Nigeria Health Watch

Nigerians - walking the walk

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Fri, 13 Nov 2009 16:30:00 +0000

Its the beginning of a weekend so lets clebrate some of our own...

Chima Onoka has recently been appointed as the Country Representative in Nigeria for the IHP+Results team. IHP+Results provides an annual independent monitoring and evaluation review of the International Health Partnership (IHP+). This process of monitoring and evaluation was mandated by the IHP+ Global Compact and the subsequent high-level Ministerial Review in February 2009. Chima says that this is an exciting time in Nigeria and the work could not have come at a better time as there is currently significant progress underway here to develop state and federal health plans, which together will be compiled to form a National Strategic Health Development Plan. This is all in line with Nigeria’s overall Development Plan (known here as 20 by 2020). This week bilateral and multilateral partners, including the IHP+ Global Compact signatories, are working on this together. In fact, a substantial IHP+ Harmonisation for Health (HHA) international team are here in Nigeria to support this whole process, including costing and a framework for monitoring and evaluation.
Find details here...

This year's John D. and Catherine T. MacArthur Foundation's genius grants awards included two well-known names in oncology: One of them is our own Olufunmilayo Funmi Olopade, MD, Professor of Medicine and Human Genetics and Director of the Center For Clinical Cancer Genetics at the University of Chicago Medical Center-whose research on individual and population cancer susceptibility has been translated into effective clinical practice for treating breast cancer among African and African-American women. Olopade is working to close the knowledge gap in several ways, including teaching pathologists and residents at Nigeria’s University of Ibadan, where she received her bachelor’s and medical degrees, how to properly screen for breast cancer. She’s also working with government and drug companies to get treatments to Africans. Finally, she’s sharing the results from the study, funded by the Breast Cancer Research Foundation and the National Women’s Cancer Research Alliance, with her peers worldwide, including at the Fifth International Conference on Cancer in Africa this November in Sénégal. Find details here...

Afam Onyema went to Stanford Law School intending to go the Big Law route. He summered at Kirkland & Ellis and got an offer from the firm. But by the time he entered his third year in 2006, Onyema's plans had changed. He turned down the K&E offer and one from Paul, Hastings, Janofsky & Walker. Instead, he decided to open a hospital in Nigeria. In doing so, he was fulfilling his father's dream. Onyema's parents had moved from Nigeria to Chicago in 1974 so that his father, an obstetrician and gynecologist, could complete his residency at Cook County Hospital. His mother, a nurse, also finished her training in the United States. Find details here...

......the most we can do in "re-branding" our country is to highlight the great work of its people. One day we hope to also be celebrating the success of Nigerian institutions....

Are waiting times over at our public hospitals?

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Wed, 11 Nov 2009 09:30:00 +0000

There are many problems that one can solve with money. There are many that money cannot solve. One example is the time it takes to be seen by a doctor in any of our public hospitals. We have mentioned this in several blog posts in the past. In any public hospital in our country - the first patient for the day is normally seen by a doctor from 11 am. In all my time as a houseman and registrar in Nigeria - I cannot remember a consultant that started his clinic before 10am. ....as my colleagues would say "na so we deh do am for Naija"

...so I was quite excited to read a recent article in The Guardian of a new policy whose goal is that in the next one year.Have you heard about SERVICOM? If not read on.....

... the Federal Ministry of Health in partnership with Servicom office gathered all the chief medical directors of university teaching hospitals, specialist hospitals and the medical directors of Federal Medical Centres in Abuja to brainstorm on how to roll out a pilot programme aimed at reducing patients' waiting time at the General Out Patient Department (GOPD) of hospitals in the country developed by the Servicom office. The pilot implemented at the Federal Medical Centre, Keffi by the Servicom office reduced waiting time at the GOPD from seven hours to 30 minutes.

Read a full account here.

Wow...so we can do these things? ....We will congratulate our Honourable Minister of Health on this and we will watch the progress of the policy. We hope that it will be extended beyond the General Out Patient Departments to the specialist clinics where the consultants reign...What a difference this would make! What a difference....

The fact is that in the context of the options for quality health care, the best specialists are still found in our teaching hospitals. The primary reason people choose not to go to these places is because they are managed like everything else in our public sector...nobody cares about the "client" or "patient" in our case. You are made to wait for hours....walk around from laboratory, that can only do half of the required tests, to pharmacists that can only provide a third of the required drugs. To be admitted you have to buy your bedsheets, kerosene lamp, mosquito net, food, drinks, gloves for doctor, syringes for nurse etc etc (please I am not exaggerating!)....If you really want to know how bad things are try taking the body of a loved one to the mortuary of any of our teaching hospitals......

These things have nothing to do with the actual delivery of health care. Nothing. They are the reason NITEL failed, the reason NEP plc is the way it is, the reason why Nigeria Airways is extinct, the reason why Sam Mbakwe "airport" in Owerri is the way it is, the reason why it takes 4 hours to get past Ore, the reason why public our Univerities were closed for 4 months, the reason why to renew our passports at Nothunberland avenue in London takes a full day plus....it is not rocket science - its our public sector!

How do we fix it? Servicom is a good idea....

Servicom a social contract between the Federal government of Nigeria and its people. Servicom gives Nigerians the right to demand good service. Details of these rights are contained in Servicom charters which are now available in all government agencies where services are provided to the public. The charters tell the public what to expect and what to do if the service fails or falls short of their expectation.

Let us support the strengthening of Servicom. It will only work if we work with them. Its a challenge for us! Let us start with our hospitals. If they do not provide the service we expect ...do not accept it. Write about it. Send to everyone you know. Send it to Servicom through the contacts below..its your problem too! Its your public sector.

No 3, Usman Dan Fodio Crescent, Zone A4, opposite Banquet Hall, Presidential Villa

Asokoro, Abuja, P.M.B 622, Garki, Abuja
FCT, Nigeria

info@servenigeria.com

09-3140372, 08036591090, +234-9-3140373

....no patient would wait for more than an hour before seeing a doctor in any Federal Government owned hospitals across the country.

The race to build our to good health continues...

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Sun, 08 Nov 2009 21:42:00 +0000

Thisday reports that ...The Adamawa State Government, at the weekend signed an agreement with a German medical consortium for the construction of a N4 billion specialist hospital. The Governor of Adamawa State, said that when he was signing the contract with Munchner Medizin Mechanik (MMM German) group of companies for the delivery of a functional unit for diagnostic, operation and general medical purposes at the new Specialist Hospital, Yola, that he was committed to the hospital project as part of his administration’s determination towards the improvement of health care delivery in the state (Kai...I wished I was the one that brought in these guys!).

Anyways....we will be visiting Yola soon to bring you update you on progress.

But here on Nigeria Health Watch we continue to insist that the problems will not be solved by importing German firms to build our way out of our health problems. We have good hospitals already - if only we will manage them well. If only we can get the systems to work for the people...to manage the "smallest" of problems...

The article below requires no further commentary. It basically says that mosqitoes have run over the University of Port Harcourt Teaching Hospitals....

Mosquitoes! Maybe we need some German companies to put up nets and insecticides! We rest our case...

Physiotherapists ask - what about us?

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Fri, 06 Nov 2009 09:30:00 +0000

One issue we find with ourselves; Nigerians; is our huge sense of entitlement. It is all pervasive. We always want to be recognised. This is the same in our percieved national identity as the so-called "Giant of Africa" and in our individual love for titles ....Chief, Professor, Doctor, Architect, esq, JP, mni, etc etc etc ...we just cannot help ourselves.

This article in 234Next caught my eyes recently....

Physiotherapists ask government for better treatment

I naively thought that our physiotherapists were advocating for better treatment for their patients, for all the accident victims on our roads, for our stroke patients, and all the other challenges they face with the system...but no! That was really really naive of me....read what I found....

Nigerian physiotherapists have called on the government to give proper recognition to the practice in order to enhance the morale and output of practitioners. Speaking at the 50th anniversary of the Nigeria Society of Physiotherapy, on Thursday, in Lagos, its president, Adeoluwa Jaiyesimi, said physiotherapists in the country suffer discrimination.

Mr. Jaiyesimi faulted how senior officials in the health sector are appointed. "There are eight directors in the Federal Ministry of Health, and they are all headed by a medical doctor, except one," he said. "That's unfair. They are supposed to distribute the rest on a plurality basis."

I could not believe what I read...of all the health problems relevant for physiotherapists in Nigeria, the president of their organisation found the apparent lack of representation of the profession among the 8 directors in the Ministry of Health as the one thing to complain about! The most important thing...the "Single over- riding Communications Objective" of his speech.

Maybe I am really naive, but maybe we all have a problem. Where do we get this sense of entitlement from? On what is it based? On the concidence of our population size based on the arbitrary delineation of our borders by our colonial masters in Berlin, or based on the coincidental finding of oil in 1956 in Oloibiri in the Niger Delta? What ever it may be.....it is a problem....a big one.

The earlier we can loose this sense of entitlement for a sense of responsibility for the people....the sooner we will find the change we so desperately seek....Our personal and collective interests are important, and that is what unions are there to fight for, but there must be more for a professional society to advocate for durings its annual meeting.

Honestly...there must be more!

Health in Vision 20: 2020 and the National Health Bill

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Thu, 05 Nov 2009 01:44:00 +0000

We have blogged severally on the National Health Bill, on the strange process it has gone through, the intrigues in both houses of parliament in the past few years including retreats in Ghana. Our understanding is that the Bill has now been ratified by both houses and is with Mr President awaiting signing.

Over the past few months, the Federal Government, led by the office of the Vice President has brought together eminent Nigerians to draft a document to guide the implementation of its Vision for Nigeria to be one of the world's 20 leading economies by the year 2020. We reached out to the eminent colleague that led on working group on health for the Vision 20:2020 Document (which you can read in full here). We asked him on how his work was tied up with the new National Health Bill awaiting signing. We got a most amazing reply. Most amazing!. Reading his email correspondence reproduced below with his kind permission. He agrees like we suggested that Nigerians have a right to know how their demoracy works!

Dr Shima Gyoh, the chair of the committee on health for Vision 20:2020 did not see a copy of the National Health Bill until their last day of sitting.

Dear Chikwe,

Attached is my submission to the FMOH on the National Health Bill (NHB). As you noted in the report of the Health Schematic Group of Vision 20, 2020, our persistent efforts landed us a copy of the National Health Bill at the end of our work. I read it overnight and presented the attached “Problems with the NHB” to the group, but they correctly said our time was up, and the members did not have the privilege to go through the document and then discuss it as a group. Since there was not going to be an extension of the time, they did not want to be involved in doing emergency work on such an important document.

None of the “distinguished” members of the Health Schematic Group had previously seen, not to talk of participating in producing the document; the only member that was familiar with it was the representative of the Federal Ministry of Health. I was alarmed by the omissions and commissions in the documents, and the indications that it might have been produced without wide consultation within the health sector. Following a dispute as to whether the copy of the NHB which I reviewed was authentic, the Minister sent us a copy from his office, and it was identical to the one reviewed.

I was informed that it was too late to recall the Bill. My opinion was that rules and regulation are made by human beings, and nothing should be beyond change if it is to serve the public but contains serious deficiencies. I therefore sought to cause a re-think by submitting this document to the Minister, urging him that if this was really the final and authentic copy of the document we were hearing has been passed by both houses and was awaiting Presidential signature, it should be quickly recalled for urgent reconsideration.

Since I have not yet received a reply, I can only pray about it, meaning I have given up, and simply hope that the much taunted NHB is something much better than what I had seen and reviewed. Copies of it should have been widely available to the public at the stage of public hearing, long before the final debate on it. Yet even at our Group, getting a copy was no easy task. Our democracy is quite peculiar!

Kind regards from

Shima K Gyoh

Chairman, Health Thematic Area,

National Technical Working Group

The analysis presented below are personal, and I alone should be blamed for its shortcomings. The Health Thematic Group did not have time to go through it, but they unanimously felt that the Bill could do with more consultation. My own work on it was rushed, and not as comprehensive as I would have liked it to be. It is my strong belief that if the Bill goes through in its present form—granting that the version I have reviewed is the final form, it would create more problems and a demand for its amendment would come sooner than later. Shima K Gyoh

Primary Health Care Development Agency.

The Bill does not create a Primary Health Care Development Agency (PHCDA). Section 11 establishes a Primary Health Care Development Fund (PHCDF) which cannot be confused with an Agency because

1. The sources of the fund are spelt out in Sections 11 (1) and (2).

2. However, clause (4) of Section 11 suddenly begins to talk of the PHCD Agency, which is nowhere established in the Bill.

Can the PHDCF be converted to PHCDA? Not really for the following reasons:

1. The Established PHCDF does not have membership because it is only a fund, and cannot be both an agency and a fund, and there is no list of membership or of functions that can be proper for an Agency.

2. Conversion of the PHCDA into a fund-disbursing body would be disastrous for the health care in Nigeria. The Government, like the WHO, is emphasising that PHC must be greatly strengthened to constitute a good foundation for our health services. The function of PHC in the health care development in Nigeria is very crucial, and the Health Committee of Vision 20, 2020 is making strong recommendation to that effect. The Agency should be involved in full-time PHC activities.

Under the leadership of Professor Olikoye Ransome-Kuti, the FMOH embarked on setting up PHC units (posts, clinics, health centres and CHC) in the States as templates which each State could replicate to cover its entire territory. The FMOH naturally gave more attention to States that were slow in implementing their PHC services, thus achieving a more uniform performance all over the Federation. Because of the importance attached to PHC, the Ministry, which had several other functions, decided remove PHC out of its multiple commitments and delegate it to a new body it created, the PHCDA, which would devote its full time to the task without other distracting duties as was the case in the Ministry. This principle for creating the PHCDA might perhaps have been modified with time, but the parastatal should never be turned into a money disbursing body. The confusion of its name with Fund in the Bill is a serious mistake that should be immediately corrected before it becomes law, especially as the proposed legislation will benefit from wider consultation.

Federal Capital Territory PHC Board

Section 12 establishes the Federal Capital Territory PHC Board with membership and functions. Problems are:

1. There was no need to multiply the cost and lengthen the process of administration by establishing a whole Board just for PHC in the capital territory. A Committee of professionals would have done.

2. Nowhere in the membership of the Board is qualification and experience in PHC demanded. It consists of just technocrats with experience in accounting. Yet the Board is to “ensure coordination, of planning, budgetary provision and monitoring of all PHC services in the FCT.

The National Council on Health

Section 5 creates the National Council on Health (NCH). The following aspects need reconsideration:

1. Each meeting of the Council requires enormous work: gathering memoranda from the States, debating them at the Top Management Committee of the Ministry to determine the correct policy to adopt, and again at the meeting of the Technical Committee of the NCH when it is presented by the originating State. There are many challenges in trying to do this properly, as any person with responsibility of organising the NCH meetings should know.

2. Section 5 (3) provides that the NCH meets at least twice in a year. The NCH is a large and expensive meeting. The Ministerial Committee has about 58 members and the Technical Committee about 150. When one adds up the secretarial and other staff, one gets a minimum of 300 delegates. There are serious problems doing the job properly even when the meetings are held annually. If they are to be held every six months, both the States and the FMOH would abandon everything else and concentrate on NCH affairs. Policy matters do not require such frequent meeting. The meetings should remain annually, and the law should only provide for extra-ordinary meetings to satisfy the occasional need.

3. The private sector which is reputed to provide from 40% to 70% of services depending on the part of the country, is severely under-represented at the Technical Committee. Even if one includes the religious health organisations, their total representation would be only 3 out of 150, about 2%. If we are serious about the public private partnership, the private sector should be allowed fuller participation at the stage of policy formulation.

National Tertiary Hospitals Commission

Section 9 creates the National Tertiary Hospitals Commission which not only takes over some of the functions of the Federal Ministry of Health; it also subsumes nearly all those of the Hospital Management Boards. Is this commission really essential? What value does it confer on the system?

i. It is another administrative body that would need offices, office equipments, secretaries, vehicles and highly paid staff that would greatly absorb the scarce resources and multiply the expense of administration without significant added value.

ii. It is a serious delay “middleman” stage that would convolute bureaucracy and delay issues because the hospitals would no longer be able to get direct and quick access to the Minister on grounds that the commission should be consulted first.

iii. The Hospital Management Boards are also Bodies Corporate that can sue and be sued. Why this additional exposure to litigation? Why create a powerful body that is not directly in charge of the hospitals, and open up another avenue of likely conflict with the Management Boards?

Research or Experimentation with Human Subject

On health matters, only a person’s doctor can give reliable, professionally competent and acceptable advice. Therefore, if any human being is going to give informed consent to participate as a subject on research or trial of any sort, he or she should do so only after his or her doctor has studied the protocol and can advise on the possibility of adverse sequelae both in the short and long term. The advice, though not perfect, would be expected to be better than that of any other person, especially those involved with the proposed research.

Yet Section 33 of the draft bill nowhere provides for this. Section 33 (1) (b) says “... with the written consent of the person after he shall have been informed of the objects of the research or experimentation and any possible effect on his health.” This does specify anyone to do the explaining, and the research team would fill this vacuum.

The draft should be amended to require the family doctor of the propositus to not only explain things, but to be an obligatory witness to the written consent.

Unfortunate Legal Requirements

Legal Blood Donation: Section 50 (a) states “A person may not remove tissue, blood or blood product from the body of another living person for any purpose unless it is done (a) with the informed and written consent of the person from whom the tissue, blood or a blood product are removed granted in the prescribed manner and (b) in accordance with the prescribed conditions by the appropriate authority.” This provision is going to kill any attempt to set up blood transfusion services in the country. If you ask blood donors to first sign a legally binding agreement, they are going to be suspicious that you are about to do something that might harm them, and you are seeking a legal escape from the consequences. Suppose they ask the doctor, why must I sign this, what would be the answer? This provision should be deleted.

Section 53 (b) (i) Provides that the written permission of the medical practitioner i/c of clinical services in the hospital is required before an organ is transplanted from a living donor to a living recipient. This introduces unnecessary complication to a relatively simple process. The consent for the operation signed by the donor, the recipient and the operating doctors provides sufficient legal requirements to do the operation without convoluting the bureaucracy.

Section 56 (3) provides that “an organ shall not be transplanted into a person who is not a Nigerian citizen or a permanent resident of the Federal Republic without authorisation of the appropriate authority in writing.” This again is unnecessary convolution of bureaucracy already noted in Section 50 (a), and 56 (3). Once the health services of Nigeria become good, there will be an influx of many patients from other countries, just like it is happening with India. Consent documents signed by the people involved will not be improved upon by introducing third parties that might complicate matters and cause unnecessary delay and controversy.

Section 7 (2) (k) The FMOH decided in the 90s to abandon the phrase “Specialist Hospital” because it was used to mean many different things; the majority of people understood it to mean “a hospital where there are specialists.” The more accurate phrase “Specialty Hospital” meaning a hospital that deals with only one specialty should be used to describe such institutions, e.g. orthopaedic, psychiatric or eye hospital.

The National Health Bill 2008: More Consultation Needed

Finally, the Health Thematic Group of the National Technical Committee of Vision 20, 2020, consisting of experienced top players in the health sector from various specialties was surprised that, while their members had all heard of the National Health Bill 2008, none had had the opportunity to read it, and none knew for sure what its provisions were.

An interview with the Minister and our comments

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Wed, 21 Oct 2009 08:30:00 +0000

Many would have missed this interview with our Minister of Health as it appeared in the SPORTS section of The Guardian.

Healthcare: Our Steps So Far, By Minister

The interview is By Chukwumah Muanya - the Health Correspondent for the Guardian. We offer a few opinions on various parts of the interview to highlight issues we think are inmportant for the Honourable Minister and his constituency: you and I. Our commments are in bold script.

In recent times, the Federal Ministry of Health has received severe knocks on the sector's performance within the last 49 years. Minister of Health, Prof. Babatunde Osotimehin, who assumed office in January 2009, in this interview with CHUKWUMA MUANYA spoke on efforts to revitalize the country's health system, and what he has been able to achieve in the last nine months. Excerpts:

Strengthening of the national health system

The Federal Ministry of Health's vision is to reduce morbidity and mortality due to communicable diseases with a view to ensuring that this is reduced to the barest minimum, having minimal prevalence of non-communicable diseases, meet global targets on the elimination and eradication of diseases and significantly increase the life expectancy and quality of life of Nigerians.

In order to deliver on the above mandate, the Ministry therefore set out at the beginning of the year to develop and implement policies and programmes as well as undertake other necessary actions that will strengthen the National Health System to be able to deliver effective, efficient, quality and affordable health services, foster improved health status of Nigerians, serve as the engine for pursuit of accelerated economic growth and sustained development.

Achievements, nine months after appointment

Vide the advocacy of the Ministry the National Health Bill was passed by the National Assembly in the course of the year. It is expected to receive Presidential assent very soon. The Bill contains several landmark details with very important implications that will transform the entire national health system of the country. This includes the following: A provision for the allocation of two per cent of the nation's Gross Domestic Product (GDP) to the health of the country; and Establishment of the National Tertiary Hospitals' Commission.

Sir, Please at every FEC every Tuesday please BEG Mr President to sign this Bill. No systematic progress can be made in the organisation of our health care provision until this bill is signed into law. We will like to believe that Mr President is spending his evenings reading the details of the Bill...but after the years it spent at the House of Representatives and Senate, including associated retreats - all we can say is pls BEG Mr President to sign the Bill Sir.....

The Ministry has delivered on its mandate of coordinating the entire health sector such that the various constituent units are now better placed to carry out their functions and responsibilities to deliver healthcare to the people. In the course of the year, the Ministry has facilitated and achieved better coordination. Among others, a meeting of the National Council on Health was convened and held in Kano bringing together all stakeholders in the national health system most important of which are the 36 States of the Federation and the Federal Capital Territory (FCT) administration. In the course of the meeting, several far reaching decisions and resolutions were taken for the benefit of the health sector.

Sir, kindly share these far reaching decisions and resolutions, with us; the people. Afterall these reaching decisions and resolutions must be in our own best interests...or?

The Ministry also provided leadership for the States when we received Bill Gates in Nigeria. This led to the signing of the Abuja Declaration by the State Governors. The far reaching commitments contained therein along with follow up actions by State Governors have crystallized into tangible achievements for the polio campaign and primary healthcare among others.

Sir, like you, we were proud to see the great man on our soil, but pray sir, what are the tangible achievements this visit has "crystallized" to? Please share.

In line with the premium placed by this administration on primary healthcare, the National Primary HealthCare Development Agency (NPHCDA) has been repositioned to institutionalize and strengthen the primary healthcare system to enable the citizenry take advantage of the benefits that comes with it.

The implementation of the Midwives Service Scheme initiative has commenced most creditably. The scheme is borne out of the paucity and inequitable distribution of health professionals in the country. Thus, the plan is to recruit 5,000 Nurses/Midwives for posting to every local government in the country in order to reduce infant and maternal mortality. Further to advertisements and interviews of the applicants, about 2,580 Midwives are presently being deployed to primary health care facilities in all the 36 States of the Federation and the Federal Capital Territory

On polio eradication efforts

Nigeria's Polio eradication programme has achieved great strides in the last one year, the effect of which indicates that we are on the path towards the eradication of Polio in Nigeria. The Expert Review Committee on Immunization in Nigeria recently concluded a review of Nigeria's Polio Eradication programme. The team noted that there is a decline in the number of Nigerian children being paralyzed by polio and that this is as a result of the progressively increasing number of children being vaccinated countrywide. The experts concluded that if the improvements being achieved are sustained and expanded, Nigeria can stop transmission of all polioviruses by mid 2010.

Sir, here we have to agree with you. After years of inept leadership based on family ties, we finally have an agency on the verge of meeting its mandate to the Nigerian people - Sir - see what leadership does! But Sir if I were you...I would avoid predictions - 2010 is next year oh! But we hope you are right. We are tied of having to defend our position in the world regarding Polio...

Free malaria treatment for all Nigerians

On assumption of duty, I established a Special Task Force under my direct supervision to look after the issues of AIDS, Tuberculosis and Malaria. This is to enable the proper coordination of the national response to the diseases. This is the vehicle with which the Ministry has been moving towards achieving its Roll Back Malaria objectives of 50 per cent reduction in malaria cases and related deaths by the year 2010.

There has been a phenomenal increase in political, religious and technical assistance and commitment towards the control of malaria as a result of high level advocacy by government. For example, the country received the United Nations Special Envoy on Malaria twice in the last one year (Dec 4-5, 2008 and March 20-22 2009).

In April, 2009, the Sultan of Sokoto and the President of the Christian Association of Nigeria led the establishment and launch of the Nigeria Inter-Faith Action Association (NIFAA) in Washington, with the objective of integrating religious institutions to serve as important instrument and advocates for achieving universal access to commodities and treatment. The body brings together the leadership of the two major faiths in Nigeria to partner with RBM on routine and campaign activities.

Going from the advocacy and mobilization described above, Nigeria was able to attract external financial and technical resources to combat the scourge of malaria from the Global Fund, World Bank, British Department for International Development (DFID), United States Agency for International Development (USAID) and the United Nations System among others.

The Year 2009 has witnessed the commencement of a massive deployment of Long Lasting Insecticide treated Nets in the country in a coordinated manner. As at now and in line with plans and schedule, 6.2m Nets have been distributed. An additional 16m Nets will be distributed before the end of the year following a plan to distribute up to 62.5m of the Nets by December 2010.

With the active encouragement and strategic plan of the Government, a local manufacturer has installed in-country, capacity for the production of Long Lasting Insecticide treated Nets is expected to be commissioned in September, 2009. Two more installations are in the pipeline.

Massive roll out of Artemisinin-Based Combination Therapy (ACTs) for effective treatment. 32 million treatment courses have so far been distributed free of charge in public health facilities. Artemisia Annua, is also being cultivated on a large scale in the country and will provide one of the major raw materials needed for the production of ACTs.

As an ordinary Nigeria, all that matters to me really Sir is an assurance from you Sir that if I walk to the Primary Health Care Centre in Amaigbo, Nwangele Local Government Area in Imo State with my sick child, that he will be treated with ACTs, and that on discharge, I will be given a insecticide treated bed net to prevent future episodes. Sir, can you assure me that that is the case and I no longer have to go to the village chemist to mix my medicines?

Treatment for Persons Living With HIV/AIDS (PLWHA)

Nigeria's response to HIV/AIDS has continued to improve in all major facets. Awareness continues to increase, prevention messages continues to grow and the personal risk perception of the individual Nigerian is on the rise. Notably, free treatment is now provided for over 60% of those in need of it.

National Strategic Health Development Plan

The Plan is at an advanced stage and it is going on according to plan. It will be completed and finalized by the end of this year 2009.

Circular on the new Medical Service Scale (MSS) salary package for doctors

The Government has approved the new Medical Service Scale in response to agitation by Medical Doctors, which has been on for 11 years. A similar package is being negotiated with other professionals in the health sector to ensure that the welfare of every worker in the entire health sector is adequately taken care of. It is expected that as soon as negotiations are completed, the package will be ready for implementation at the beginning of 2010.

Thank you Sir. But you know it is not only money we want, although it might sound that way sometimes. We want you to take the management of our centres seriously. We want you to re-think the way our CMDs and Boards are appointed. We admit that many of us asked to manage large teaching hospitals have no clue about management, absolutely no clue. In fact many of us have not managed anything beyond our wives before we were given these huge budgets to manage. How will we manage? Sir, you do not blame us when we fail, when our hospital beds are emty, theatres not used and medicines not available. We need help Sir....

National Ambulance Services Scheme

The Scheme is to ensure that ambulances are available and working for the entire citizenry. The scheme is being operated under the leadership of the Federal Ministry of Health in conjunction with the Federal Road Safety Commission (FRSC), National Emergency Management Agency (NEMA), The Nigeria Police, The National Security and Civil Defence Corps (NSCDC) and the Federal Fire Service among other very important stakeholders. The pilot phase of the Scheme, which is for accident victims in and around the Federal Capital territory was launched in July, 2009.

Sir - ...but....so out of all the agencies you mention - who is actually providing the actual emergency MEDICAL services? NEMA? Sir, as you well know, an ambulance service is more than the ambulance. It cannot be a stand alone service. It can only work Sir, if integregrated in an emergency medical services programme involving accident and emergency services in specialist centres. There needs to be continuity of care from recieving the patient to recovery. This service will only work if it is LED by medical services, not by FRSC.....even if they bought the ambulances.

On quality of services provided at Federal Hospitals

Improvement in the quality of the services provided at Federal Hospitals, which has been a source of concern to Nigerians, has received major attention of the government. In response to this concern, the government has invested massively towards providing state of the art equipments in the hospitals. We have thus commissioned various projects in the Federal Tertiary Institutions' Accident and Emergency Unit, National Orthopedic Hospital, Dala, Kano, National Ear Care, Kaduna and the Neuropsychiatric Hospital, Aro, Abeokuta.

Thank you Sir. Pls help us beg your colleagues in the Ministry of Power to help us with the electricity to run these equipment. Sir, also apart from the equipment - the quality we seek are the "small" things. To be attended to quickly, for the doctor to be courteous, not to be asked to pay for gloves. Sir, the small things matter to small people.

National Blood Transfusion Service

The government has established 12 operational national blood transfusion service centers to provide blood transfusion service to the people. Five other centers are at various stages of readiness. Notably also, the Government has gone ahead to provide linkages between the centers and 40 selected hospitals nationwide to provide blood cold storage systems

On emergency preparedness and response for swine flu- A(H1N1) Influenza- Cerebro Spinal Meningitis (CSM), Lassa fever, and cholera

The country recorded a number of epidemics in the course of the last one year notable among which are those of CSM, Lassa Fever, Measles and Cholera. The Federal Government ahead of the outbreak of the epidemics issued alerts to the health authorities of all States of the Federation and provided drugs and laboratory materials in order to minimize mortality resulting from the epidemics. In all 6 million doses of CSM vaccines and 500,000 doses of ceftriaxone and oily chloramphenicol were distributed to the 26 high risk States

In this regard also, the Federal Government carried out an assessment of all public health laboratories in the 36 States and FCT in addition to several advocacy and sensitization visits to endemic places. Specifically for CSM, the Ministry held a training and sensitization workshop on enhanced CSM preparedness and response for all the 26 CSM high risk States officials including Health Commissioners, Directors of Public Health, Epidemiologists, Public Health Lab focal persons, Clinicians and WHO surveillance officers. Follow up actions included the Conduction of cases detection, verification and confirmation of CSM in addition to Supportive supervision for CSM vaccination campaign in the 26 high risk States.

The government inaugurated a Technical Working Group of the Lassa Fever Stakeholders Forum and went on to procure and distribute 300,000 and 100,000 doses of Ribavirin injection and tablets respectively for the treatment of Lassa fever patients.

With the advent of the A(H1N1) Influenza, the Federal Government quickly moved into action to inform the general public about the influenza in such a manner as to prevent the entry of the virus into the country. To do this, advertisements were placed in the electronic and print media to sensitize the public. In addition to this, information booklets, posters, fliers and pamphlets in various languages were also distributed far and wide in the country, including the airports and all the nation's borders. Special sensitization programmes were also embarked upon to bring the issues involved to the attention of relevant government officials at the nation's airports.

To prepare for any eventuality, the National Epidemic Preparedness Committee was inaugurated and sensitization meetings were held for all State Epidemiologists and desk officers to enable them respond appropriately if any case is discovered.

Thank you Sir, our humble advice on this is well known. As in most other countries we need a center with the expertise to respond to any infectious disease threat. Neither committees, nor task forces can save us if we do get a major epidemic....Sir please advise them at FEC - that infectious disease do not observe protocols. They too are at risk!

We hope that by asking these questions, the Ministry of Health will continue refining its policies. We are not in doubt that Professor Osotimehin has a massive challenge but also a great opportunity to bring health closer to the Nigerian people. We understand the difficult context in which he works. We wish him well.

Bitter sweet weekend....

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Sat, 17 Oct 2009 16:03:00 +0000

Yesterday evening I celebrated with most other Africans as Ghana won the U21 FIFA world cup. After several attempts this was the first time an African country was winning the cup. It just takes walking around any African country to understand what football means to us. But despite the joy, I went to bed reminiscing at my disappointment that Nigeria was eliminated early in the tournament and had previously been embroiled in the usual controversy around their ages. What an evening it would have been if it was "us"....I celebrate and envy Ghanaians. They have a functioning democracy, their economy is booming, they are respected in international politics..and now they are winning world cups. Bitter / sweet.

This morning I finally get to the piles of the journals I subscribe to for some speed reading. Then staring at me on top of the pile is this cover page..... The whole edition was dedicated to the progress being made in South Africa.

We are told the President Zuma has 5 priorities (unlike our 7-Point agenda). Health is not hidden in a tertiary category but firmly as one of the major 5. One of his campaign promises is not to build more health centres or CT scanners but to close South Africa's health gaps.

His South African Minister of Health acknowledged to Lancet that the new government will have a transparent, confident and science based approach, breaking cleanly from Thabo Mbeki's legacy. South Africa spends more on health both in absolute and relative terms than any other African country - 8.7% of its GDP. In its editorial The Lancet concludes that South Africa is a yound democracy with pride and hope, and above all with high expectations for a fair, equitable and peaceful society. Many of the articles in this special edition of the Lancet on Health in South Africa are available for free on the website of The Lancet. (will require registration).

What do these two stories have in common? Well to find out - visit the major hotels from Johannesburg through Capetown to Accra over the Christmas period in the next few months. You will find them full of Nigerians that can afford to travel. Seeking new solace in a pan African vision, with the demise of a Nigerian vision. Last weekend I was speaking to a colleague, a surgeon whose group has been collaborating with 2 major Hospitals in Ghana for years....he had tried for years to get something started in Nigeria, but finally gave up.

Yet if we want others to take us seriously, we have to take ourselves and our reality seriously. We all need to re-engage with the political process in the 2011 elections, and ask specifically what this government (at national, state and LGA levels has done with its mandate) in the health sector. If we want to take pride in events in our country and attention paid to it by preeminent journals in the world, and attract attention to a functioning country - we will all have to re-engage.

....

Stories from the ANPA convention in Abuja...

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Wed, 14 Oct 2009 08:30:00 +0000

You might have heard that the ASSOCIATION OF NIGERIAN PHYSICIANS IN THE AMERICAS (ANPA) held its annual conference for the first time ever in Abuja Nigeria, this year. This was done in collaboration with the MEDICAL ASSOCIATION OF NIGERIAN SPECIALISTS AND GENERAL PRACTITIONERS (MANSAG) in the UK and the NIGERIAN MEDICAL ASSOCIATION.

The symbolism of this is huge. DESPITE our government's perennial inability to figure out how to tap into one of its biggest resources - the human capital outside the country, Nigerians continue to insist on contributing to the development of their country. As we were not able to attend this conference ourselves - we will bring you a collection of accounts from various aspects and various points of view from this conference. In all these reports - you will find a common theme. You will read from, and about Nigerians that have chosen not to sit back and focus on their private lives, raising their children, playing golf and arguing about football. You will read about Nigerians that continue to give up their spare time and resources seeking ways to contribute...not because of their government's invitation but despite their government's indifference.

This is one account - on an issue we rarely consider in health care - management.

by Enoma Alade

The health care situation in Nigeria is recognized by many as facing challenging times. By many indicators e.g. immunization, mortality rates, it is actually worse today than it was in the 1980s. Several diaspora physicians have recently responded to the call to help improve the health care system by building new hospitals - several of which have been commented on in earlier blogs. However, for every successful diaspora health venture (we applaud Dr Johnson's recent successes on the cardiac front), there are quite a few unsuccessful ventures which have resulted in a waste of resources.

At the recently held Association of Nigerian Physicians in the Americas (ANPA) Annual convention in Abuja; Anadach Consulting Group organized a workshop that addressed Key Drivers and Challenges to consider in setting up a successful healthcare business in Nigeria and other emerging markets. The panelists included physician management, legal and business experts from Nigeria and the US. Physicians and other medical professionals tend to focus on the clinical perspective and often underrate the managerial or administrative challenges required in ensuring a sustainable operational service is in place. It is refreshing to see that ANPA decided to address these perspectives at its first convention in Nigeria.

Further information on the workshop and the presentations are available on here

Stella Obasanjo - Before we rejoice...

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Fri, 09 Oct 2009 08:30:00 +0000

The media was agog a few weeks ago with reports that a plastic surgeon in Spain was convicted of negligence in the death of Nigeria's former first lady, and was given a suspended sentence of a year in jail...

Stella Obasanjo, wife of then President Olusegun Obasanjo, died Oct. 23, 2005, two days after undergoing liposuction on her abdomen and other parts of her body at a clinic in the southern Spanish town of Marbella. A court in Malaga convicted plastic surgeon Antonio Mena Molina of negligent homicide. (a criminal charge brought against people who, through criminal negligence, allow others to die.) Mena was also barred from practicing medicine for three years and ordered to pay euro120,000 ($175,000) in damages to the former first ladies son. The judge said Mena Molina had shown "carelessness and neglect."

The medical profession prides itself across the world for self regulation in the first instance. The case described above that has gone through the legal system is an extreme example. Another recent case in the UK that is leading to fundamental changes in how out-of-ours care is provided is the story of a "German" doctor Dr Daniel Ubani who is reported to have given a patient 10 times too much painkiller while working for a Cambridgeshire health trust, as a locum out-of-hours general practitioner. It might have been a mistake - but he is paying a huge price, has a suspended sentence over his neck and almost irreparable loss of reputation. Many people think he got off lightly.

So what would be the consequences of medical malpractice in Nigeria?

Zilch... nothing. Many colleagues get away with murder.

We acknowledge the valiant work of Dr Shima Gyoh, during his time as Chairman, Medical and Dental Council of Nigeria. Dr Gyoh tried to get the MDCN to make the doctors and dentists self regulate thier profession. We watched sessions on Network news where colleagues were brought to face up to their responibilities of accountability. We saw the Registrar of MDCN; Dr. C. O. Ezeani, compulsorily retired. The MDCN needs to be supported and strenghthened. Meet the council members here.

But...not anymore.

You must have read about the murder of Bayo Ayanlola Ohu, who until his death was the Assistant News Editor, Guardian Newspapers. What you might not have read is that Bayo was rushed to the family's hospital located within the Akowonjo area in Lagos but was rejected and no treatment could be administered to him due to the apparent non-provision of a police report. (for non Nigerian readers - this refers to a report to say that the gunshot victim is himself not a robber!!!) The requirement for a police report before treatment is not part of the Nigerian constitution, and ofcourse breaks all our fundamental human rights. Even the Nigerian Police despite its legendary apathy has severally gone public to declare that this does not exist.

BUT THAT HOSPITAL REMAINS OPEN. You will not hear a whisper from the MDCN, nor from the Nigerian Medical Association. We all coil around in silence and pretend we are different. We are not. We are ALL guilty.

Even if there is such a ridiculous directive in place can our profession not stand up and say NO? Can we not inistst that we are bound by the vows we all make on graduation. By not treating a sick man in front of him, is this colleague not guilty negligent homicide. For the rest of us that have taken similar vows, yet keep quiet in the wake of this incident, are we not all complicit in NEGLIGENT HOMICIDE?....

Well...we live in a country where there are no consequences for the paths of dishonour we chose.....sadly therefore, no incentive to chose a path of intergrity....

Nigeria's cancer advocate on CNN

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Sun, 04 Oct 2009 18:33:00 +0000

CNN has a new programme; AFRICAN VOICES that highlights the activities of amazing people from our continent. Many great interviews every Saturday with our heroes...the real heroes that we as Africans hear very little about; Trevor Ncube a Zimbabwean is one of southern Africa's most powerful publishers, Leslie Lumeh; the 39-year-old Liberian artist exiled during the country's civil war, but who returned after the conflict to open a gallery, and the Moroccan Malika Zarra that has taken her mezzo-soprano voice across the world.

I was intrigued when I recieved the email advertising this week's programme....

Nigerian princess Nikky Onyeri has takes the issues of health in Africa After being wrongly diagnosed with breast cancer, she founded the Princess Nikky Breast Cancer Foundation to improve detection and treatment.

...and what a programme it was....watch it here on CNN

We were treated to an engaging interview to an "ordinary" Nigerian, telling the story of how she found her calling. She was misdiagnosed with breast cancer and was thrown into the complex world of understanding cancer.

Breast cancer is one of those few cancers for which a significant proportion can be prevented. But this prevention can only happen with a complex of factors relating to the individuals' awareness and proactivity in self examining, the availability of screening programmes (as opposed to screening machines) and the availability of the expert health care provision to provide care including surgery.

...it was even more intruiging to listen to her work being described as;

"Profoundly effective"

"Her tenacity is legendary"

....but most intriguing was the story of how she brought together all African First Ladies to a meeting in Cape Town South Africa to help put breast cancer on the agenda....There were clips of an articulate Mrs Museveni saying...."You cannot say "NO" to her"

....are you thinking what I am thinking? If CNN could find this lone voice from our country to give a voice to this problem., why has our first Lady and her minders not worked with her in their planning of their £40M Cancer Centre in Abuja.

Breast cancer, like other cancers are complex health challenges. Rather than another multi million dollar centre, we really need to the thinking that will help provide a system.....from prevention to early detection by screening to referral systems to surgical services to radio and chemotherapy to palliative care....across primary, secondary and tertiary care, with equitable access to women from Maiduguri to Yenogoa.

NOT POSSIBLE? - that is the same thing NITEL told us 10 years ago! Remember?

This is Princess Onyeri's message.....hopefully someone will listen.

Their Nigeria.....

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Thu, 01 Oct 2009 21:57:00 +0000

Today is October 1. Our country is 49.

It would be easy for us to do a post about how bad things have become after 49 years. To write about how our collective dreams have remained just that; dreams....how in even the short lives that my generation of Nigerians have lived, we have seen our country regress so much. It would be easy for us to write yet another blog on the cholera outbreaks reported this week in Adamawa, cholera!!!!. Easy to write about our ongoing challenges with polio.It would be too easy for us to moan about the state of our hospitals and Obasanjo's MRIs in a country dark without electricity, whose leaders jet out for the slightest ailment. We could write about our "teaching" hospitals, the accidents on our roads, the children in our neonatal units.

But no...today let us reflect on the next generation and on the legacy we wish to bequeath to them. What will our answer be when they ask; but Daddy...what did you do?

...what are You doing?

Happy Independence Day!

David Morley - a career of service that started in Nigeria

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Sun, 27 Sep 2009 08:30:00 +0000

It was in 2007, at an event at the Institute for Global Health at the UCL, I sat on a table at the back of the lunch room with my sandwich. On my table, I met an elderly English gentleman in a sweater who asked my name, and we did the usual small talk. He was a bit frail and spoke of his days in Nigeria with warmth and affection. He spoke about how his work in Nigeria was the first time the measles vaccine was tested in West Africa. In truth I did not take him seriously, but all the same I got back and searched for his work on PubMed.....and I found 2 links:

Measles in Nigeria: Am J Dis Child. 1962 Mar;103:230-3

The severe measles of West Africa. Proc R Soc Med. 1964 Sep;57:846-9.

These articles are so old that abstracts are not available on Pubmed, so I ordered them from our library. At that point I understood the depth of this man's work in Nigeria! At this time, 40 years after his work in Nigeria, we are still experiencing outbreaks of measles, and children continue to die. I then invited him to a conference we organised on health in Nigeria, in London in November 2008. He did not reply to my emails, or letter in the post. Now I know why....

Professor David Morley, died at the age of 86 on the 2nd July 2009. A paediatrician whose life was dedicated to transforming the chances of survival of children born in the developing world.

We asked a dear friend; Bryan Pearson, Publisher of Africa Health to provide some insight into David's amazing contribution to our country....his piece;

Sad news from the UK last month was the announcement of the passing of Professor David Morley, aged 86, ex head of the Institute of Child Health, and founder of the remarkable Teaching Aids at Low Cost (TALC) charity which had provided millions of slide sets and books all over the world... and still does. His seminal book 'Paediatric priorities in developing countries' is still a standard text. In many respects he was the father of Primary Health Care... and his origin of his work? Nigeria.

In the mists of time, many forget that his inspiration was from working from the Wesley Guild Hospital (WGH), Ilesa, in the old Western Region back in the 1950s and early 60s. His pioneering work in the local Imesi-Ile community revolutionised global child health. It is just sad to reflect that such landmark developments which were completely 'made in Nigeria' were adopted internationally, but largely ignored in the country of their birth.

The process commenced when the then senior doctors at Wesley Guild, Drs Andrew Pearson and John Wright were discussing the huge caseload of acute paediatric cases and resolved that surely much of this could be prevented if appropriate measures were instituted in the community. To a degree they had brought the problem on themselves having negotiated a deal with their new regional Governor, Chief Awolowo to provide free health services for under 18's. Awo's administration agreed to pay three shillings per patient. Not surprisingly, attendance surged.
Undeterred, Dr Pearson approached the West African College of Medical Research (WACMR) in Yaba and obtained funding for an expatriate to come out and spend half their time on community-based child health research, and half their time on clinical duties. Dr David Morley was recruited.
Quickly he made his mark. A survey of the population of Imesi-Ile village was undertaken, which revealed that 450 children out of every 1000 was dying before the age of five years. A full longitudinal study was initiated and over the next 18 months all children born into the community were registered... and then followed with monthly checks for a full five years. Growth charts were introduced (now utilised universally) and a special 'Under Fives Clinic' was initiated back at WGH. High protein weaning food was introduced. Mothers kept the children's records (less loss than for hospital based records); Grade II midwives were taught to deal with 90% of clinical need and to refer the other 10%. By 1960 outpatient attendance had reached 200 000 at WGH, 80% of whom were under 18 year olds. The first measles vaccine was trialled at Ilesa and Imesi-Ile in 1960...
And thus the community-based health revolution was born. Quickly the Imesi-Ile population started growing at more than 9% per annum, and the first family planning programme (as it was known then) had to be initiated.

It is no accident that Prof Olikoye Ransome-Kuti was closely involved and inspired by David Morley. Just a shame, that despite all Olikoye's efforts, so little of what was learned from this landmark work of community-based prevention was adopted throughout the Federation. Many other countries did take heed, and probably millions of children have benefitted.

READ A MOST ENLIGHTENING MEMORIAL IN THE TELEGRAPH

Every year our country gives its national awards to all sorts of characters. People that really affect the lives of people are hardly eve honoured. But what greater honour can we do for David than if we did finally saved our children from measles ...nearly 50 years after his seminal work! Well...thats our country..its up to us!

Have you heard about "Vision 2020"?

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Thu, 24 Sep 2009 08:30:00 +0000

If not please listen to our friends at NTA Network news every night!

This is one of the illusions (some say delusions) of grandeur that our government occasional emerges with. We "the people" ask no questions, as we are ourselves carried away with the hype. We start believing that we are actually the "giants" of Africa, and that by some waving of a magic wand we can actually emerge as one of the leading 20 economies in the world by the year 2020.

So the office of the Vice President puts together groups of eminent Nigerians, organises them in thematic groups and asks them to come up with a blue print to achieve this vision more than half way into the tenure of the government of the day. They set up a website, make long speeches, and bring our colleagues to Abuja to draw up the vision.

The website of OUR vision says "The Vision 2020 is a grand agenda, which the federal government has adopted as the main thrust of what it is out to accomplish between now and the year 2020. It is a 13-year plan of dramatic socio-economic transformation of the country. The goal of the vision is to transform the Nigerian economy to be in the league of the 20 most industrialized countries of the world,"

The thematic group on health was led by eminent colleagues; Dr Shima Gyoh and Dr Mike Mbanefo Ogbalu.

The forward of their report illuminates the seriousness this governments places on policy development.

"The Health Thematic Groups did not get all the documents it needed, and many came rather late. The version of the National Health Bill described as authentic, and which we understood had gone through all the stages of legislation was obviously very important for our work, but it arrived only after we had completed our report....

....The group would have probably worked more efficiently if it had a secretariat with computers, printers and photocopying capabilities. Members were however, very resilient, using their own machines, flash drives and individual internet access to fill the gaps."

Their report makes extremely interesting reading. The eminent colleagues that worked on this for weeks obviously took this task on with energy, passion and obvious competence. I recommend it unreservedly to fellow Nigerians. We hope that this government that chooses to ignore two consecutive UN assemblies, does not ignore the work it has commisioned itself.....but I am sadly not optimistic. I hope to eat my words in the year 2020.

The year 2020 might seem very far away....but it is not really. By the year 2020, it is the Vision of the Thematic group on health that every household in each town in Nigeria should havea running pipe borne water supply!

Wow....maybe thats why its called a "Vision"!

2020 ...here we come!

Read the full report here....afterall its OUR government therefore OUR vision ...

Report of the Vision 2020 Technical working group on Health.

Where is your NAFDAC number?

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Mon, 21 Sep 2009 08:30:00 +0000

You might not have heard a lot about him, but NAFDAC actually does have a "new" Director General, Dr Paul Orhii. A Russian trained doctor, he holds a PhD in medicine, and has a Juris Doctor degree from the Thurgood Marshall School of Law at the Texas Southern University. After initial debate about his suitability for the job, and links with our most reverred Attorney General. Now he seems ready to make his mark....

He recently called "a world press conference" in Abuja where he proposed a new law, advocating for the death penalty or life-jail term for manufacturers and distributors of fake drugs, especially in situations where it is determined that such medicines caused death or injury.

Wow ...the death penalty!

This has led us to have a think at the Nigerian pharmaceatical "market".

This article in 234Next describes the Idumota open drug market, the Sabongeri market of Kano and the Onitsha Head Bridge Market, which was reopened in 2008 after it was closed by NAFDAC in 2007 for drug counterfeiting. All three are still fledging OPEN markets where anyone can walk in and buy the most potent medicines....anyone!

Do not ask me if these medicines are kept at the temperatures many of them have to be kept in to preserve their efficacy. In fact, the the same article outlines a report by the University of Lagos College of Medicine, showing that most of these medicines failed a sensitivity test.

Are all the traders in Idumota open drug market, the Sabongeri market of Kano and the Onitsha Head Bridge Market facing the death penalty if the medicines they sell, lead to a therapeutic failure and death? Wow...

Yes, of course we advocate for a sanitisation of the medicine, industry in Nigeria and yes we do hope that one day we will find the leadership to provide this, but we suggest that we need to move beyond world press conferences! This is just one step ahead of calling the press together to burn medicines in public, then proclaiming across several newspaper pages that they had successfully burnt drugs worth millions of naira. This is still being done by NAFDAC in 2009...in 2009!

What are our governments and NAFDAC doing to provide institutional alternatives to these markets? We celebrated the innovative idea of a modern drug store to be handled by professionals such as the one built by the Segun Oni-led government of Ekiti state opened by the NAFDAC boss himself!. How many have been built since then? Why is the only one in the country in Ado Ekiti...and not in Onitsha, Kano or Idumota?

A lot is made of Professor Dora Akunyili's successes at NAFDAC rightly so!

Very few Nigerians had heard about this agency before Professor Akunyili's tenure. It was at the same level as several other parastatals of the Ministry of Health in the late nineties such as NPHCDA, NPI, that were barely doing more than paying salaries.

In one area where NAFDAC can claim significant progress is in the enlightment of Nigerians. We are all aware of the existence of fake medicines and we make a conscious effort to check if the product has a NAFDAC number. Now even the Kellogs Cornflakes sold in all the supermarkets in th UK carry a NAFDAC registration number. Recently NAFDAC appointed one of Nigeria's most popular contemporary musician 2Face Idibia as an Ambassador! Note that Alhaja Turai, is also its Grand Matron! (Naija! :)

During every advertising break while the Network news is being broadcast, we watch NAFDAC public announcements warning citizens not to buy fake drugs, and to report those that do.

Nigerians are doing their best. But the era of celebrating individuals and awards has passed. We desire strong institutions. We do not want to see NAFDAC officials gathering a few mobile police men in drug burning orgies...

We want to see institutional changes. In the past 10 years what has actuallly changed with the medicine trade?. Anyone can walk into any open market, anywhere in Nigeria and buy any medicine they want from people who have not finished primary school. The best the average Nigerian can do is ask if it has a NAFDAC number. From the "My Pikin" story...you know what that means.

NAFDAC is one Nigeria's instiitutions with a good reputation. World press conferences are not going to solve our problems. Let them roll up their sleeves and go to work.

The Obama speech on health care reform and our country

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Mon, 14 Sep 2009 08:30:00 +0000

Last week was particularly interesting. My facebook updates were on-fire again with ooops and aaahhs for another great Obama speech.

...yes it was a great speech. A friend of mine asked me to change my status to an Obama quote "No one should die because they can't afford health care, and no one should go broke because they get sick. If you agree, please post this as your status for the rest of the day."

This has got me really thinking. Before the financial crisis, healthcare was probably the single largest domestic issue in American politics. The biggest issue? It can't be!

But then I thought of sense of loss I felt at the death of Senator Ted Kennedy. I am still not sure why I (and many in my generation) feel such an intense affinity to the Kennedys. I have been following the politics of Senator Kennedy for quite a while, especially the pride he took in public service. I have listened to him speak and wondered when we will ever get a senator in our Senate with the passion, knowledge and ability to articulate as Senator Kenney.....I digress. I remember one of his favorite quotes: This is the cause of my life. For four decades I have carried this cause—from the floor of the United States Senate to every part of this country. It has never been merely a question of policy; it goes to the heart of my belief in a just society.

Can healthcare really be that important in the politics of the USA?

I remember my early lectures on health systems and the evolution of the NHS. I remember reading with intrigue about the attempt at creating an "internal market" in the UK's NHS in 1990s. Its big idea was the creation of a market so that some parts of the organisation would become providers selling their services to the others, the purchasers. I remember the lecturer enthusiastically pointing out the peoples' opposition to Margaret Thatcher’s plans for the NHS contributed significantly to her fall from power. Again I wondered...

Can healthcare really be that important in the politics of the UK?

Many of you might know that we in Nigeria have had National Health Bill stuck with in our houses of parliament for over 5 years. Our Senators have been to Ghana and back to discuss the Bill and finally passed it in 2008. In February 2009, without a wimper the the bill was passed by the House of Representatives in 2009. I gather both houses have now passed the bills and it is now waiting for Mr President to sign it into an ACT. Do you hear any speeches? The irony of our situation is that our president is widely believed to have significant health challenges of his own!

Why is there such a lack of any popular momentum around the National Health Bill? How can we be so indifferent to how our health system is managed.

Why is HEALTH not on the agenda in Nigerian politics?

………..WHO AFRO 59th session and a few more resolutions

noreply@blogger.com (Ndubuisi Edeoga) — Wed, 09 Sep 2009 08:30:00 +0000

by ndubuisi edeoga

Four resolutions aimed at scaling up action in areas deemed key to improving the health situation on the African continent were proposed at the 59th Session of the World Health Organization (WHO) Regional Committee for Africa which just ended Kigali, Rwanda, in attendance were African health ministers, with their official and unofficial retinue as usual. (if you have not been to Kigali...you should! If only to understand hpw far way we are in Nigeria to a decent standard of living)

Nigeria and many other African countries seem to have given up on the MDG goals, you can read more here:

In some Nigerian states the MDG is a source of contention as exemplified by this statement from one of our dailies (quote)

“The Governor of Niger State, Dr. Muazu Babangida Aliyu, visibly worried by the grim reality evident in his state, ordered the probe of all the contracts awarded under the MDGs in the state since 2006. According to him, inspite of the huge sum totaling N3.7bn “claimed to have been spent” by the Federal Government on MDGs- related projects in Niger state, “there was nothing on ground to show that such amount was committed to development projects in the state”.

Some of the new resolution sound and look good on paper…….. as always:

1.Tackling drug resistance related to AIDS, tuberculosis (TB) and malaria;

The resolution on drug resistance related to AIDS, TB and malaria urged countries to establish drug resistance and drug efficacy monitoring systems; strengthen procurement and management of HIV/AIDS, TB and malaria supplies; and develop and implement policies and strategies to improve diagnosis and effective early treatment.

2.Strengthening outbreak preparedness and response in the context of the current influenza pandemic.

Regarding the current influenza A (H1N1) pandemic, the meeting urged countries to: ensure the highest level of government support in addressing the threat; strengthen national capacity for influenza diagnosis, and of health services to reduce transmission; periodically update preparedness and response plans; implement communication strategies that regularly provide updated information; and contribute regularly to the African Health Emergency Fund.

3.Policy orientation on the establishment of centers of excellence for disease surveillance, public health laboratories, food and medicines regulation.

To boost national capacities for effective and comprehensive disease surveillance and response, laboratory investigation and food and medicines regulation, the meeting urged countries to conduct an assessment of existing infrastructure and human capacity to determine their state of preparedness to set up centers of excellence; develop a national policy frame-work on centers of excellence; sensitize relevant national departments and ministries to the need to create centers of excellence and secure multiple funding for centers of excellence to guarantee their sustained performance.

4.Accelerating progress towards malaria elimination in the African region.

On prospects for malaria elimination in the region, the meeting adopted a resolution calling on member-states to integrate malaria control in their national development plans and poverty reduction strategies; support ongoing research and development initiatives; strengthen national health information systems, and invest more in health promotion, community education and participation.

To these I say “yes we can” especially the part about community education and participation.

My prescription:

Let the 60th session next year be spent on evaluating which of the resolutions in 2009 are implemented in our countries. Let the Ministers go back home and tell the peopel what they have resolved to do and ask that the people hold them accountable if they do no deliver on their words.

Nigerians...note the resoolutions. Hold your Government accountable for their delivery!

Enough of meetings and resolutions…enough…..Lets start implementing!!

Doping, MRI and our sports

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Mon, 07 Sep 2009 09:05:00 +0000

(apologies for typos in previous post...pressed send too early!)

I love sports...even if I am not great at any myself. I love sports in the Nigerian context because it is the closest to a meritocracy most of us will get to experience living in Nigeria. I woke up on Sunday morning to the Nigerian papers and as usual our leaders never fail to disappoint you...The Guardian reported that "The President, Alhaji Umaru Musa Yar' Adua has handed a 'presidential order' to players and officials of the Super Eagles to go all out and secure victory against Tunisia in today's 2010 World Cup qualifier in Abuja." To the President, victory in today's game is non-negotiable.

I though about the scandals in our sport in the last few weeks. How we were learning to cut corners to win despite the scrutiny to athletes these days. When last has our country of 150 million won a medal at a major sporting event? It has been a while. You see…you can bring Julius Berger to build you the best stadium in West Africa...but just like hospital buildings don’t treat patients...stadia do not produce good athletes.

Just a few weeks ago too, our youth team was exposed. Medical tests showed that they could not be anywhere close to the ages they were claiming. Well...this was not really news to any Nigerian. We have long known what the truth as many of us went to the same primary and secondary schools as our Under 17 "heroes"....but who would stick out his neck? Doing so would be seen as terrible. We have come to accept the unacceptable. So yes I do love sports. Despite the doping and the age-cheating...it is still the closes to a meritocracy we will experience in our country.

And what happened to the president’s order to the "Super" Eagles....well what do you think? The chances are that the World Cup in South Africa may well happen with out us. But maybe we should make the point to FIFA. If one of every fifth African is really Nigerian....maybe we should have an automatic place?

A few years ago, we could no detect who was doping their way to success or cheating their ways to under aged championships...but now that we have found a way, meritocracy rules again!

Contradictions of Abuja III

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Fri, 04 Sep 2009 08:30:00 +0000

In 2008 ...the erstwhile Minister of our Federal Capital announced with great fanfare that smoking was banned in Abuja! Thisday declared that the is a master stroke that signifies a new dawn for the city's public health. Just before that...there was fanfare in the press as it was reported that the Nigerian government was suing three international tobacco firms for $44bn (£22bn) - the first such case in the developing world....wow...I thought...our government is waking up to taking its public health responsibilities seriously! The billboards still stand tall in strategic locations.

So the other day ...when PHCN had dome the usual, we had run out of diesel and the inverter was not charged as we had not had power for days...I left the house to search for a bar to watch the midweek chamions league game between Arsenal and Celtic.

Was I surprised that not in a single bar did anyone pay attention to the so called smoking ban...of course not!

Was I surprised that Arsenal cruised to an other conmfortable win.......of course not!

Most inportant is that we have a billboard a large billboard, quite impressive for our visitiors when the come down "Bill Clinton" from the airport....it is reassuring to note that smoking is still banned...at least on-paper.

Abuja...!

The contradictions of Abuja II

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Wed, 02 Sep 2009 08:30:00 +0000

Its interesting driving around Abuja....our beloved capital city. You see refuse disposal trucks with smartly dressed young men emptying the bins....impressive.

Then you drive around in Fashola's Lagos...and you see the street sweepers...making sure no piece of rubbish is left on any road. Nothing...as this lady on the middle of Third Mainland Bridge...yes really!

What you will not see are these scenes in Onitsha, Aba, Kano, etc....the other face of our country. In states without the attention Abuja gets and without inspirational leaders as Fashola.

Photo credit WIEF

But maybe ...just maybe....as Lagos was turned around...maybe one day Aba will ...and Onitsha will see the opportunities at their doorsteps and become the model clean cities they can so easily become.

CORRECTION!: The contradictions of Abuja

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Sun, 30 Aug 2009 07:01:00 +0000

In our last post "The contradictions of Abuja" there were three important points.

1. That our government that has shown that building a ten lane expressway from the airport to the city in Abuja is an absolute priority.

2. This is so important that the funding to do this was derived from funds previously allocated to health and education.

3. And finally that unless we push health up the political agenda, our people will continue to suffer.

In making these points I put up a picture of a hospital I had come across in Abuja which the people living around had told me we was Utako General Hospital. I found it in a derelict state, yet the quality of the building suggested that it was built to the same high standards of many other buildings in Abuja.

I WAS WRONG...this is NOT Utako General Hospital!

This used to be the Abuja International Diagnostic Centre in Utako built in the late nineties. It was apparently the brain child of Dr Benjamin Ohiaeri of First Consultants Medical Centre Lagos, built and initially managed by the International Hospital Group (it is still advertised as one of their projects). The picture below was sent to us by a member of staff who worked there for the few years that it functioned.

You will remember the International Hospital Group. It was brought in from the UK in 2003 to manage our National Hospital in Abuja for 10 years. It was sacked a year later for incompetence following a report that concluded that "The National Hospital was a bottomless pit, with little to show for it by way of palpable improvement in the quantum and quality of care".

The Abuja International Diagnostic Centre (don't we love BIG names?) project was financed inter alia with a World Bank IFC loan of 2.5 million dollars (find details in 1999 annual report on their website here).

It is said to have thirty something single large rooms (obviously not intentioned for the average Nigerian...) and I am reliably informed that is full of the same "high tech" medical diagnostic equipment similar to those apparently procured by Obasanjo's government via the Vamed project ....including a CAT scanner that is said never to have been used!

What is IFC? From their website...the International Finance Coorporation "fosters sustainable economic growth in developing countries by financing private sector investment, mobilizing capital in the international financial markets, and providing advisory services to businesses and governments. IFC helps companies and financial institutions in emerging markets create jobs, generate tax revenues, improve corporate governance and environmental performance, and contribute to their local communities. The goal is to improve lives, especially for the people who most need the benefits of growth."

BUT it is difficult to blame the IFC! This is not the only IFC project in Nigeria as in 2007 they reached an agreement with Hygeia Nigeria to upgrade hospitals in Apapa and Ikeja and the reconstruction of a third hospital, on Victoria Island. The most well-known project financed by the IFC in Nigeria is "The Palms Shopping Centre" in Lekki, Lagos....

So why would a health care venture as big as this fail in a country like this where even our very own president has to go abroad to receive basic health care. Another contradiction of the country we call our own.

At least we will have our 10 lanes into Abuja!

The contradictions of Abuja

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Thu, 27 Aug 2009 21:00:00 +0000

There is a huge project going on in Abuja at the moment. The beatiful trees that lined both sides of the motorway from the airport to the city in Abuja have been mowed down. The plan is to expand the current 4 lane express way into a 10 lane super express! The cost, quoting the FCT Minister; Senator Aliero is N224.5 million as reported by The Independent. For such important projects - we do not waste time in Nigeria. All hands are on deck! Equipment has been mobilised to the site....Julius Berger of course. Only the best is good enough for our federal capital.

Yes....this is the project that led to an uproar in Nigeria when it was approved by our beloved Senate. Try as hard as Senator Victor Ndoma-Egba (SAN) tried, he could not convince his colleagues, that it did not make sence to cut the budgets for health and education for a project to massage our egos.....but there you go.

Below are pictures of the Utako General Hospital in our Federal Capital City, over grown by weeds, inhabited by our non-human friends.

My thesis - until we put health back on the political agenda, nothing will change...nothing

Pfizer and Kano - Heads or Tail...the people loose

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Fri, 21 Aug 2009 08:30:00 +0000

Reuters - KANO, Nigeria, July 27 (Reuters) - Nigeria's Kano state and drugmaker Pfizer Inc have reached a final court settlement in a multi-billion dollar lawsuit over a 1996 drug trial, lawyers for both parties said on Monday. The northern state of Kano sued the world's largest drugmaker in May 2007 for $2 billion in damages over testing of the meningitis drug Trovan, which state authorities said killed 11 children and left dozens disabled. The lawyers would not describe the settlement, but a source close to the deal said it obliges Pfizer to pay $75 million.

Here’s how the $75 million will break down:

- $35 million of the settlement is slated to go to a fund that would provide payments to eligible people who participated in the Trovan study.

- $30 million of the settlement would be set aside for healthcare initiatives chosen by the Kano State government.

- $10 million of the settlement would be used to reimburse Kano State for legal costs associated with the lawsuit.

Pfizer says there will be some oversight on the Kano State initiatives and seeks to name a separate six-member board to oversee the $30 million allocated to support healthcare initiatives designated by Kano State. Kano State government does not want any interference and are calling for self determination in managing the disbursal of the settlement funds...

Naija....we know what that means :) Aluta!

Credit to BNET for links.

The new "Mega hospitals" and how they are going to save your life...maybe

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Wed, 19 Aug 2009 08:30:00 +0000

Health in the Nigerian polity is often discussed in terms of "hospitals built"....

While all these are important to some extent...no building has ever saved a life...on its own. We will not be able to avoid the critical thinking required to build a health care system. But in the typical Nigerian way...we are trying to build our way out of a problem...

Apollo one of the largest healthcare groups in Asia and best hospital in India is planning to invest $175 million on five new specialty hospitals for children (four in India and one in Nigeria) . I hope that this is good news for the country, and that specialist care will become more accessible to Nigerians. It will not be cheap but it will at least open up a few opportunities for those of us that cannot afford to go to Germany for common colds or strained knees.

Thisday reports that work has commenced on the $150 million Justice Karibi Whyte Mega Specialist Hospital in Rivers State. The state-of-the-art mega specialist hospital that is expected to be one of the best in sub-saharan Africa on completion, is being built by the Amaechi-led administration with Clinotech Diagnostics and Pharmaceuticals of Canada as the project consultants.

Daily Trust New health diagnostic centres worth about N1 billion will soon be constructed across the Federal Capital Territory, Abuja, the FCT Minister, Mohammed Adamu Aleiro

Silva's promise to Bayelsa....

Nigerian in Britain Hopes to Build Hospital in Homeland

Afam Onyema's singular goal: to build a hospital in Nigeria

Foundation laying ceremony of the much publicized American Hospital to be built in Abuja

Even Imo State claims to have built the first e- tertiary hospital at Imo State University Teaching Hospital.

...success depends on how it is measured...in the beauty of the hospitals or in terms of "lives saved"

A sign of things to come?

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Mon, 17 Aug 2009 08:30:00 +0000

You will might have read from the new and rich newspaper in Nigeria 123Next of the first coronary angioplasty and stenting procedure performed in Nigeria.

The procedure was carried out be by a Nigerian cardiologist, Dr. Adeyemi Johnson, of First Cardiology Consultants, who returned to Nigeria after practising in the United States for over 25 years.

Dr. Johnson is quoted as saying that believes that angioplasty has come to stay in Nigeria, because his team is now based here. The team is made up of a British-trained Nigerian nurse, a Lebanese-trained nurse and Indian-trained nurses, while the Reddington Hospital is providing the high-tech equipment being used.

Reddington hospital is presumed to be the best tertiary medical care facility in Nigeria. Newly built on nine floors, it provides care in all fields of Internal Medicine all supported by the latest technology. The CEO says that they will not relent in our quest to pursue medical excellence....

There is just one small catch....wait for the bill!

But ...we celebrate this first step...and hope that our colleagues with similar expertise all over the world will move from their "jobs", and "careers"...and seek their "calling"...at home in Nigeria.

Hajia Turai's £40M Cancer Centre in Abuja

chikwe.ihekweazu@gmail.com (Chikwe Ihekweazu) — Fri, 14 Aug 2009 08:30:00 +0000

Our country is an interesting place.

In a single afternoon in Abuja N7 Billion (£28 million) was raised in a single day to finance HajiaTurai YarAdua's pet project - A state of the art cancer centre in Abuja. The plan is to raise N10 Billion (£40,000,000)! Hajia Turai's project is reported by the Vanguard "to be born out of her utmost desire to contribute her little quota to achieve a focused delivery of health care. She said the centre is meant to render services to women and children, especially the rural and urban poor". Read a full report in the Vanguard.

Hajia YarAdua is reported to have gotten the idea after a visit to the MD Anderson Cancer Center in Texas in 2008.

Reading the reports on the launch has been interesting. Our politicians falling over themselves to commit funds to this project, while they cannot keep the few general hospitals in their states working. Legislators coming together to "donate" huge amounts while the National Health Bill has been stuck in the National Assembly for close to 5 years. The most comical was the Minister for the Federal Capital territory, and former Senator of our Federal Republic quoting health statistics - "disclosing" that in 2005 alone, 89,000 Nigerians lost their lives to cancer. Wow...where did he get his stat from? From the National Health Information Management System?

Since we are obviously passionate about health and health care in Nigeria...why are we not celebrating? There are several reasons....

1. We have several "centres of excellence" for medical care in our teaching hospitals. The last government spent most of its health sector budget in renovating them. Would £40 million pounds not be enough to set up a moderate cancer management centre affiliated to it. You would already have the doctors, nurses etc in place?

2. Nigeria extends 1,127 km (700 mi) E–W and 1,046 km (650 mi) N–S. How will the the rural women and children Hajia is targeting find their way to Abuja?

3. If Cancer Centre's site had to be in Abuja, why not add it onto the National Hospital?

It turns out that we are not the only ones worried. Salisu Suleiman on 123NEXT advises that the worst killer disease in Nigeria today is not cancer, but poverty.

BUT having said all this, we still hope that the project works.

We really do. We hope she is being advised by professionals ready to see this to fruition, ready for the long haul. We hope that her advisers also advise her how to build cancer education programme across the country to inform people how to detect early tumours.

We hope that her advisers are planning a screening programme. We hope that her advisers are planning on the referral mechanisms from primary health care centres to Abuja. We hope that she is being advised that it is necessary for the knowledge, skills and equipment necessary for Pap smears, Mammographies, Chest xrays and other means to detect tumors etc...We hope that they are advising her on the skills and capacity to manage this centre. We hope that there is a clear strategy on how this center will interface with the rest of the country's health system....

We hope...we hope...what else can we do?