming it on one or two scapegoat individuals and proceed to move on with our lives as if nothing happened. Until the next crisis.

However, if we had only taken some time to reflect on the last crisis, we would have learnt lessons that would affect our behaviour and prevent the next crisis. But time and again, our leadership has shown that it has not the consistency to sustain the the process of resolving the remote and not so remote causes of these crises.

Now for instance, it would be recalled that that there was a religious/Ethnic crisis in Kaduna in 2000, and that as a result of that crisis the government set up a commission of inquiry to determine the causes of that crisis and prevent a re occurrence. However if you recall, little or nothing was done to implement that report of this commission and most importantly those behind the crisis were never unmasked nor punished and I vividly recall one of the members of that commission stating that if the previous report of the commission of inquiry that looked into the Zangon Kataf crisis in the 80s had been implemented, it would have likely prevented the Kaduna crisis. You would expect that this type of talk would lead to some proactive action, but then we had the Jos crisis soon after.

Now Jos used to be a city known for its serene atmosphere and everyone was caught off guard by the crisis that enveloped Jos in 2001. However, when the crisis re occurred with greater casualties in 2004, the government should have had some inbuilt mechanism geared towards containing the crisis. Well the government did not and so set up another commission of inquiry to again look into the causes of that crisis. Now what steps did the government take to avoid a re occurrence of that crisis? The commission’s recommendations were again swept under the carpet and then it happened again!

This time in 2008 the orgy of violence was even worse. More people died during this crisis than the two previous crisis put together, but the most painful thing is that again this crisis was foreseeable and preventable if the government had simply implemented the recommendations from previous panels of inquiry.

But what was even worse is the amount of politics engaged in by the Federal and state government after the Jos crisis, the dilly dallying and the parallel commissions set up. What we failed to understand is that some things should be beyond politics and as the elder brother the Federal Government has to show the way by leading by example and putting national interest before politics in matters such as these.

If we had done this, then perhaps the most recent crisis, the deadly ‘boko haram‘ crisis would not have happened. But happen it did and once again Nigeria was portrayed to the outside world as a nation in turmoil with potential foreign investors watching on TV the orgy of violence as human beings were beheaded, hacked to pieces in the most barbaric manner and thinking to themselves that this could be me if I go there to invest!

So now that we have contained this latest crisis, what happens? So now what? Again, so now what?

Do we heave a sigh of relief and carry on as before and say it was all Mohammed Yusuf’s fault? Or do we do the proper thing and carry out a proper post mortem of the crisis? I am not talking about another window dressing ‘panel of inquiry’ which would again be swept under the carpet like its predecessors. No! I am talking about a fact finding effort, geared towards a level headed and sober investigation into the causes of the crisis and most important to suggest ways that MUST be implemented so that we do not have a re occurrence.

Poverty is at the root of these crises. People are feeling the pressure and the rat race is taking its toll on the masses and on top of this resources are dwindling bringing out the worst in human nature. All these may perhaps be bearable, but what is unbearable is that in the midst of such grinding poverty, with people living in sqaulor, we have a political class that is so unashamedly engaged in squandermania and an opulent lifestyle as if taunting the masses and telling them that they are in some way sub human. Little effort is made at improving the standard of life of the masses. Health care, education and power are at an abysmally poor state, while our elite access health care overseas, school themselves and also school their kids abroad and escape from darkness with generators.

It is this type of environment that empowers a Mohammed Yusuf and provides him with the arsenal to mislead desperately poor people into following his movement and engaging in acts of violence as they did. It is easy to convince an illiterate that since we did not have this level of corruption when we were not so Westernized, it must be that Western education is at the root of the corruption, so we must do away with it via bloodshed.

And what is the solution? Is the solution to be found in unleashing soldiers and police to crush these folk? No! That is a reaction and it is acceptable as an emergency measure, but afterwards we need to ease the burdens of the masses and remove some of the pressures they face by a heavy and sustained investment in social services . When we do this, we will find that we are not so vulnerable to these crisis. If we invest in education and have schools that are always in session and not on strike and we implement a compulsory and comprehensive education nation wide, youths who are usually used in these crisis would have better things to occupy their minds. If we invest in power, we will see a dramatic, steady and sustained rise in small and medium scale enterprises and the economy will start to expand and when people are at work, they will have little time to take offense at miss world pageants, newspaper articles, settlers and such like.

But perhaps most importantly if we have a political elite that is more responive to the people. That is able to curb some of its opulence. That can be less thieving and more service oriented and that is headed by a true ’servant leader’ who models behaviour for the masses to emulate, we will have a public that is well behaved, investor friendly and at peace with themselves and their neighbours.

Politicians can not keep having 300 million naira weddings, multi-million naira wedding anniversary bashes, long convoys of cars that regularly get involved in fatal crashes killing hapless pedestrians and multiple guest houses maintained at public expense. We can not be having a multi billion FIFA fiesta when we have majority of our population living on less than a dollar a day. We can not spend 523 billion naira on a legislature that has produced only 523 laws that have had little impact in bringing the people out of poverty. We would have to remember that society is like a pyramid and the top flows down. Very important it is to remember that fish starts to get rotten from the head.

Also, we can not expect to take the lid of the pressure cooker that Nigerians are living in if we do not tackle the issue of free and fair elections. We need to allow people freely choose their own leaders. Leaders can not have genuine influence over their people if they are imposed on them. This is why we continue to see this disconnect between the leadership and the led were the led are suffering from crumbling social infrastructure and the leaders are accessing their social services (health care, education, banking, insurance) abroad. We need to implement the Justice Uwais Electoral Reform Committee’s recommendations chief of which is that the board and head of the INEC should not be appointed by the president but by the National Judicial Commission.

As it is with these crises, so it is with almost every aspect of our national life. In sports for instance, we perform woefully at a football, basket ball or volley ball tournament, or an Olympic games and the national mood is one of sadness. Everyone complains, but very soon, we forget about the let down and go about our normal activities and then the next tournament or Olympic games are around the corner and we start our usual ‘fire brigade’ preparations, always in crisis mode.

This is the same approach we took in the Niger Delta and now we have a full blown insurgency where we could have nipped this problem in the bud back in the 80s and 90s. We can not afford to have more Niger Delta crises around Nigeria.

Life is just like a farm, we can not plant a seed and refuse to water it, and go and play and make merry and just a few weeks to harvest time we come and start making hasty preparations, watering and manuring the crop at a time when it is too late to expect any yield from a farm that has been neglected for sooooooo long.

In closing I say to Nigeria’s current leaders that they have two choices. They can have a sober reflection on the ‘boko haram’ crisis and then do something tangible to address the causes of this incidence or they can bury their heads in the sand like the Ostrich ‘until the next crisis’.

Once again, God bless Nigeria.

PU

PS: This blog piece was published on my blog www.patitospost.com, two days before reports of the recent shiite protest/clashes in Kaduna resulted in deaths.

Haiti Emergency Relief

I’m pleased to announce that my dear friend, Reno Omokri, is taking part in an airlift of relief materials meant for the victims of the Haiti Earthquake. It would be great if anyone can donate non perishable relief items like blankets, medicines, cereal, canned foods etc (No Cash Please). I will pay to have these items flown to Michigan where they will be airlifted to Haiti. The airlift is scheduled for next week, so it will be great if any donations can be made by Monday the 25^th of January, 2010. You can reach Reno at 510-619-6801. Thanks a million.

PU

I’d like to use this opportunity to thank all those who have made a donation to Nigeria Haiti Relief Effort which is currently accepting relief materials to send to Haiti for the victim of the earth quake. Please if you have not yet done so and want to join the efforts, please send relief materials (none perishable items e.g canned foods, clothes, sugar, toiletries, detergent, medicines etc) to Nigeria Haiti Relief, 6 Balarabe Musa Crescent, Victoria Island, Lagos, or if abroad to 660 Shrewsbury Dr, Clarkson, Michigan, 48348.

I’d also like to thank Syed Ali Abdul Rahman, of Friendfinder Inc in Sunnyvale California for his generous cash donation. Please make an effort, but if you can not send anything, at least please say a prayer for our Haitian Brothers.

PU.

The president’s call to the BBC radio today raises more questions than it answers. There are too many pressing issues in Nigeria this new year. From the Abdul Mutallab incidence to the controversy over the signing of the supplementary budget and then the controversial swearing in of the new CJN by the outgoing one as well as the recent unrest in Bauchi which claimed not a few lives and in the midst of all these our president placed a call to the BBC and did not touch on any of these issues or other pressing issues. The only thing he touched on besides his health is football! This is troubling!

Here is a president whose sole achievement in office is the amnesty in the Niger Delta and yet that very achievement is unraveling what with the recent attacks on Chevron’s pipelines and the kidnap of some Britons and a Colombian and yet there is hardly a pip squeak from Mr. President nor the government he heads and yet the Federal Executive Council tells us that his absence has not affected government. With the amnesty unraveling what will history remember Umaru Yar’adua for?

The question begging an answer is what are the president’s priorities? Here he had a chance to calm the anxieties of a troubled nation and he did not. What are we then to believe? Is it that the president is not aware of the attempted terrorist attack by Farouk? Nigeria has been blacklisted by the U.S, the Nigerian senate has issued an ultimatum to the U.S and the government purportedly headed by Umaru Yar’adua has not made any concrete efforts to show the outside world that Nigeria realises that there were some systemic lapses and that we would take steps to resolve these lapses. I mean what is going on? If the president did not comment on the issue of the attempted terrorist attack, the only conclusion that can be drawn are that he is not aware of the incidence or if he is aware then he does not care. As I have already written elsewhere, nothing the government of Nigeria is doing right now can be as effective in getting the U.S to have a rethink on the issue of Nigeria’s travel blacklisting than for our president to tell the outside world that we accept some responsibility for the incidence being that the young man is a Nigerian and that he passed through our airports and that we have identified lapses which we have taken steps to plug those loop holes and make sure that such an incidence will not happen. Such a statement coming from Nigeria’s president will be more effective than any ultimatum because in the final analysis an ultimatum issued without any consequence is an empty threat.

So what are we to do with the President’s call? Are we to receive assurances from this call? Even Yar’adua himself confessed that he ‘hopes that there will be tremendous progress’. In short Nigeria is relying on chance and hope? A nation of 150 million people are holding their breath. But why? And to further add insult to injury the Federal Government yesterday told us in court that we are not entitled to the president’s medical records even though which we are collectively paying his medical bills. This is not some stone age empire living under a despot that we dare not question. Nigeria is a democracy or supposedly so, why cant we be told the truth about our own leader? Why cant we be addressed by our president on television? Why this secrecy?

It is Nigerians who have been praying for Yar’adua, paying his bills and paying the price of his absence. The least he can do is to address us on NTA, AIT or FRCN and speak to us on those issues that are critical to us . I still can not fathom why a man who styles himself as a ’servant leader’ will be so hell bent on sticking to power rather than temporarily handing over to his vice so that his nation can function properly. That is the true action of a servant leader. What a pity!

Finally, let me state on a lighter note that we had hoped that the off shore/on shore dichotomy had perished with the Obasanjo administration with the pronouncement of the Supreme Court on the matter, however we have now been undeceived because right now we have an off shore president and we desperately need judicial intervention once again!

Once again, God bless Nigeria,

PU.

Imagine my surprise when I picked up the paper today and discovered that the National Assembly has issued a seven day ultimatum to the United States government asking them to rescind their decision to include Nigeria on a list of countries blacklisted for terrorism activities or else. I mean this was the same National Assembly that told us their hands were tied on the issue of acting decisvely on President Yar’adua continued absence from duty yet their hands are not tied over this issue. Which has a more negative impact on Nigeria? You have yet to issue an ultimatum to your president to identify his state of mind and his location and yet you want to control events in another county.

The truth is that if President Obama had been able to contact President Yar’adua directly after the Farouk Abdul Mutallab incidence to have high level discussions and received assurances of Nigeria’s commitment to the fight against terrorism from the highest level the blacklisting may not have occurred. But there was no one for President Obama to reach out to. The Vice president is understandably unable to act without being constitutionally empowered to do so and the FEC are self serving in wanting to protect their jobs so they do nothing which leaves the National Assembly to salvage the leadership vaccuum, but rather than do this they bury their heads in the sand like the Ostrich. President Obama is concerned and involved in this issue and has spoken, Prime Minister Gordon Blair is concerned and involved and has also spoken, Yemeni President Abdullah Saleh is involved and has spoken, why the deafening silence from our own president, Umaru Yar’adua in these trying times?

Now what would happen after the 7 day ultimatum? Obviously the U.S is not going to change its stance, so what will the National Assembly do. If you issue an ultimatum, there ought to at least be some consequence to the person or body that does not meet the terms of your ultimatum. If the National Assembly is unable to do anything after the ultimatum expires (which is most likely) then of what use has the ultimatum been beyond empty sloganeering or at best a knee jerk approach. Are they going to stop flying to the U.S for shopping trips and medical treatments? Will they refrain from sending their wards to school there? Would they stop importing goods from America? Would they also reject foreign aid from the U.S? In fact can they boast of doing anything to America that will hurt America more than themselves? It is actually more effective for them to reach out to President Yar’adua wherever he is and ask him to intervene directly to the U.S President and give the reassurance the U.S requires that Nigeria will do what it takes to increase her anti terrorism efforts. Our parliamentarians have to think globally and ACT locally!

Today as I write this, Nigeria’s foreign minister has just told the BBC that he has not spoken to the president since he was evacuated from the country on November 23rd, 2009 and yet the government claims that he is ‘responding to treatment and getting better’. Even further we are told that he is in charge of Nigeria from Saudi Arabia. Upon what basis are these assurances given when people at the highest levels have not seen or heard from the president?

As it stands now, Nigeria is turning into a laughing stock in the International Community. It is so ridiculous that the government’s defense in court to the suit filed by Femi Falana in which he requested for the president’s medical report is that the medical reports are ‘private’. Was that a joke? Private? Nigerian tax payers are paying for President Yar’adua’s medical treatments. They are said to have ‘elected’ him after he put himself up for election into a ‘public office’ to be their president making him an employee of over 140 million Nigerians. President Yar’adua’s medical state are a lot of things but one thing they are not is PRIVATE! If he wishes his medical records to be private, he ought to first resign from public office and pay his own medical bills. When he does so then we will accept that they are private.

As for the National Assembly I only have this piece of advise-if the owner of a calabash calls it a worthless calabash others will help him use the calabash to carry thrash. If our parliamentarians can say publicly that their hands are tied from intervening in the current vacuum in leadership that has left Nigeria prostrate they should not blame others who heard what they said and concluded that since no one is in charge and no one will intervene the best approach would then be to paint us all with the same brush which is what the blacklisting has done.

Once again, God bless Nigeria.

PU.

With the impending constitutional crisis now looming in the nation, I have voiced my views on what I think should happen and that is that the Nigerian constitution should be allowed to prevail. If for any reason the president is incapacitated, then the Vice President should be immediately sworn in to take his place and must be encouraged to conduct elections in 2011, after implementing the Justice Uwais electoral reform committee’s recommendation,in which he should not be a participant.

Having said this, I begin to wonder if there has been a hidden agenda all this while. For one thing, former president Olusegun Obasanjo could not have been unaware of the precarious health situation of president Yar’adua, yet he personally picked him to be his successor and imposed him on the nation. Why? Is it that Obasanjo wanted revenge for his failed alleged third term agenda and foisted on us a man whose health was notoriously bad. Did he expect that we will be facing what we are facing now? Knowing the reptilian and calculating brain of former president Obasanjo, I simply can not put this past him though I have no proof.

I recall that when there was a raging controversy over the exact interpretation of the unwritten power shift internal arrangement of the PDP, Obasanjo was quoted to have said ‘allow me as leader to interprete what this means’. Is what we are now experiencing Obasanjo’s interpretation?

Given the fact that the Vice President, Goodluck Jonathan, was propelled by Obasanjo via the impeachment of his then boss, Governor DSP Alamieyeseigha, to leap from being deputy governor to being a governor, could it be that Obasanjo even back then was calculating the events that are unfolding right now?

Goodluck Jonathan owes his emergence as governor not to an election, but to one man alone, i.e Obasanjo. He also owed his choice as then candidate Yar’adua’s deputy to Obasanjo, and ultimately he became Vice President riding on the back of Olusegun Obasanjo.

Somehow as I sleep, the words of Fela Kuti in his song ‘Overtake don overtake overtake’ ring in my sub conscious. I recall Fela sang ’when Obasanjo and Yar’adua—-belleful and go, dem put civilian friends for there dem shout 2nd republic. People when no know they happy, people when know them dey look’. This whole thing looks like Deja vu. The more things change the more they seem the same.

Come to think of it, why did former president Ibrahim Babangida who was obviously very determined to become a civilian president suddenly drop out of the race in 2006 after he had bought the PDP Presidential nomination form? I mean, yes he gave an excuse that he considered himself a member of the Yar’adua family and could not see himself running against Shehu Yar’adua’s brother because of his brotherly relationship with the late Shehu Yar’adua. Well of course we bought it then because  the frenzy of an impending election got us all excited, but now that we have lost that excitement its now clear that that could not have been true and does not wash because if Babangida loved the late Shehu Yar’adua as he led us to believe, why did he cancel the 1991 elections that Shehu Yar’adua was poised to win? Something here does not add up. Was IBB in cahoots with Obasanjo all this time? Did they know that it was all a grand charade and that Umaru Yar’adua was only………. I cant even complete the sentence.

Vice President Good luck Jonathan must be supported by all lovers of democracy in this trying period and if the unthinkable happens then he must be allowed to ascend the throne as the constitution prescribes, but we must not lose sight of the fact that he appears to have a guardian angel in former president Obasanjo and we must insist that if these manipulations and illussions which have characterized the political activities of Olusegun Obasanjo and Ibrahim Babangida since 1975 must cease, then we must make sure that going forward these two individuals are shut out of our political space. You can not prove anything, but the convenient way and manner that things continue to work out for them and their surrogates as well as their public spats and private love affair far away from the prying eyes of Nigerians make these two principalities very suspect. No one can prove it, but it is too neat to be a coincidence!

From the inexplicable manner in which Babangida was able to go into the Ikoyi Federal Radio Corporation office without arms to rout Dimka to Obasanjo’s subsequent ascension as head of the Supreme Military Council to the late hour Supreme Court judgment of 12 2/3rds to Shagari’s ouster for which Babangida recently confessed that the initial plot was to return Obasanjo to power until Obasanjo himself refused only because he did not want to take over from the man he gave power to, to the annulment of the June 12 election when Obasanjo rather than speak out for Nigerians said in far away Zimbabwe that ‘Abiola is not the Messiah Nigerians are looking for’ to Abacha being left behind to conveniently take over from Ernest Shonekan, to the framing up of Diya before Abacha died under still as yet unclear circumstances to pave way for Babangida’s cousin General Abdulsalami rather than Diya to succeed the late Abacha,whose first major act was to release and pardon Obasanjo only for Abiola to die in still as yet suspicious circumstances paving the way for Obasanjo’s election which would have been impossible had Abiola not mysteriously died to the plot to stop an almost unstoppable Atiku Abubakar which paved the way for Umaru Yar’adua’s ascension and now this. Oh no, these two must now retire from Nigerian politics.

Once again, God bless Nigeria.

PU