I hope this finds you well. I penned this short note on the go, so you (and the public) would please excuse my inability to be too detailed. This is a terse response to your statement on the Primary Health Care Under One Roof (PHCUOR) policy. Before going into the heart of this, I need to tell you why I chose to write to you.
A few days ago when your appointment was announced, many people were shocked at your choice to speak for a party that suffers immense identity and reputational crises for reasons of its antecedents and leadership. I leave you to ponder on this. It is the belief of many that the PDP in Kwara needs a transcendent leadership that would intentionally break away from its horrid past. Why were people shocked at your choice? You know it. Those who were shocked also know it.
But no one is forever condemned to their past; so, as your elder brother, I hold the view that you can still make your mark. This is the reason for this letter: I want you to properly represent your generation in this role. I wager that you are either a millennial or Gen Z, both of which are angry with the older generations for reasons of not giving them a solid head start that offers a brighter future. By implication, you are a ‘digital native’, which again means you should be hungry for facts and be willing to deploy facts to contextualise your argument as a party spokesman. A few people have placed a bet that the PDP is ready to run an effective opposition campaign, hence its gunning for millennials or Gen Z to hold its key positions. That is fine.
But your statement on PHCUOR policy is a gaffe, I am afraid. You did not show reasonable members of the public a single reason they should now look up to your party as an alternative. That is because you did not show any knowledge of what PHCUOR is — and why the government deserves a knock. The starting point for a serious opposition (and conversations) is to show a clear understanding of the issues and then offer an alternative policy position to challenge the ruling party. You did not do that. You know a big implication of that? It shows you are not offering anything. As a student of policy who is serving in this administration, I always look forward to hearing policy alternatives from the other side. This will help the government itself to always critically think through its policy options vis-à-vis its financial strengths and its constraints. That way, the people will have distinct options to sign up for and our society will grow. Everyone benefits.
The rating of Kwara is not necessarily connected to the quality of service delivery. States were ranked based on the level of implementation of the PHCUOR policy. What the PHCUOR policy is meant to achieve is improved health indices, which we are already achieving. Matter-of-factly, many of the states in good standing in the PHCUOR rating are far behind Kwara in basic health indices. You can check up on the important health indices such as under-five and maternal deaths, nutrition, immunisation, and quality of infrastructure. But the rating is not useless. It is a strong call on the states to adopt PHCUOR policy. The PHCUOR, in summary, is a policy to reduce fragmentation in the delivery of Primary Health Care (PHC) services. It seeks to bring primary health-related agencies and authorities under one authority and to pull resources together from state and local government for a more effective healthcare delivery at the basic level. It involves huge bureaucratic changes. It is a policy design anchored on the belief that more resources, and a less fragmented system, will deliver better services. It is a policy proposal of the Federal Government. But, like every policy option, the proposal is a trigger for rivalry among longstanding competitors in the healthcare ecosystem. People do not like to lose their ‘authority’ or autonomy. This is especially true for a state like Kwara where institutions are often very political, itself a product of its age long politics and orientation. The other ‘second-order effect’, to quote renowned policy scholar Rebecca Stone, is the perceived intrusion into the financial autonomy of local government as you pull resources together. In Kwara, we are trying to navigate these nuances and see how this policy works for us. We are still at it, although arguments may be made that we should be faster in the transitioning. Don’t forget, however: this is a democracy. Our rating, in summary, was never about performance but about operational structure based on the fact that we have not adopted PHCUOR policy, which Federal authorities feel would enhance basic healthcare delivery across Nigeria.
As the spokesman for the PDP whose appointment (along with a few others) some feel should energise your party, I expected you to understand this as a basis for any public statement. It does not mean you cannot play politics in weaving your narrative. Beyond understanding the issues, I expected you to say your party commits to implementation of the PHCUOR policy because of so and so benefits, which would be open to debates, as against the current system which a few other states are still doing. My dear brother, it may interest you to note that PHCUOR assessment has been stepped down for the year 2023 because of the issues around the indicators. Indeed, the National Primary Health Care Development Agency has called a meeting of stakeholders for next week to review the indicators. You see my points? As I said earlier, Kwara is many miles ahead of many of the states who scored excellent in PHCUOR. Go and verify!
In conclusion, I like the fact that Governor Abdulrahman Abdulrazaq has conditioned everyone to make substantial concessions in favour of young people and women holding key positions in government and party leadership. This has expectedly spurred the revolution within your own party, and I am glad to see a few young people like you getting a mention. But the only way to justify this generational shift and ‘retire’ the old warhorses is for the young blood to do things differently, such as speaking to facts and offering viable policy alternatives for people to pick from. That way, our politics and society will get better.
I wish you all the best, dear brother.
–Ajakaye is CPS to the Governor of Kwara State
