THE First Emmanuel Adeyemo Elebute Memorial Lecture, and matters arising
By Femi Olugbile
On the 21st of April, 2022, an event took place at the MUSON Centre, Lagos. It was the first memorial lecture held in honour of Professor Emmanuel Adeyemo Elebute, who died in 2019 at the age of 87 years. The Memorial lecture was originally scheduled for a date in 2020. However, the date turned out to fall on a time when COVID-19 was coming into its own, and much of the world was going into lockdown. The event was postponed.
Professor Elebute was a distinguished Professor of Surgery who scored many firsts in the Nigerian healthcare space. He was the first Provost of the College of Medicine, University of Lagos. He was the first Chief Medical Director of Lagos University Teaching Hospital, Idiaraba. He was the first, and only, person to hold both positions simultaneously. He was President of the Nigerian Postgraduate Medical College at a crucial time in the development of postgraduate medical education in Nigeria.
After retirement from public service, he, with his wife, Prof(Mrs) Oyinade Elebute, founded the Hygiea group. This grew into a Health Management Organisation and a Community Health Plan which did ground-breaking work in grassroots healthcare in Kwara State and elsewhere. It also spawned the Lagoon Hospitals, an entity that would become the first healthcare facility in sub-Saharan African to receive Quality Certification from Joint Commission International (JCI), the gold standard for Quality in the world-wide practice of Medicine.
With like-minded collaborators, Elebute set up the Society for Quality Health in Nigeria (SQHN), which was incorporated in 2006. The Society has since grown to a level where it is providing training on Quality Improvement to a wide swathe of facilities and health personnel across the nation. It has received certification from ISQua – the international body responsible for Quality Accreditation world-wide, to conduct Accreditation of health facilities under its own brand, thus becoming only the second body in sub-Saharan Africa, after COHSASA (the Council for Health Service Accreditation of Southern Africa), to domesticate the international Accreditation function. This represented the actualization of a life-long ambition of Professor Elebute – to have Nigerian health facilities at all levels, from ‘federal’ Teaching Hospitals to the lowliest Primary Health Care Centre, work towards being assessed and Accredited domestically for Quality in a way that will bring them on a par with international standards.
As the event got off to a start, Fola Adeola, Chairman of the occasion, got up to make his opening remarks. He started off by recounting the exact and precise rituals that aircraft pilots enact on the ground every time before taking an aircraft into the air. A long check-list of queries, meticulously gone through, item by item, and ticked off. As he explained, once the aircraft is airborne, ‘there are no bus stops’. He likened the need for meticulous, standardized and repeatable quality in healthcare to the situation in the pilot’s cabin. He spoke glowingly of his association with the late Professor Elebute.
‘His white shirt was always white’ he said, referring to the neatness of turn-out that was a part of the Elebute persona.
Fola Laoye, one of the children of the Professor, introduced the guest lecturer.
Professor Muhammad Ali Pate, is the Julio Frenk Professor of Public Health and Leadership in the Department of Global Health and Population at Harvard T.H.Chan School of Public Health, USA. He is the Co-Chairman of the initiative on the Future of Health and Economic Resilience in Africa (FHERA). He was also the Minister of State for Health in the Federal Republic of Nigeria for some time. While in the latter office, he was credited with the first efforts to introduce Quality Improvement in Federal tertiary hospitals across the nation.
His topic was ‘Reimagining the future of Healthcare in Africa – A Healthcare Quality Perspective’.
He started off by paying fulsome tribute to Elebute, who he knew personally. He emphasized the crucial importance of Quality in Healthcare and commended the efforts of the Society for Quality Healthcare in Nigeria in carrying forward Elebute’s vision. He recalled an incident that caused the death of a patient in one of the Federal Medical Centres in the northern part of the country when he was Minister. The matter was in the news, and he decided to pay an unscheduled visit to the Centre. Once there, he demanded to see records of the incident. It was clear that the hospital documents had been altered. When he took steps to dig deeper, he began to hear ominous rumblings from the workers’ Unions, accusing him of not following ‘due process’. Eventually the matter died. There was simply no evidence to work with. He described another widely reported incident involving the death of woman in a tertiary facility in Lagos. Her care and the communication with her family were mishandled at every step of her hospitalization, and her tragic, and avoidable death, left a very sour taste in everyone’s mouth. Nothing happened following the critical incident to give assurance it would not happen again.
He homed in on his key deliverable. Everyone, from politician to journalist, was talking nowadays about the need to achieve Universal Healthcare Access for all citizens. He wanted to add a caveat.
‘Healthcare Access without Quality is dangerous.’
Lecturer and honoree had coalesced around the point Elebute spent his final years trying to make. Quality was the crucial ingredient required to take the healthcare of Nigerians, high and low, to the next level. Universal Access, riding on the back of measured, standardised Quality at every level, was the entitlement of every Nigerian citizen.
Sitting next to Fola, the Chairman, on the front-row provided you with an opportunity to hear about his latest, colossal venture into healthcare finance. As usual he was economical with words, but you heard enough to catch a whiff of increasing enthusiasm for private sector participation in the business of healthcare in Nigeria.
You shook hands with Dr Pate.
It was time to leave.