From my days as a Paediatric resident training in the US, I saw the difference in the approach to the system of Pediatric training between Nigeria and the US, and the better outcomes that this difference yields.  This not only validated the knowledge that access to high quality healthcare (facilities and specialists) supports children to thrive and achieve their highest potential but also ignited a desire to effect necessary change at home.

In 2007, soon after I returned to Nigeria, I visited the Massey Street Children’s Hospital – MSCH, which unfortunately, years of neglect have left in a poor state. MSCH has a storied history in the Nigerian medical community and has been providing services to children since 1960.. It was initially conceived as a referral center and then an accredited post graduate training center, serving as the training ground for Nigeria’s first indigenous Paediatricians- notably Prof Adenike Grange. 

A few things struck me during this visit to MSCH.  There was no on-site mortuary or blood banking services; the emergency room was not on the ground floor, meaning emergencies had to be shuttled up and down the stairs by relatives to receive care or to be transported out of the facility. Also, the pharmacy and laboratory had very minimal capacity, and the radiology unit wasn’t functional. Therefore, patients had to get laboratory, pharmacy and radiologic services off site via a unidirectional access road running through a meat market. 

What I saw at MSCH set me on a personal mission to support the work of health care facility leaders in effecting systemic change. I carried out an initial assessment of the facility with a view to determining where their strengths and opportunities lay, and set aside time to map the opportunities for a transformation of MSCH. As work and life continued, I visited from time to time to understand the complex stakeholder network. Two years later, in 2009, I decided to pursue this transformation as part of my commitment as a fellow of the African Leadership Initiative West Africa and the Aspen Global Leadership Network, to take on a venture that would not only stretch me but would make a significant impact in the lives of others. Having spent time at Tygerberg Children’s Hospital in Cape Town, I had a sense of how a best practice African children’s hospital functioned. 

In the preliminary phase of the MSCH transformation, we used the transformation of the General Hospital Lesotho as a blueprint for brownfield transformation of a health care system.  At the time, I had the benefit of amazing advisors: Dr. Muhammad Pate and Dr. Kelechi Ohiri both then at the World Bank, and Mr. Ade Obatoyinbo who at the time was with McKinsey.  

Good fortune and strong networks prevailed.  We shared our initial findings with the Lagos State Government and through the help of Mrs. Ibukun Awosika, reached the then Governor Babatunde Raji Fashola, and Honourable Commissioner for Health, Dr Jide Idris.  Along with Mr. Chukwuka Monye of Ciuci, and with ongoing advice from Drs. Pate and Ohiri and Mr. Obatoyinbo, we conducted a diagnostic study of the Massey Street Children’s Hospital with permission from the Ministry for Health and presented our preliminary findings to the sitting committee of the Lagos State Health Ministry. 

Additional notable findings were that given the number of children being managed at MSCH annually and the broad range of their diagnoses, we were missing a significant opportunity to train locally relevant paediatric specialists. 

We presented our findings to the state team along with recommendations to proceed to transform the hospital in three phases- short, medium and long term. We would start with non-capital-intensive interventions measure the improvements and develop a plan for further interventions as we went along.  This led to moving the emergency room downstairs and the acceleration of the plans to resume an accredited residency training program. 

Unfortunately, our work ceased as other priorities emerged. However, our work with Massey made it clear that with continuing small interventions significant improvements can be made in the provision of healthcare that ultimately improve healthcare outcomes for children. Over the years, my commitment to this has not changed and my training in paediatrics and public health has led me to consider systems of care as critical for both training and care provision. 

Preventable paediatric deaths though significantly reduced are still with us, and in the past two decades in spite of all the progress we have made with infant and under five deaths across the African continent, we have not moved the needle on neonatal deaths. Related to this is the ratio of trained pediatricians to children on the continent- 1:100,000 on average (In Nigeria this ratio ranges from 1:95,000 to 1:875,000). With approximately 400 million children and less than two dozen dedicated Pediatric facilities on the continent, the children to facility ratio is far worse. 

Children are not miniature adults. Yet our healthcare systems often treat them as such.  Their healthcare needs are usually far more complex, requiring specialist care, and ideally requiring a multi-disciplinary team in nearly every phase of their development. Thus, systems of care need to be developed for child healthcare to be adequately provided. This is also true in newborn health and might explain our delays around solving the neonatal morbidity and mortality emergency. Childhood cancer, allergic and rheumatologic disease, childhood developmental delays, adolescent and sexual reproductive health, mental health, issues of child abuse and violence against children are largely ignored and have relatively little specialist representation. In the large teaching hospitals, even though the volumes of children’s health requirements largely equal those of adults, children get a fraction of the adults department healthcare costs because it is almost always incorrectly assumed that children benefit from primary healthcare services and have less need for secondary and tertiary healthcare. This might be so if the primary health care services were functional, but usually they are not, and screening and early intervention services are not readily available in many African countries.

My hope is that ACHF will catalyse increased advocacy and drive policy for the strengthening of paediatric health systems to successfully address the extensive healthcare needs of children on the African continent.