Why cassava bread remains elusive

YEMI OLAKITAN 

The Federal Government sometime ago introduced the cassava flour policy to encourage facilitate the blending of well-processed high quality cassava flour with wheat flour to reduce import dependency in the bakery and confectionaries sub-sector by at least by 40 per cent, yet it seems that most Nigeria are yet to taste the cassava flour. Head of Investigations, Yemi Olakitan, examines how the policy implementation has fared.  

When the Federal Government introduced the cassava bread initiative as part of its Agricultural Transformation Agenda, ATA, Nigerians received it with mixed feelings though the consensus appeared to be that this was necessary to reduce the huge wheat import bill which was close to N650bn yearly.

The Federal Ministry of Agriculture and Rural Development, headed by Dr. Akinwumi Adesina, was however able to create the necessary publicity to encourage Nigerians to embrace the introduction of the composite cassava bread into the market.  President Goodluck Jonathan in Aso Villa, and former President Olusegun Obasanjo were some of the first official consumers of the new bread, eating fresh loaves in public view.

The Federal Government’s argument was that the initiative would encourage increased cultivation of cassava on a commercial scale, drive down cost for bakers and already established user of cassava products, save foreign exchange from reduction in wheat imports with the overall effect of creating more job opportunities in the agricultural and agro-allied processing sectors.

Efforts by the Federal Government to reduce wheat flour in bread dates back to the 1960s.   The whole idea was to improve on agro-output to make Nigeria self-reliant in production of certain staple food crops and subsequently save huge foreign exchange committed to flour importation.

The advocacy heightened in 2004 when former President Olusegun Obasanjo visited the Federal Institute of Industrial Research, Oshodi, FIIRO, Lagos.  The visit prompted government to initiate a policy towards achieving 10 per cent cassava inclusion in a short term; 20 per cent in the medium term and ultimately 40 per cent.  The ongoing cassava bread campaign aims at achieving 20 per cent cassava flour inclusion in bread, which is also considered healthier for consumption.

FIIRO claims, if fully developed, the policy has the capacity to generate over three million jobs to reduce the rate of unemployment in Nigeria. FIIRO explained that in terms of price, quality and quantity, bread has remained the only staple food affordable to all Nigerians.

The director-general of the agency, Mrs. Grace Elemo, said that before the evolution of the cassava inclusion initiative, bread was 100 per cent produced from wheat flour and as such, huge amount of hard-earned foreign exchange is used every year for its importation.

The DG said, importation of wheat flour costs the nation a whopping sum of N635bn annually. She pointed out that with the cassava bread initiative, especially the production of composite bread in commercial quantities, local farmers would have opportunities to experience high returns.

In a bid to redress the country’s undue dependence on 100 per cent wheat flour for bread-making and other confectioneries, the federal government came up with the policy of gradually increasing the substitution of high grade cassava flour from 10 per cent to 40 per cent

Prior to the introduction of this policy, FIIRO has not only perfected the technology of 10 per cent high quality cassava flour (HQCF) inclusion in wheat flour but also transferred the technology to numerous flour millers and bakers in the country.  FIIRO has also gone further to introduce baking laboratory where it produces composite (cassava/wheat) bread which it sells to staff on a daily basis, as a demonstration of the technical feasibility and economic viability of the technology.

The composite bread produced is adjudged by all those who eat them to be of very high quality and in tandem with the institute’s sensory evaluation reports on cassava bread consumption In addition to baking bread with the 10 and 20 per cent composite cassava, FIIRO has also successfully baked various acceptable confectioneries with over 20 per cent cassava flour inclusion in wheat flour.

To further drive the initiative, government rolled out some incentives and intervention schemes in cultivation of high quality cassava, cassava flour processing and training of bakers across the country on the best techniques of mixing or blending the wheat flour with the cassava flour.

As parts of efforts aimed at making the policy a success, the Bank of Industry announced a N2.2bn Cassava Bread Fund Initiative for 174 members of the Association of Master Bakers of Nigeria. The money is being disbursed to the beneficiaries in forms of loans and grants in collaboration with the Federal Ministry of Agriculture and Rural Development.

Managing Director/ Chief Executive Officer, BOI, Mr. Rasheed Olaoluwa, had said the bakers would to use the money for the acquisition of bakery equipment to enable them achieve the inclusion of 20 per cent cassava flour into wheat flour.  According to him, “The members were grouped in two batches. The sum of N989m has been disbursed to the first batch of 100 beneficiaries, which represents 92 per cent of the approved sum of N1.074 billion.

He had explained that of the remaining 74 beneficiaries, only 60 have met basic conditions precedent to facilitate the disbursement of 50 per cent grant amounting to N537.93 million.

National President of Master Bakers Association of Nigeria, Mr. Simeon Abanulor, confirmed that members of the association nationwide got a total of N886m out of the N2.2bn cassava bread intervention fund.

Abanulor disclosed that members from all the geo-political zones of the country have benefitted from the amount disbursed so far. He said the BoI had promised the disbursement of the remaining fund.

On the research and development side, Head, Baking and Milling Division of Federal Institute of Industrial Research, FIIRO, Mrs. Osibanjo Adetokumbo, said the institute has made concerted efforts to mobilise bakers and millers to embrace the initiative, following its successful research on its feasibility and production of composite bread in-house.

She said, the millers were reluctant initially but gradually begun to mobilise themselves after seeing the benefits, and from a mere five per cent, they have moved to 20 per cent cassava flour inclusion in their products.

According to her, the cassava flour is available, the technology is available.

“It is practical, the bakers are not putting up any opposition and we have gone across the country training bakers and it is very positive. We have achieved 20 per cent in FIIRO and our bread was personally launched by the Minister of Agriculture, Dr Akinwumi Adesina, here in FIIRO. It contains 20 per cent of cassava and we bake it on a daily basis.’’

She named Honeywell among major millers in the country who have achieved a mixture of both wheat and cassava flour in their production. According to her, “In every new policy, change is usually slow and sometimes resisted until when people begin to feel the impact”.

She said that the challenge would be surmounted as such is usually the case with a new initiative pointing out that as demand grows for cassava flour, farmers would be persuaded to grow more.

The FIIRO DG however believes that legislation may need to be emplaced to help the policy succeed on large scale and appealed to the National Assembly to pass a law on compulsory use of cassava in bread-making, which she said the institute had already proposed.

According to her, the absence of a legal framework to drive the cassava bread policy constitutes a big challenge to the implementation of the policy due to poor public enlightenment.

A bill to legislate on the cassava bread has however reportedly suffered a set-back in the House of Representatives, when FIIRO first took the initiative.

The Senate Committee on Science and Technology on its part said nothing much is known about the initiative.

Chairman of the committee, Senator Robert Borofice, who led his committee to the agency, requested that FIIRO forward to it, a comprehensive report, outlining research on the cassava flour as well as the economic and health benefits to enable it take a position that would facilitate its adoption.

However, the National Association of Nigerian Traders, NANTS, which conducted a survey of the experience and challenges faced by the Federal Government’s cassava bread programme said while there was a high level of interest, the programme was still beset by several problems.

The NANTS report “showed a 94 per cent interest among Nigerians interviewed”, but found that the “cassava bread production level to date remains is domiciled largely among corporate bakers”.

While government officials acknowledged that there are “teething challenges” faced by the programme, they maintained that the government is “creating market opportunities so that those who can produce will come on board”.

The report identifies six main challenges faced in the implementation of the cassava bread programme. One of them is the shortage of cassava for industrial use as 80 per cent of cassava produced in the country is already used for direct consumption, so only 20 per cent is available for industrial use.

Another problem is technical difficulties in ensuring the required quality of cassava flour, in part due to lack of adequate training; unclear labeling requirements, so consumers are not generally aware of the use of cassava in bread production as a replacement for wheat flour; unfounded concerns over health threats arising from fears over possible fungal threats arising from the use of cassava flour;  the need to build technical capacity along the supply chain to provide quality cassava flour for use in cassava/wheat flour blends in bread production and access to funding for the initiative.

It is little wonder then that that the general public do not pear to know if cassava bread is in the market or not though the big milers claimed to have started blending cassava with what flour.

Consumers, who spoke with Sunday Mirror, however said the bread is not available, Dele Okikiola, a trader in Obalende said, I have never seen or tasted the cassava bread. I don’t even know what it looks like.”

Bakers who spoke with Sunday Mirror on the initiative however said that cassava bread in plentiful in the market though consumers may not be aware.

Managing Director, Gooday Loaves, a bakery based in Lagos, Mrs. Roseline Aburime, said her company has achieved 10 per cent cassava flour inclusion in its products. “There is plenty of cassava bread in the market. Anyone who wants cassava flour will be able to get it. It’s in the market. Bakers and consumers who are claiming ignorance are deceiving themselves. It’s possible that they do not want to change from the norm. Consumers may eat the cassava bread and may not know because it does not look different from the wheat bread which majority is used to.”

According to bread distributor, Alhaja Hasdan Ayodele from Lagos Island said, “Most of the bread we sell here has cassava flour included. In fact, I will say all of them have cassava flour included. It is the percentage that varies from company to company. Some use a lot of cassava flour, some used small but all of them use cassava flour.

For her, the policy is working, although some consumers prefer the wheat bread. Nonetheless, I believe it’s a success because all the bakers are using cassava flour as far as I can see.’’

A Lagos-based beautician, Mrs. Shola Abimbola, said, “Cassava bread is available in the market. The wheat bread is also available. It depends on what you want. Cassava flour is available for bakers. They are selling it in the market. I prefer wheat bread to cassava bread though. Maybe, it’s because I am not used to it yet, I just don’t like the taste of the cassava bread. It’s not the same.” she said.

Nonetheless government remains optimistic the cassava sector is s sure growth driver as estimates suggest that about N16bn worth of cassava flour would be needed this year alone to produce the estimated 550 million (950g) loaves of bread valued at about N117bn currently produced annually in the country.

Apart from bread, there are several other industrial applications backed by new investments already being seen.

According to Adesina,  “As we speak, there are at least 10 new large scale factories, two for starch, two for  sweeteners, three for ethanol and three for dried chips that are being planned for commissioning in 2015. Such dynamism of private sector investment in cassava processing has never happened before in Nigeria’s history. Mechanised and highly productive cassava production is a magnet for industrial scale processing, which we are now seeing in Nigeria. The industry is responding to the positive development in the cassava sector”.

Group Managing Director, Flour Mills of Nigeria Plc, Mr. Paul Gbededo, stated recently that a draft policy, which is designed to actively promote the inclusion of locally cultivated cassava and sorghum in bread flour is one which his company welcomes and supports because of the positive impact it will have on the economy of Nigeria by way of huge savings in foreign exchange, wealth creation for farmers, direct farm jobs for nearly 500,000 persons and an income generation of about N24bn going to farmers.

He said the policy is expected to create additional 1,500 jobs and is also expected to create a value of over N800bn in 10 years.

Some public commentators insist that the issue of cassava bread needs to be addressed more seriously as a matter of strategic national interest.

According to Barrister Olabode Shittu, “Nigeria is a nation with the capacity to feed the whole of Africa, to become import dependent, due to our high taste for foreign foods. As we import food, we are making our economy weaker. We are exporting jobs, instead of creating jobs at home.

“We are making the farmers of food exporting countries richer, while our own farmers are poorer for lack of markets. While food exporting countries create jobs, Nigerian young graduates roam the streets. As the economy of Europe and the US continues to struggle, demand for our oil is dwindling. Times are different now. While we could afford to lavish our foreign exchange on food imports before, today we cannot, because we must create jobs at home”, he said.

Islam is a religion of peace

by YEMI OLAKITAN on Feb 22, 2015 | 

Saadula Bello is the Chief Imam Oluwole Ogba Central Mosque in Lagos. He is also the Secretary General of the Council of Imams, Lagos Division. He spoke with Yemi Olakitan on the subject of female suicide bombing, the position of Islam on violence and other issues. Excerpts:

What is your reaction to the use of female suicide bombers by insurgents in the North?

As you all know, Islam is a religion of peace, in all its characteristics and nature. There are two definitions to Islam. Islam is a religion of peace. Islam is also submission in totality to the will of God. Inside and outside, Islam is a religion of peace and tranquility. If you look at our fasting and prayers, the Hajj, alms giving, they are all about peace.  When people see a certain Muslim doing something wrong, they then generalise and say that all Muslims are bad. It is not so.  Female suicide bombing or male suicide bombing, none is condoned in Islam.

If a Muslim is not good, he is not good by himself.  It does not imply that Islam is bad and every other Muslim is bad. There are rules and laws to living a righteous life in Islam.  Nobody can spoil Islam. One can only spoil himself and no one can break the rules of God and go free. There is no religion that preaches that people should kill one another. The rules of God will break you. Killing is not allowed in Islam and even suicide bombing is not allowed as well. Islam does not preach suicide bombing. The Holy Quran said, we should not kill and we should not commit suicide, no matter the circumstances. You cannot say your condition is terrible and then decide to end your life. Islam forbids it, no matter your situation in life. You cannot commit suicide.  So if Islam forbids suicide, where is the ground for using young girls as suicide bombers?

What would you say is the cause of the violence and the reasons for using underage girls?

They are using politics to deceive people; some people want to rule by force and they are using religion as a pretext. All these have political undertone. They have brought deceit into religion and they brainwashed some people. Look at the fasting period, Islam said during the festivities, Muslims should look out for those in need and give to them from the abundance that they have. Islam does not preach violence at all. At other period, beggars beg for food but after the fasting, Islam instructs us to look out for the poor and give to them from whatever we have. Islam teaches us to consider others. It is a religion that puts others into consideration. If you have something to eat, think about those who do not have. Suicide is not allowed in Islam. Anyone who kills himself will inherit fire and will not make paradise. Anyone who kills another will also be killed according to Islam. They are using politics to deceive people. Islam forbids killings of any kind.

What is the meaning of Jihad?

Jihad means to strive for something. Whoever goes to school and succeeds has done Jihad. If you go out to care for your family and look for what they will eat, you have striven for something good. Anything that you can strive to attain that is good is called Jihad. It does not mean war alone. The Holy Prophet did not kill. If you look at all the wars that the prophet fought, they were defensive. War is in two fold, defensive and offensive. How did Jihad start? The pagans pursued the Holy prophet from his house. They also pursued him to where he ran to, and then Allah instructed him to defend himself.  The Holy Prophet said that all the defensive wars are even small jihads. The Prophet said that the greatest Jihad is the Jihad of the soul, elevating oneself to be closer to God from the animalistic stage to the higher level.  The greatest Jihad is the discipline of the soul. Those who commit suicide bombings are not following the tenets of Islam. A person says he wants to make paradise and then he goes to the market to denote a bomb which kills many people, both Muslims and Christians.  That is complete madness and not religion. If we want to kill a chicken, the Holy Prophet said we should look for a very sharp knife, consider the animals and not subject the animal to cruelty.

Medical tourism, another drain on the economy

by  YEMI OLAKITAN on Mar 15, 2015 | 

It has now become common place for Nigerians who can afford it especially public officials in Nigeria to seek medical care abroad even for ailments that could be handled at home. It is said that Nigerians spend about $500m (N78bn) yearly for medical treatment abroad. The most popular destinations are India, Germany, UK, and the United States. This is despite the fact that Nigeria has many trained medical practitioners and numerous medical centers. Ag. Head of Investigations, YEMI OLAKITAN, examines the reasons for this medical exodus abroad and what could be done to address it.

Health is wealth so the saying goes, which is why people go to great lengths to ensure proper medical care for sundry ailments. However, the rising spate of chronic illnesses such cancer, renal failure and cardiovascular diseases has raised demand for specialist and sophisticated medical care, which is in short supply in Nigeria. Even though some of the nation’s tertiary institutions still have requisite personnel and equipment to manage chronic cases, many Nigerian prefer to fly abroad to treat both chronic and not-so-chronic conditions believing that the level of care available in-country is not up to scratch.

Indeed, people fly to London for mere check medical ups and common colds and many even end up in the hands of Nigerian doctors in the United States, where about 20,000 Nigerian are estimated to be practicing medicine and in other countries such as the UK and Saudi Arabia.

Expectedly, the overall bill is high since this come in dollars, a situation that has not gone down well with Nigerian doctors, who wonder why people are ready to pay so much abroad while they often hold the short end of the stick at home often going on strike to get decent wages and allowances. Private clinics hardly fare better with many struggling to cope with patients’ debts and unremitted fees from Healthcare Maintenance Organisations, which is threatening the entire National Health Insurance Scheme.

Most worrisome if the fact that public officials in middle to senior cadre travel aboard at the drop of a hat for medical care and the bills are picked by the government, which is accused of failing to properly address the needs of the health sector in terms of staffing, equipment and facilities.

Some of the high profile cases of top government officials and family members seeking medical treatment abroad including late President Umaru Yar’Adua, First lady Patience Jonathan, prominent, state governors and ministers drive home the point most poignantly.

The Nigerian Medical Association, NMA, estimates that Nigerians spend over N120bn annually, on medical tourism while about 5,000 patients travel to India monthly for treatment in line which a rising phenomenon called medical tourism.

Medical tourism’ is originally a term used to qualify a patient’s movement from highly developed nations to other areas of the world to get medical treatment, usually at a lower cost.

More recently, however, the term is being generally used to mean every form of travel from one country to another in search of medical help, which can also simply be called ‘medical travel’. It also includes traveling to countries where treatments for particular conditions are better understood.

NMA President, Dr. Osahon Enabulele, says the organisation had been encouraging public office holders to patronise Nigerian hospitals rather than going overseas for minor ailments that could be handled locally.

“In fact, things have gone so bad in the country that Nigerians travel abroad to conduct medical check-up on simple matters such as blood pressure,” he said.

According to the NMA, Nigeria has the resources and manpower to tackle most ailments ravaging citizens within the country.

It says the country is suffering in the midst of plenty and needs laws to address issues of medical tourism. A medical board that would screen public office holders to ascertain their eligibility for medical treatment abroad is necessary particularly where public funds are involved.

The association warns about the staggering amount of money Nigeria is losing to foreign countries (especially India) on medical tourism.

According to reports, U.S and Great Britain used to have greater share of Nigerians seeking foreign healthcare; Indian has outperformed these countries in recent years. It is estimated that 95 per cent of Nigerians traveling abroad for medical treatment go to India.

The NMA said India rakes in well over N40bn, which is about 50 per cent of the bill. (Over 5000 Nigerians travel to India, with each of them spending between $20,000 and $40,000 on the average a year.) India was also projected to have raked in a whopping $2bn from a global medical tourism valued at $20billion a year.

Reports reveal that the phenomenon called medical tourism is not limited to Nigeria alone. It is a subject of global concern. This is because many surgical procedures performed in medical tourism destinations cost a fraction of the price they do in the Europe of the US

Investigations reveal that a liver transplant that costs $300,000 in America costs about $91,000 in Taiwan. Another problem is that countries that operate public health-care systems often have long wait times for certain operations. In Canada, for an example, an estimated 782,936 Canadians spent time on medical waiting lists in 2005, waiting an average of 9.4 weeks. This prompted Canada to set waiting-time benchmarks, such as 26 weeks for a hip replacement and 16 weeks for cataract surgery, for non-urgent medical procedures. This is one of the reasons why people seek medical care abroad.

Medical tourists come from a variety of locations including Europe, the Middle East, Japan, the United States, and Canada. Factors that drive demand for medical services abroad in First World countries include: large populations, comparatively high wealth, the high expense of health care or lack of health care options locally, and increasingly high expectations of their populations with respect to health care.

In countries, like the United States, medical tourism has large growth prospects and potentially destabilising implications. It is projected that medical tourism originating in the US could jump by a factor of 10 over the next decade.

An estimated 750,000 Americans went abroad for health care in 2007, and a report estimated that 1.5 million would seek health care outside the US in 2008. The growth in medical tourism has the potential to cost US health care providers billions of dollars in lost revenue.  Popular medical travel worldwide destinations include: Costa Rica, India, Israel, Malaysia, Mexico, Singapore, South Korea, Taiwan, Thailand, Turkey, United states.

Investigations reveal that India is placed among the top three medical tourism destinations in Asia, mainly due to the low cost of treatment, quality healthcare infrastructure and availability of highly-skilled doctors.

In Nigeria, India has become the doyen of medical tourism and the preferred location. India, Thailand and Singapore are the three countries that receive maximum medical tourists owing to low cost of treatment, quality healthcare infrastructure, and availability of highly-skilled doctors within Asia itself.

Why have Nigeria chosen India over other countries of the world? It is said that in Indian, medical tourism is one of the largest sectors and is poised to grow at an annual rate of 15 per cent to reach about $158.2 billion by 2017. India and other Asian countries have introduced various marketing strategies to attract medical tourists, and they have succeeded immensely and Nigeria is just one of the countries going there.

Patients are attracted to low priced treatment options, availability of variety of treatments, improved infrastructure in terms of healthcare facilities and attractive locations for spending time after treatment.

A nation such as Thailand positions itself as a dual purpose destination for both medical and economic holiday with attractive locations; Singapore promotes itself as a destination for fine quality in medical treatment. India is known mostly for its cost-effective medical treatments along with high standards in cardiology, orthopedics, nephrology, oncology and neuro-surgery.

Another reason why Indian is reportedly a popular destination for medical tourists is that she is known for its alternative treatment options such as yoga and ayurveda. India’s medical travel industry is clipping along at a 30 per cent growth rate annually. India welcomes most of its cross-border travelers from the immediate region (e.g. Bangladesh, the Middle East and Africa). However, some of those gains have arisen from increasing numbers of Americans, Canadians, and Europeans seeking treatment, particularly the more expensive cardiac and orthopedic surgeries, for which health travelers can save tens of thousands of dollars compared to the cost of treatment at home.

India’s official national health policy encourages medical travel as part of its economy’s “export” activities, although the services are performed within India. The government uses revenues generated from medical travel to increase its holdings in foreign currency. With government and corporate investment solidly behind its healthcare system, more international hospitals and super-specialty centers are opening every year.

Heart care has become a specialty in India, with centers such as Fortis Wockhardt (Mumbai) and Apollo (New Delhi and Chennai) leading the way. Success and morbidity rates are on par with those found in the US and Europe, with major surgeries at up to 15 per cent of the cost.

Factors that have led to the increasing popularity of medical travel include the high cost of health care, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries. The avoidance of waiting times is the leading factor for medical tourism from the UK, whereas in the US, the main reason is cheaper prices abroad.

Biodun Ogungbo, a consultant neurosurgeon, said there are huge risks for Nigerians in medical tourism. There are dangers in going to places such as India, South Africa, United Kingdom and Egypt for medical treatment, without proper information about the doctors working there, their qualifications and experience.

“Many patients and their relatives have no clue about the doctors treating them and whether they are truly qualified to carry out the prescribed treatment. A few patients have returned from these countries with much more than they bargained for. Some have had the wrong operation, unnecessary procedures and treatments and others have significant, lingering and life-long complications. Some hospitals also perform totally useless and experimental procedures on patients at huge costs”, he said.

“When the treatments have gone well, who will continue the necessary follow-up care here in Nigeria? When you receive treatment in a foreign country; it becomes expensive to travel back for follow up in order to consult with whoever provided you with primary care. When you shop around for a hospital in Nigeria, you can easily visit them in person and meet with the staff.  But, this type of in-person inspection becomes harder if the hospital is in another country. These hospitals are not vetted by the Nigerian Medical Association, NMA, the Health Ministries or the Medical and Dental Council of Nigeria, MDCN, so you don’t know what you are involved in. We do have good hospitals here and doctors who are credible and well trained.’’

Chief Medical Director, the Lagos State University Teaching Hospital, LASUTH, Ikeja, Prof. Olawale Oke, said some of these treatments can be obtained in Nigeria.  According to him, some Nigerians who seek medical help abroad die in the process based on wrong diagnosis and treatment.  “Anyone who goes on medical tourism should be sure of where they are going to because some of the ailments they go for can be treated here. They could fall into wrong hands”, he said.

Investigations by Sunday Mirror reveal that, medical tourism is facilitated through companies who openly advertise here in Nigeria while Nigerian hospitals and doctors are not allowed to advertise. Yet, many of these hospitals and businesses in India, Egypt and South Africa do not subscribe to the same ideals and openly advertise their services in Nigeria.

This development has prompted the Federal Government through the Minister of state for Health, Alhaji Suleiman Bello to issue a statement saying, the “Federal Government will no longer be interested in funding medical trips for its officials abroad. President Jonathan said the funds used for such trips have led to loss of the nation’s scarce resources.’’

The House of Representatives also decried the culture of affluent Nigerians seeking medical services overseas. It says the trend was detrimental to the improvement of health care services locally and a drain on the nation’s scarce resources. It therefore tasked the Federal Ministry of Health to set in motion all necessary machineries that would enhance the full implementation of the budget in the health sector so as to elevate the quality of medical services available in the local health institutions and discourage what has now become medical tourism.

Sunday Mirror investigations reveal that even poor Nigerians seek treatment abroad. There have been cases of poor and sick people campaigning for funds to travel abroad to secure medical care for ailments that could be treated in Nigeria.

There are also cases for which the Nigerian medical system is incapable of treating- or is believed to be incapable of treating, due to lack of standard equipments or perceived lack of qualified and experienced personnel.

Popular music producer, Babatunde Okungbuwa aka OJB Jezreel, had a kidney transplant in India although he was not a government official or political office holder. He could not afford to go but well meaning Nigerians picked up the bill. He was quoted to have quarreled with the expression, medical tourism, saying “How can a life-saving trip be compared in any way to tourism! Really, trips like this are motivated by lack of medical commitment ‎to saving lives and poor facilities in our country,” he said.

Indian national policy continued to be directed at positioning the country as a medical destination of choice in global medical/health care delivery. India is achieving this because of the competitive costs, seamless facilitation through pre-diagnostics in Nigeria itself and smoother visa issuance procedure, wide choice of good hospitals and the better patient-doctor interface leading to higher mutual comfort and trust.

Mr. Babatunde Adisa, a Lagos businessman who spoke to Sunday Mirror on the subject said, ‘‘Medical tourism is a global issue. It is not just a Nigeria problem alone. The world is fast becoming a global village and we must sink or rise to compete favourably with rest of the world, not only in medicine but in other sectors. There is no reason why Nigeria cannot and should not achieve what India has achieved. They are not better economically. These things are simply based on preferred priorities. If Nigeria decides to position herself as a medical center of choice for the global community and invest in that sector, the world will come to us. We have the resources, instead of lamenting we should simply go to the drawing board”.

Reports reveal that there is a National Health Bill on the floor of the National Assembly that seeks to curb medical tourism although some have argued that patients are free to seek medical care from wherever and whoever they deem fit, and with the globalization of the world, things are continually changing and the options for where to seek care from are increasing. It will not be right to force people to get treatment from where they have no confidence.

Another problem affecting the medical sector in Nigeria is that Nigerian doctors and hospitals are not allowed to advertise while their counterparts abroad advertise regularly on the internet and other media platforms.

Reports reveal that physicians were once not allowed to advertise by the American Medical Association, AMA. This situation has changed after the AMA was sued by doctors and the US Supreme Court declared that it was an unfair restriction. The Court ruled that it was also unfair to patients, who need access to information on doctors, so they can select the best for themselves.

Several other countries have also followed the pattern of regulated advertisements and have made information about their services and professionals available to the world, attracting seekers of medical care worldwide including Nigerians.

By allowing this kind of outdated policies to continue, Nigerians limit the growth of medical care in the country and build up those of other countries.

Ola Ayodeji, a kidney specialist with the Peninsula Kidney Associates in Hampton, Virginia while speaking on whether banning overseas medical treatment for senior government officials would help improve Nigeria’s health system, said, “I would not advocate restricting access to highly needed care, because when you have a medical problem, it becomes a personal thing, you want to survive, whatever it takes, wherever you can get the care, whatever you have to pay”.

However, some experts see the need to encourage private sector investments in the medical sector as most of the hospitals being patronised abroad are in any case privately-owned facilities.

Chairman Life Bridge Medical and Diagnostic Centre, Senator Ikechukwu Godson Abana, said, high import duties, multiple taxations and exorbitant fees by various government agencies are responsible for low patronage of private investment in Medicare in Nigeria.

He noted that the various taxes are often transferred into the costs of providing services to Nigerians. The reason why Nigeria loses huge sums in capital flight to medical tourism is because of citizens’ lack of confidence as Nigerians often complain that most of the nation’s hospitals lack the modern equipment needed for effective diagnosis and treatment.

It appears however that government is waking up to this reality.

President Goodluck Jonathan, whose wife had made some medical trips to Germany in recent years, had recently expressed his determination to curb medical tourism by involving private investors in the health sector reforms.

The president made the declaration during the inauguration of the Nigeria-Turkish Nizamiye Hospital in Abuja.  The president said that the state-of-the-art hospital demonstrated a pragmatic response to the government’s policy aimed at enhancing private-sector participation in healthcare delivery in Nigeria.

“A lot of Nigerians go out almost on a daily basis to seek medical help abroad and almost all the hospitals that attend to them outside this country are privately owned.  If we encourage the private sector to take the lead; that would save the amount of money Nigerians pay outside.  The determination of our government is to ensure that our citizens have access to quality and affordable healthcare services. In this regard, the role of the private sector in complementing government efforts is very crucial. private-sector initiatives such as this hospital will aid government’s efforts to halt the enormous capital flight arising from increased medical tourism and the avoidable stress experienced by Nigerians”, he had said.

The president said that the Federal Government had constituted a committee to develop a network of improved modern healthcare infrastructure to further stimulate investments in the health sector.  Jonathan stressed that a number of world-class diagnostic and treatment facilities were being developed in Abuja, Lagos and other locations across the country.

Dr Mustafa Ahsen, the hospital’s Medical Director, said that the hospital offered Nigerians the opportunity of staying in their country and receiving world-class medical treatment which they hitherto sought abroad.

According to him, the hospital aims to encourage Nigerians to receive medical treatment in Nigeria where their friends and relatives are readily available.

“The crux of the hospital’s operational mode centered on the treatment of patients with compassion, respect and utmost care, we will never lose our compassion and concern; we will never fall into the wrong delusion of viewing our patients as file numbers.  We want to approach people who are suffering, distressed, frightened and on the verge of despair with empathy to end their pain.  Our goal is to be a friend to someone who seeks a friend and a symbol of hope to the needy”, he added.

Observers stress that Nigeria is blessed with a lot of qualified, seasoned and proficient medical personnel, and doctors, who can manage any medical condition or disease. However, serious improvements in state of Nigerian hospitals in terms of equipment and funding will go a long way in curtailing medical tourism.

A veteran nurse and midwife, Mrs. Olayinka Adeyemo, who spoke with Sunday Mirror on the subject, said, Nigeria must first of all solve the problem of electricity. “This is a major problem in medical practice. A private hospital in Nigeria that is running on diesel on a daily basis cannot perform a surgical operation at the same cost as an Indian hospital would. It will be cheaper. Our epileptic power supply is a major obstacle to curbing medical tourism”, she stressed.

Unending demand for state creation

By YEMI OLAKITAN 

 

 01 March 2015

Many interests have mobilised to campaign for creation of more states in Nigeria. These agitations have been persistent and seemingly endless. Nearly every ethnic group has at one time or the other demanded its own state even though most of the 36 states remain economically unviable and rely on monthly allocations from the Federal Government to survive. Ag. Head of Investigations, Yemi Olakitan looks at the politics.

There seems to be no end in sight to the demands for state creation in Nigeria. Ethnic jingoists and politicians keep agitating for state creation in order to address perceived marginalisation of their people in the scheme of things. The campaign for state creation has always been present throughout the history of Nigeria and has continued to this day.

Each ethnic group has continuously come to think of itself as a distinct entity with interests and demands. They want states created whether or not the states have the capacity to survive economically or not. At a time the late sage Chief Obafemi Awolowo mocked some of the proponents of states creation when he said that such agitations will stop when his home town, Ikenne, becomes a state.

According to vocal preacher and activist, Pastor Tunde Bakare of Latter Rain Assembly, only about four of the states in Nigeria are viable. According to him, the agitations for state creation are usually to satisfy ethnic nationalism to the detriment of Nigerian nationalism. Most of the states are wholly dependent on the federal purse for survival.

Olufemi Gbolahan, a politician and native of Ado-Odo Ota local Government in Ogun State observed that “the call for state creation is ever present among us and it is usually as a result of marginalisation and lack of development of certain ethnic groups or areas in the country. Nigeria is a nation of diverse tribes, languages, cultures and religions and each group wants to have a share of the nation’s resources. Nobody wants to be left behind in terms of development”.

Speaking further, Gbolahan said, “The issue of marginalisation is also real. Take the Yewa community in Ogun State for example, where I come from. We have always been marginalised. Ado Odo-Ota is the richest local government and the most industrialised in Ogun State. It is also the second largest and yet the least developed. Ado-Odo-Ota has never produced a governor in Ogun since the state was created and all the past governors have concentrated development efforts on Abeokuta, the capital city. Take Ado-Odo for example, development in Ado-Odo is zero, the roads are bad, there is no university, no college of education, no polytechnic and the town is nearly the size of Abeokuta, Tell me, why we won’t support the agitation for state creation? These are the factors that lead to the campaign for state creation in Nigeria.”

Speaking further, he said, “State creation is good for a nation like Nigeria because of our diversity. No matter what the skeptics say. The states will develop with time and will become strong. Rome was not built in a day. We need states because it creates a sense of belonging.” he said.

Investigations by Sunday Mirror reveal that the agitation for states creation can be traced to the British Colonial Administration with the indirect rule system which was created to suit the purposes of colonial ideology and ease of administration. The indirect rule system encouraged ethnicity since Nigerians of Northern and Southern regions did not interact as one people. The colonial master was more interested in the easy administration of the large entity called Nigeria,

Thus, the phenomenon of regional ethnicity found its way into Nigerian politics. The earliest political parties in Nigeria; the National Council of Nigerians and Cameroon, NCNC, founded in 1944, the Northern People’s Congress, NPC, and Action Group, AG, both established in 1951, were defined along tribal and ethnic bases.

Ethnicity and regionalism became Nigeria’s way of life. It was this development that led to minorities’ agitation for self-determination in virtually all the regions during the colonial rule. Ethnicity has been a re-occurring factor in Nigerian politics since then. This has continued to influence the agitation for state creation. Successive governments also use state creation either as a tool for political self-enhancement, or as a means to gain stronger hold on power.

Nigeria was initially a Federal State with three regions – Northern, Western and Eastern regions, during the First Republic; the Mid-Western Region was created out of the Western Region. These regions were virtually self sufficient depending on mainly agricultural produce and exports to keep their respective economies going.

Historians suggest the creation of that region was aimed at the excision of the non-Yoruba from the Western region. It did not arise from genuine concern by the nation’s leaders for the predicament of the minorities. The reorganisation was part of vindictive campaign by the ruling Federal coalition parties – the NPC and the NCNC to destroy the opposition party, the AG, while resisting the statehood ambitions of minorities in their home regions.

The creation on 27th May, 1967 of 12 states from the existing four regions by the Gowon regime was an attempt to nip the secession of the Eastern Region bid in the bud.

It was as a result of a desire to cut the influence of the then Governor of Eastern Region, the late Chief Chukwuemeka Odimegbu-Ojukwu at the height of hostilities between the Region and the Federal Government. It was also aimed at solving the perceived political problem threatening the continued existence of Nigeria as a single entity.

However, the politics of state creation has not taken into account the ability of these states to sustain their existence.

Also, another set of problems started with some ethnic groups claiming that the new states were highly unequal. For example, the North-Eastern State alone accounted for about one third of the total land area of Nigeria, while the 11 other accounted for the balance. In view of these, Gowon promised that he would review the whole issue of state creation after the war.

This promise heightened the tempo of demands for new states, but no effort was taken to re-assess the exercise until Gowon was overthrown in 1975.

When the late General Murtala Mohammed overthrew General Gowon, he quickly set up the Justice Ayo Irikefe Panel to look into the issue of state creation. The panel received about 32 demands for new states. It was based on the memoranda submitted to the government by the panel that the number of states was raised to 19, on 3rd February, 1976. The 19 states were Lagos, Ogun, Ondo, Oyo, Bendel, Cross-River, Anambra, Imo, Rivers, Kwara, Benue, Plateau, Borno, Bauchi, Gongola, Sokoto, Niger, Kano and Kaduna. The 1976 exercise was implemented in the wake of a phenomenal growth in Federal petroleum exports revenue. Thus, in addition to being a vehicle for extending political and economic self-governance to distinct ethnic communities, states creation became an administrative strategy for the devolution of Federal generosity to an unstructured array of territorial communities and coalitions.

This gave rise to a phenomenal increase in the demand for even more states as various ethnic groups and elites struggled to maximise their share of the national cake. Consequently, the Igbo people argued later that a situation where they had only two states (Anambra and Imo) from the 1976 exercise while the Yoruba and Hausa/Fulani, the other two majority groups, had about five each, was unjust and unacceptable. Invariably, the agitation for states creation in the country became a contest among majority ethnic groups, struggling to square up, more than the struggle of the minorities for self-determination. The agitation for more states went unabated during the Second Republic (1979-1983) and the demands for new states were so volatile that none was eventually created till the collapse of the Republic.

When General Ibrahim Babangida took over power in his 1985 coup, the clamour for states creation reached new heights and he set up the Political Bureau, headed by Dr. S.J. Cookey to look into the fresh demands.

It was based on the recommendations of the Bureau that the Federal Government in September 1987 created two more states – Akwa-Ibom and Katsina – thus, increasing the number of States in the country to 21. The Bureau had actually recommended the creation of six new states – Akwa-Ibom, Delta, Katsina, Kogi, Sarduana and Wawa.

In creating the two states, Babangida announced that the demands for new states will no longer be tolerated. However, in August, 1991, the regime reversed itself and created nine new states to bring the number of states to 30. The nine states were Abia, Enugu, Delta, Jigawa, Kebbi, Osun, Kogi, Taraba and Yobe. The regime justified the creation of more states as the need for balanced federation, bringing government nearer to the people, even development among others. However, critics insisted that “the 1991 exercise was largely intended to galvanise support for the regime, whose strength was ebbing and to compensate close allies.”

The agitations for states creation seemed to redouble when General Sani Abacha came to power in 1993. Thus, following the recommendations of the National Constitutional Conference on the need to create more states, Abacha set up a Committee for States Creation, Local Government and Boundary Adjustment, headed by Arthur Mbanefo. The Committee received a total of 85 requests for new states and on the occasion of the country’s 36th Independence Anniversary on 1st October, 1996; late Abacha announced the creation of six new states. This last exercise brought the number of states in the Nigerian Federation to 36 States and the Federal Capital Territory, and 774 Local Government Areas.

The question remains whether the continuous division of Nigeria into smaller, weaker units has actually brought government, power and development closer to the people.

Postponements of state creation have argued that the creation of states brings the government closer to the people because of the population and land mass of Nigeria. It has also been argued that state creation reduces marginalisation.

As result, The National Conference under President Goodluck Jonathan approved 18 requests, in principle, for state creation across the country as a way of meeting the yearnings and aspirations of the people.

The approved requests, included Apa State from the present Benue, Kainji from Niger State, Katagum from Bauchi State, Savannah State from Borno, Amana from Adamawa, Ghari from Kano, Gurara from Kaduna, Etiti State from the South-East zone, Aba from Abia, Adada from Enugu, Njaba/Anim from both Anambra and Imo States, Ogoja from Cross River, Anioma from Delta, Ijebu from Ogun, New Oyo from the present Oyo State and others. The conference said apart from the 18 new states proposed, a separate state-yet-to-be named should be carved out of the South-East to bring the number of the states in the zone to six. The conference said the creation would correct the imbalance of the zone having the least number of states. In the existing 36 states arrangement, each zone has six states with only the North-West having seven states. It was agreed by the delegates that the 18 new states would be shared among the six zones in a manner that no zone would have more states than the other. It was also agreed that states were free to have their own constitutions. The delegates rejected a motion that the number of states in Nigeria should not be more than 55. This gives the impression that in the future more states could still be created.

A delegate, Mr. Femi Falana, SAN, condemned the decision to create more states. He said the action was at variance with the decisions and resolutions earlier taken by the conference on the need by government to cut costs. “Having regard to the several resolutions of the National Conference on the need to reduce the cost of governance, I found the recommendation for the creation of additional 18 states rather contradictory,” Falana said.

Another delegate, a SAN, Chief Mike Ozekhome said, “I stand by the recommendations; we have recommended that 18 more states and an additional state should be created for the Igbo, they are the only one with five states. With 54 states I believe that government would be brought closer to the people.”

According to Mrs. Funke Adekoya, SAN, the creation of more states will not solve the problem of underdevelopment. “I don’t think that it will solve the problem of bureaucracy in the society. What I think we should focus on is the delivery of dividends of democracy to Nigerians. I don’t support creation of more states.”

In another chat with Barister Jesica Ikechuwu, she was convinced that the prospects for national development depend on the emergence of a courageous, visionary and national leadership stressing that Nigeria needs a true Federal system. Ikechukwu said, “The center is too strong and the states rely too much on resources from the center.”

According to her, ‘‘the endless demands for state creation will not end unless there is real development in the grassroots such as good roads, electricity, access to education and affordable health care. “Unemployment must be reduced to the barest minimum. As long as these problems are rampant, we will continue to have agitations for state creation in the next two or three decades,” she said.

Pa Ayodeji Ogunjobi, the president and founder of Hope for the Youth initiative, a non-governmental organisation focusing on the problems of youth unemployment in Nigeria, said “the creation of more states will multiply the existing problems – ethnic minority issues, lack of development, corruption, unemployment.’’

He said states must begin to look inwards and generate income by themselves in such a way that they can become economically strong.

“A situation where all the states created continue to look up to the Federal Government for monthly allocation for survival will continue to inspire fresh agitations for state creation in the country. If the states created already become economically strong and prosperous, the incessant agitations will die,’’ he said.

According to Senate President, David Mark, states creation will bring development closer to the doorsteps of many Nigerians. The scope of political development will be widened to accommodate more governors, more legislators, more state high courts, more police officers. More states will also see to the presence of more federal agencies in the states including higher institution of education as well as other modern developmental structures like airports, banks etc. The agitators for states creation maintain that such an exercise will create an opportunity for the marginalised people or ethnic groups to have access to power. They also maintain that by creating new bureaucracies, it will give mass employment to youths and other qualified graduates.

However, current realities indicate that more states could create more problems than they were meant to solve.

According to the former Governor of the Central Bank of Nigeria, CBN, now Emir of Kano, Muhammad Sunusi II, most of the present 36 States in Nigeria are economically unviable.

Analysing the precarious finances of the states last year, he had said, “Most of the states are spending about 96 per cent of their revenue in paying civil servants’ wage bills. We have created states and other structures that are economically unviable and the result is that we do not have funding for infrastructure, education, health and so on. The unviable status of the existing states has therefore vitiated the argument for more states. Almost all states depend on the Federation Account to survive, and this dependent nature of states makes them subordinate to the Federal centre and negates the Federal principle of local autonomy”.

He had noted that because of the large number of sharing units and the lack of independent sources of revenue, the dependence of these units on the Federal government has virtually impinged on their autonomy and hindered their capacity to carry out independent development.

Other analysts also point to the fact that reduction in land space that comes with carving out new state from existing ones, implies a drastic reduction in the economic power and activities of the states.

Addressing the effect of incessant state creation on the autonomy of the state and true fiscal Federalism in Nigeria, former Vice President Alex Ekwueme observed that, “the increase in the number of states has tended to reduce the states to a level where they have virtually ceased to function as component, autonomous and cognate units in a Federal polity.”

Investigations reveal that there are many federations with higher populations, larger land mass, ethnic and other diversities, higher GDP and higher internally generated revenue by the federating units, yet, have less states than Nigeria.

Indeed, if Nigeria were a federating unit in the United States of America, she would have been the 25th state, in the ranking of the US States by their GDP after Louisiana. Nigeria’s GDP is less than five per cent of the US national GDP.

According to Elder Theophilus Ajibola, an educationist, “State creation if not controlled will not move the country forward. States creation is not, in the least, an answer to the myriad problems the country is facing. Previous exercises have never been done from the perspective of bringing government and development closer to the people. Rather, it has been to score some political goals and satisfy particular interests. A constitutional adjustment that will ensure true federalism, rather than creating unviable and dependent states will help develop the nation economically.”

Speaking further, Ajibola said, the states should be allowed to control up to 50 per cent of their resources. “This will reduce the number of agitations for new states because many of the proposed new states have no economic basis to sustain themselves, except their dependence on federal revenue. It will also encourage states to look inward for internally generated revenue thereby diversifying the economy”, he said.

Sunday Mirror investigations reveal that to actually get the government and development to the people, there is need to reposition the local governments, which is the closest tier of government to the grassroots. The local governments are operating under the strangulating control of state governors. They are centers of corruption and mediocrity. The powers and functions of the local government system should be enshrined in the Constitution and their finances ensured.

Some other commentators point to the fact that new state will only end up as additional cost centres, which Nigeria cannot afford.

In a nation where electricity remains epileptic and industries are relocating to neighboring countries for a more efficient operational base, creation of more states will further raise the already high cost of governance in the country.

Each of the states to be created will become a new cost centre to the federation account. The newly created states will need fresh civil service of their own, a legislature, governor, aides to the governor, commissioners, local governments etc. All these are new cost centers to the federation.

At the moment, both the federal and state governments spend close to 70 per cent of their annual budgets on salaries and cost of running the government. There is little or nothing left for infrastructure and other social services. The result is the high level of under-development in the country.

State governments cannot even pay the N18,000 minimum wage approved for civil servants by the Federal Government. As more states are created, the share of the states from the federation account diminishes.

The consensus however is that creation of new states in Nigeria has had both negative and positive effects on the wheels of governance in Nigeria at different periods.

However, despite the present situation, the creation of states in Nigeria has gone a long way in fostering unity, minimising conflicts, and bringing government closer to the people, avoiding domination of the country by one section of the state by another and ensuring a reasonable level of economic development of all parts.

Another impact of state creation in the business of governance in Nigeria is the fact that the practice has enhanced greater political participation by local governments.

As more states were created in Nigeria, grassroots participation in government and development has increased. The people at the local level benefit directly from the creation of states as they feel less dominated within the existing structure.

If the rationale behind the creation of new states is sincere and effectively applied, there would be healthier economic development and effective collaborations among the various tiers of government in Nigeria, as some have argued.

Apparently, the report of the National Conference indicates that Nigerians are not done yet and state creation will likely remain a key feature of political dialogue for some time to come.