On Wednesday the 19th of November, the Professors Adeyemo and Oyinade Elebute Memorial Lecture took place in Lagos.
It promised to be a full day of activities hosted by the Society for Quality Health in Nigeria (SQHN) and the Elebute family.
The keynote address was to be delivered by Dr Don Berwick on the topic ‘Global Perspectives on Quality in Healthcare in Nigeria and the Nigerian Imperative.’
The issue of Quality in Healthcare in Nigeria was an abiding passion for the husband and wife Elebute partnership. They left on the healthcare space of Nigeria an impact that continues to expand day by day as more policymakers and healthcare practitioners buy into the vision. This was a vision of Quality Healthcare made accessible to the generality of the population. It led to the formation of the Hygiea HMO in 1984, and to the foundation of the Society for Quality Healthcare in Nigeria, in 2006. They set up the Lagoon Hospitals to practice what they preached.
Prof Adeyemo Elebute had already retired from the apogee of a distinguished career as a Professor of Surgery and the first Provost and Chief Medical Director of the Lagos University Teaching Hospital, Idi araba. Lagoon Hospitals went on to become the first health facility in sub-Saharan Africa to obtain international Quality Accreditation by the Joint Commission International (JCI).
The Society for Quality Health in Nigeria became the country’s first internationally certified body for Accreditation of Healthcare facilities, with the imprimatur of the Institute for Quality (IsQua), the international regulatory body for Accreditation.
Sadly, Prof Adeyemo Elebute passed on to the great beyond in February 2019, and was not around to see SQHN take its place in the sun as an Accreditation body in 2021.
Prof Oyinade Elebute remained around till September 2025, providing gentle guidance and a reassuring presence to a portfolio of innovative projects the couple had birthed, which had by then acquired lives of their own.
The choice of guest lecturer for such an occasion was always bound to be based on prominent recognition in the subject matter. Prof Ali Pate gave the first lecture in 2022. There was a rumour then that he would be giving up a recent appointment to head the international vaccine alliance GAVI to return home to be Minister of Health in the incoming Bola Tinubu administration. In his lecture, he had acknowledged gratitude to Professor Adeyemo Elebute for the relationship they had, and his passion for Quality.
A lot of water has passed under the bridge in the time since. Pate is now ‘Coordinating Minister for Health and Social Welfare’. A National Tertiary Institutions Standards Committee has been set up by his Ministry, charged with the task, among others, of ensuring the Teaching Hospitals attained proper Quality standards. SQHN, appropriately, is one of the bodies assigned with the task of guiding them through that process.
The choice of Don Berwick for today’s lecture carried gravitas, but also some political baggage. His distinction was not in doubt, with multiple degrees from Harvard, and a Knighthood from the United Kingdom. Under President Obama, he was Administrator of Centres for Medicare and Medicaid Services in the USA from 2010 to 2011. A vocal Democrat known to favour some aspects of the Single Payer National Health Insurance system of the United Kingdom over the expensive, profit-driven health insurance system in his home country, which left many poor people falling through the cracks. He resigned to contest for Governor of Massachusetts but lost his party’s nomination. A consultant paediatrician, he had left Harvard in 1989 to cofound the Institute of Healthcare Improvement, the foremost body for training and researching on Healthcare Quality worldwide. He remains a Senior Fellow at the Institute.
He started off with a restatement of the target areas for Healthcare Quality Improvement – Safety, Effectiveness, Patient-Centeredness, Timeliness, Efficiency, Equity. The Elebute acolytes in the audience would note in their minds that Adeyemo Elebute had added to the list ‘Empathy’, from the general observation that a sense of genuine compassion for the patient was often lacking in the Nigerian healthcare worker.
Berwick took his audience through the processes of the maturation of the Quality Agenda to the triple aims of improvement of Experience of individual Care, optimisation of Cost of care, and maximisation of the health of the population. He articulated an expanded definition of Quality to include social determinants of health. Sensitivity to the patient’s inner experience was crucial. He gave the example of the upset of a friend of his with a suspected diagnosis of a terminal illness who was given the routine answer that the result of his laboratory test would take ‘five working days’. He extolled the virtue of the ‘flash mob’ where everyone in the team enthusiastically contributed to meeting the needs of the patient. He spoke of a ‘Health Gap’ as part of the challenges of an unequal world, and decried inequities in power and resources. He was scathing in his criticism of President Donald Trump and the various cutbacks he has initiated.
To Nigeria, he recommended strengthening primary care, improving skills, and designing a ‘4-R’ project model of Recognise, Rescue, Reassess, Refer to urgently deal with the humongous maternal mortality burden of the country, which has 27 percent of all maternity related deaths in the whole world.
The audience applauded warmly.
A panel discussed the ‘Role of Quality in Universal Health Coverage’, and another examined the need for ‘Regulation as a driver of Quality’, focusing on the incipient creation of a National Health Facilities Regulatory Agency. There were issues that could not be taken, including the visible lack of Team-spirit and Leadership in the healthcare team, especially in the public sphere.
It was time to go.
It was a good way to celebrate the spirit and enduring impact of Professors Adeyemo and Oyinade Elebute on the Health of Nigerians. But it was, of course, all still work in progress.
