Alumni Stories

Dr. Nii Ayite Coleman, Takemi Fellow 1997-1998

Dr. Nii Ayite Coleman is a public health physician specializing in health systems policy and financing. He has extensive experience working as a physician, public health manager, policy maker, and public health regulator in Ghana. He is currently with the Ministry of Health as the Focal Person for the National Health Insurance Scheme.

Dr. Coleman’s career as a physician and public health leader began during his studies of medicine at the Kwame Nkrumah University of Science and Technology in Ghana. After his medical education, he assumed the position of Medical Officer in Agogo Hospital in 1985. In 1987, he began a residency program in pediatrics at Komfo Anokye Hospital and later strayed into public health. Dr. Coleman’s education continued with his attainment of a public health degree from Harvard University School of Public Health. In 1997, he became a Takemi Fellow.

He served as a District Medical Officer of Health in Jasikan from 1998 to 1990 when the law on decentralization was promulgated, and was a pioneer in the creation and development of District Health Services. As Regional Director of Health Services from 1992 to 1995, he led and managed the decentralization process as well as the establishment of District Health Services in the Brong Ahafo region, and provided technical leadership in the establishment of the first District Health Insurance Scheme at Nkoranza, Ghana. As Director of PPME from 1988 to 1998, he provided technical leadership in the conception and development of Ghana’s National Health Insurance Scheme.

Dr. Coleman served as Director of Public Health and Metropolitan Medical Officer of Health for the Accra Metropolitan Assembly from 2002 to 2004 and reformed health inspection in the metropolis. He also worked in Nigeria from 2005 to 2006 as a consultant with Partnership for Transforming Health Systems (PATHS) project as State Team Leader for Benue. He is currently on the Board of Directors of The Wawa Project, a non-profit organization improving physical access to all facilities within a school for children with movement disabilities and enhancing retention of children with physical disabilities in school.

Throughout his public service career, Dr. Coleman coupled public health practice with teaching. He taught several courses at both the School of Medical Sciences, KNUST and the School of Public Health, University of Ghana. He is Fellow of the Ghana College of Physicians, and in 2011, he introduced health policy education into the curriculum of the Ghana College of Physicians and Surgeons. He later established and led the development of a Health Policy and Leadership program to train public health physicians at the College.

How has the Takemi program contributed to the development of your career?

The Takemi Program engendered a clear definition of my domain of expertise and deepened my commitment to public service. It afforded the time and flexibility to reflect on an early phase of my career, to reconcile the theory and practice of public health with my own experience and unique insights as a public health practitioner and manager, and to crystallize my perspective on global health.

What do you believe are the most pertinent global health issues the next generation will face?

How are we allocating the scarce health resources? Consumption on healthcare or investment in health development? UHC is focusing global efforts and resources to improve health on healthcare instead key determinants of health. We are devoting scarce resources to  healthcare consumption instead of health development that emphasizes nutrition, sanitation and hygiene, and the adoption of healthy lifestyles; we are buying increasing quantities of vaccines for the control of cholera whilst communities and citizens wallow in filth. I am questioning the cost-effectiveness of health spending. I am concerned about the misallocation of scarce health resources.

Who is controlling the resources and where are the resources being spent? Northern intermediaries control and take most of the resources back to their countries. This not only highlights another dimension of misallocation of resources, it raises the issue of governance in global health. How do we hold Northern-based advocates, activists, and non-governmental organizations accountable?

What one piece of advice to your younger self at the beginning of your public health career?

Public health is profoundly political – advocacy, activism, and delivery in terms or resource reallocation as well as the redistribution of resources in the society. The outcome of any public health initiative is influenced more by politics and less by technical capability. Hence, effective public health practice requires building alliances, bargaining with stakeholders, and making concessions; the ABC of politics.

Dr. Friday Okonofua, Takemi Fellow 1991-1992

We recently had the opportunity to speak with Dr. Okonofua about his experiences as a Takemi Fellow, research since completing the Program and perspectives concerning some of the most pressing public health challenges.

Dr. Okonofua is a Professor of Gynecology and Obstetrics and currently the Vice Chancellor of the University of Medical Sciences in Ondo City, Nigeria. He is also the founder of the Women Health and Action Research Centre (WHARC), a leading not-for-profit focused on reproductive health research. When he took part in the Takemi program in 1991, he was an Associate Professor in Obstetrics and Gynecology at the  Obafemi Awolowo University, Ile-Ife, Nigeria. He later served as Provost at the College of Medical Sciences at the University of Benin in Nigeria, and also as Program Officer at the West African office of the Ford Foundation in Lagos. Dr. Okonofua was initially drawn to the Takemi Program “because of its international fervor. I felt I had the opportunity to take my work in public health to the global stage by participating in the program.” We were able to interact “with key players in global health from around the world.”

Many Fellows have identified the Takemi Program as a turning point in their career trajectory. For Dr. Okonofua, the Takemi Program helped him to “to chart a new pattern for essential research and programming in the field of reproductive health.” He was able to apply this foundational knowledge not only to the context of his country, but to the broader African context.

Dr. Okonofua received funding from the Ford Foundation shortly after completing the Program. This funding led to the establishment of the Women’s Health and Action Research Centre and the African Journal of Reproductive Health, two institutions that have made and are still making impactful and significant contributions to the field of reproductive health. For him, “the mentorship aspect of the program whereby the program managers continue to support the program participants in working on health issues in their various countries and regions is unsurpassable by any of its kind that I know.”

Since the Program, what has been the primary focus of your work?

“Since completing the program, I have focused on interventional and translational research aimed at health systems strengthening especially within the context of the existing high rates of maternal, neonatal and child mortality in the African region. I believe that increased political commitment from policymakers is important to scale up best practices for improving the indicators of maternal and child health. However, unless policymakers have the evidence, they are unlikely to be able to take appropriate remediating actions. Our applied research is designed to provide evidence of effective interventions, and to push for policy transfer of the evidence for improving maternal and perinatal health within sub-national, national and regional levels.”

What do you see as the biggest public health challenge within your context?

“I believe that the biggest public health challenge in the Nigerian (and indeed, African) context is the inequitable and un-equal access to preventive and curative health care to different categories of citizens. The large concentration of extremely poor persons in the region is a major deterrent to access to health care. Yet, on the supply side, very limited improvements have taken place, in part due to the ill-effects of the continuing exodus of health professionals overseas, and the persisting lowly systemic organization of health services.”

In what ways have you taken steps to address this issue?

“I have taken my work with governments to a higher level of propulsion. I believe that governments at various levels ought to give greater priority and consideration to the health care of their citizens as part of the basic minimum in democratic governance. My current research focuses on building the capacity (and commitments) of policymakers and government agencies to effectively deliver primary health care and emergency obstetric care for the prevention of maternal, perinatal and newborn mortality in rural parts of Nigeria.”

What advice do you have for the next generation of public health professionals?

“My advice is that they should focus on addressing the most pressing public health needs of their immediate communities. Public health professionals should be able to undertake appropriate needs assessments on health priorities within their local contexts and lead the pathway to finding solutions to address such health and developmental challenges. In future, the relevance of public health professionals will be assessed at the global level, not by their technical know-how, but by the extent to which they contribute to improving health outcomes in their local communities.”