To protest, or not to protest - a doctor's dilemma

The protests on the withdrawal of petrol subsidies in Nigeria has provided doctors with an ethical dilemma. Do they join the protests on the petrol subsidy removal and "close shop", or stay in their clinics and hospitals since the service they provide is  an essential one? In many cases, this is a rhetorical question as even when healthcare professionals intend to get to work – this is not an easy feat – especially in areas where the protests have been most intensive, as has been the case in Lagos, Kano, and Kaduna. Unless ofcourse one lived within the hospital premises. 

Photo credit: Jide Odukoya

The Nigerian press reported that both the Lagos University Teaching Hospital (LUTH) and Eko Hospital, Lagos, two of the largest providers of healthcare in Lagos have been rendering only skeletal services since the beginning of the protests. Suleja General Hospital, Niger State discharged all the patients on admission at the hospital as they  claimed that hospital workers had deserted their duty posts to participate in the protests. In Lagos, hundreds of doctors were said to be ‘on ground’ at the epicentre of the demonstrations at the Gani Fawehinmi Memorial Park in Ojota to provide immediate medical attention to protesters who sustained injuries during the protests. 


The professional associations have also been at a loss regarding how to respond, trying hard to stay on the side of the people. First, the Nigerian Medical Association threatened to ask its members to withdraw its services. The President of the NMA released a statement saying 

“The NMA will not hesitate to completely close down all health facilities in the country if government allows the NLC/TUC civil society strike/protest extend to Friday, January 13, 2012”. 

After an uproar by members of the public, it rescinded its own decision. The Association of General and Private Medical Practitioners of Nigeria (AGPMPN) called on the Federal Government to put palliative measures in place and urged negotiations to reduce the price of petrol, while the Ekiti State chapter of the Nigerian Medical Association on Friday opened a free medical camp, where protesters against fuel subsidy removal could receive treatment for free. So it continued.....and my personal view is that medical doctors should not leave their clinical practice to join the protests. We can show our solidarity by not charging the patients that come to us during the protests or even by working longer hours but not by abdicating our duty of care to patients. The patient with her pregnancy, acute abdomen, stroke or cardiac arrest will come, despite the protests, so we really have no choice but to work and care for our patients. Of course, when off-duty we can do what we choose to.....what do you think?  What would you expect your doctor to do?

Photo credit Jide Odukoya

Ultimately, these protests are about much more that petrol. They are also about a failure of trust in government. The Nigerian government expects citizens to tighten their belts while they go on living in ostentatious luxury. But lately, with more access to information on how our government’s spending borders on the obscene, Nigerians are using this access to information to increasingly look to hold our government to account. This is aptly illustrated by this tweet: 

@aizukanne - Are u aware the VP's medicine cabinet @ N314m is almost as much and the National hospitals total overhead @ N350m

Find the budget for the Federal Ministry of Health here. In addition to the lack of trust in our government, Nigerians have also had enough of a government that often just refuses to lead. As with the controversial Petroleum Industry Bill, the Health Bill just lies around – everyone in government ignores it. So, for most Nigerians, these protests are also about a lack of transparency, good governance and a wasteful use of our financial resources (not forgetting human resources), and unless the government uses this opportunity to restructure its relationship with its citizens, it is unlikely that Nigeria will know peace for a while to come.


Something has changed in Nigeria and things will never be the same again. Those that want to - let them listen. 

My New Year's wish - an efficient, proactive and responsive Blood Service for Nigeria

Over the Christmas period, our country Nigeria was again in the news for the wrong reasons. On Christmas day, we made headline news on all the major international news channels as a bomb exploded in a church on the outskirts of Abuja. Again there were calls in the press for Nigerians to run out and donate blood, focusing the country again on the paucity of our emergency preparedness. Every woman that has given birth in Nigeria will tell you about the high drama that surrounds securing emergency blood should it be needed. We run around for blood as if it is rocket science to organise a blood service- it is not.

So, we have done a bit of thinking into what it will take to run an efficient, proactive and responsive blood transfusion service in Nigeria. Firstly - lets look at how blood transfusion happens in Nigeria - Almost all of it is based on family or replacement and paid donations. For instance - when  a woman is about to give birth, or a patient is about to go for surgery - they are asked to provide a number of units of blood. This is either donated by a family member or if unavailable, by a paid "donor". This method increases the risk of infections including HIV (even when tested), Hepatitis B, Hepatitis C etc.

Culled from the National Blood Transfusion Service Website

So basically there is an entire industry of illegal and lucrative blood banks that rely on "blood touts" for the supply of blood sold to needy patients. It is  an incredible hassle getting blood, the chances are it might cause more harm than good. In recognition of this problem the National Blood Transfusion Services was set up and a National Blood Transfusion Policy adopted. But with its 15 centres across the entire country, there is very little it can do - and just like all our public sector services - it barely functions. To find out how a national blood service can work - I recently visited the South African National Blood Service headquarters in Johannesburg.

My first surprise was entirely organisational. While it is called the South African National Blood Service (SANBS) - it is actually not part of government and run as an autonomous not-for-profit organisation. It receives absolutely no allocated funds from government. However - the Department of Health of the Government of South Africa is its biggest client, taking up 55% of its services. Government hospitals buys blood from SANBS for its patients. SANBS ensures that all the required blood is delivered safely and, on time, and to to There is a negotiated price for a pint of blood, SANBS only gets paid when the blood required is delivered and runs its services completely based on fee-for-service income, in addition to some donations.

My second surprise - all its operations - all its 900,000 pints of blood required annually across the entire country are sourced entirely through voluntary blood donations. In addition to a strong regular donor base, it has an extremely active "marketing" team - using telerecruiting, university campaigns and increasingly social media tools such as twitter, Facebook to recruit donors. This is supported by a significant electronic database of all previous donors, enabling active management, follow up etc.

My third surprise - the risk of transmitting HIV through blood transmission in South Africa has been eliminated. This is because South Africa introduced NAT testing (a testing method that detects HIV almost immediately after infection). Since the introduction of NAT testing there has not been a single documented transfusion associated transmission of HIV. In Nigeria, blood  is screened for HIV using only antibody tests. This does not detect HIV during the "window period" meaning that some blood units will continue to pass through screening undetected.

But, by far my biggest surprise was the steely determination of staff working at the blood unit to keep the blood supplies flowing. With this ticker on their website indication stock levels across the service they not only motivate themselves, but also alert the country to the needs of patients. Apart from the competence and determination of the staff - what else made this system work I asked ?. Three things - I was told.
1. three well equipped and managed  laboratories
2. an integrated IT system
3. a tightly managed transport and logistics operations.

On driving away from SANBS ...the penny drops. With a subvention driven blood service, managed by our Ministry of Health, it will never be able to meet the needs of the Nigerian people. The South Africans have managed to innovatively integrate incentives to drive a successful model - if they do not source the donors in order to supply the hospitals - they do not get paid! There are no such incentives for my colleagues at the Nigerian Blood Transfusion Service.

I hear many of you saying - but this is South Africa - Nigeria is way behind in terms of infrastructural and societal development. Well, that may well be the case, but it did not stop MTN from leap frogging its South African operations. Nigerian banks are right on the heels of the South Africans. So what is it that is driving exponential growth in these sectors that is absent in the health sector.

The answer is simple - a tax funded system of delivering services - almost entirely subsidised by government is unworkable in Nigeria. It is the same reason reason NITEL, NEPA, Nigerian Airways, our refineries etc all failed. Yes, we cannot completely privatise all our public services but we must innovate around them, seeking ways of introducing incentives to ensure delivery. This requires innovation - innovation is absent from the Nigerian public sector.

Consider that government organisations still carry files around manually from desk to desk as was the case in the 60s !!

What a year: 2011

This guest post by Chima Onoka....brings the year to an end for NHW

What a year it was.....2011 seemed to be one of those years when it started, but it turned out a significant year in many respects to history bookmakers. The events are numerous – End of an era in many countries – people who have been national leaders since I was in primary school – from Libya (Ghaddafi) to Egypt (Mubarak), Tunisia, North Korea (Kim Jong il), Ivory Coast etc (though Mugabe seems to be the oldest last man standing, and perhaps the Cameroonian and Ugandan presidents). There were uprisings that changed the face of the Arab world in a direction yet to unfold, exchange of 1 Israeli life for over 1,000 Palestinian prisoners, declaration of interest for statehood by Palestine at the UN, death of Bin Laden, a Nuclear disaster in Japan to remind us of what we live with, a new global economic crisis, suspension of a funding round for HIV/AIDS by Global fund, slash of funding for UNICEF and other organizations, death of Steve Jobs of Apple, break-up of Sudan into two nations, 2 royal British weddings mixed with riots, and protests in the USA.

There were also Cancer hits – from Venezuelan and Argentine presidents (which Chavez says US is giving them), unbelievable protests in Russia, threatened Euro zone, some hope for a malaria vaccine, breast implant recall, downing of a Drone in Iran for inspection, memorable election in Nigeria and Liberia, Barcelona winning all football competitions it participated in, 3 joint female Nobel peace prize winners, and the world hitting a population of 7 billion despite all the deaths inflicted on others by evil hearted people, conflicts and numerous natural disasters.

In Nigeria, where do we start? Recurrent massacres of innocent, ordinary Nigerians by an ill-defined sect called Boko Haram has left the country and its people bewildered. ...Christmas day saw 43 killed in the Madalla Church and still counting. But there were other deaths too.... some of those who influenced the path of Nigeria – gold medallist Sunday Bada, industrialist and publisher Alex Ibru, the Dim, Odumegwu Ojukwu, Admiral Aikhomu on the day his boss IBB clocked 70, banker Aderinokun of GTBank, singer Christy Essien-Igbokwe, many in the bombed UN house Abuja who are from nations around the world that helped shape health related policies, and so many uncountable people whose names are little known.

For many who face our health system, the challenges they go through navigating the system are just too painful to be ignored. The absence of accessible and quality health care especially in rural and peri-urban areas, the absence of emergency and referral services, absence of health insurance cover for over 150 million of Nigeria’s 160 million population, poor commitment to implementation of health policies by politicians, health facility managers, and professional associations, and unending strikes in hospitals. The situation is further compounded by problems with institutional and infrastructural promoters of health – poor roads and transportation, loss of accreditation by medical schools, insecurity and impoverishment, a health bill that is still waiting for the president’s signature, and the deficiency of labour and civil society organizations with sincere interests and political power to influence change.

As we enter the New Year, we could all determine to make a difference in our society. Let us determine in the New Year to show love to those who are products of conflicts...orphans, widows, homeless, and to those with difficult marriages, children and parents, and the poor. These all have underlying social determinants, precipitators and propagators of ill health. Let us also chose to Care for the poor, visit those who are unfortunate to be in hospital beds or who live in fear with health conditions that threaten their very existence. May we all spend more time thinking about solutions and praying for and about our leaders than we do criticizing them. Let us determine to help develop systems that will hold our political leaders and health managers to account. Let us also provide support in any way we can to the people who meet us daily in health facilities... while we hope that health will be taken more seriously in the political agenda in 2012.

Finally, let us pause a while and reflect on our blessings, God’s mercies, forgiveness, and love even when you did things that were inappropriate...or took risks... on the road, in the air, and in places that people go to and never return because of insecurity. We may have talked about what we ‘were passing through’... but really...we passed through them with God’s help... since we are still around. The gift of life we have as we enter the New Year is enough for us to determine to make the contribution necessary for people to be thankful that we existed. 

Happy New Year!

GMC withdrawal of recognition from some Nigerian medical schools: a lesson in poor information management

The General Medical Council in the United Kingdom recently posted on its website a list of medical schools whose primary medical qualifications were no longer accepted for registration or licencing. Graduates from these schools from certain dates were advised that they were not to apply for the PLAB examinations which are the main route for international medical graduates seeking registration to practise in the United Kingdom. Nine Nigerian medical schools were listed including the University of Nigeria, the Universities of Benin, Jos, Port Harcourt and Nnamdi Azikiwe University. The full list of universities is available here

As the editors of this blog are all graduates of the University of Nigeria, we were naturally concerned. But apart from some agitation by colleagues on Facebook and Twitter, we could not identify any activity in response to this. We therefore decided to contact the relevant parties to understand why this decision had been taken and what steps were being taken to resolve the situation. We received a prompt response from the GMC asking us to put our request in writing to the press office, which we did. Attempts to contact the Medical and Dental Council of Nigeria by telephone and email failed. Similarly, an attempt to contact the Chief Medical Director of the University of Nigeria Teaching Hospital did not produce any response.

In its formal reply to our enquiries, the General Medical Council said

“The decision to add a number of Nigerian qualifications to our list of qualifications that we do not accept for the purpose of registration was made in light of information we received from the Medical and Dental Council of Nigeria (MDCN). We were advised that the MDCN had suspended their accreditation of those schools…..The decision to add the Nigerian qualifications to our list of those that we do not accept took effect on 14 February 2011. The decision only applies to students who graduated from those medical schools after the MDCN suspended their accreditation. The GMC is currently considering information from the MDCN indicating that the medical schools’ accreditation has been reinstated. We hope to be in a position to make a further decision regarding the acceptability of these qualifications shortly and subject to receiving responses to any relevant enquiries that we may need to make.”

It speaks volumes that there is no information about the withdrawal of accreditation from these institutions on the MDCN website or the websites of the concerned universities or the Federal Ministry of Health (their website is down - on 17/12/12) There has been virtually no news article about this in Nigerian newspapers or websites. The MDCN has not proactively stated why it withdrew the accreditation from these universities, to the best of our knowledge. There might have been press releases in local Nigerian newspapers, but in 2011 this is hardly enough. The universities themselves have not tried to put their own sides of the story in the public domain.

We have previously on this blog commended the MDCN for its attempts at trying to take more seriously its role in regulating professional standards in Nigeria. However it is important that it communicates clearly to the public what it is doing and why it is doing it. As a publicly funded organization, and one whose role includes promoting public confidence in the medical profession, clear and timely communication is not only essential but critical in today’s world. If the MDCN found the time to communicate its decision to the GMC in the UK, surely it could have found the time to do the same for the Nigerian public. Perhaps in the past, these decisions could be made in secret rooms and private meetings; this is no longer the case.

As for the affected institutions, they appear not to have grasped the importance of communication in an age where the internet has made information easily accessible. Once the information was published on the General Medical Council website, it was accessible to virtually the whole world- potential employers, graduates, patients all over the world. The first step people would take after reading the article would be to seek a response from the affected institution or the Medical and Dental Council of Nigeria. In the absence of their side of the story, there is the opportunity for rumours to spread. A statement on their website would take an hour to put up!

In addition to this, it is important that in addition to not being proactive in communicating its own decisions or its impact, it was only the British General Medical Council that felt it was important enough to respond to our queries. The Nigerian media also has an important role to play in ensuring patient safety- that they all appeared to have missed this story is an indictment.Given that the response from the GMC suggests that they expect to be able to issue a revised statement soon, it appears that this issue may be resolved soon. However, the key lesson for the institutions, the Medical and Dental Council of Nigeria, the Nigerian media and other social institutions seems to be that although things go wrong even in the best organized societies how information and communication is handled can either improve or worsen the situation.

We hope that the public relations directors in these organisations are listening; but more importantly we hope that the leaders of these organisations referred to above realise that communication is not some "extra peripheral activity" but an integral and important part of the leadership function. They will either learn from this or learn the hard way in the future...

Musings on World AIDS Day 2011

Dear Friends,

Today is World AIDS Day.

HIV continues to be one of the most important communicable diseases in Nigeria. It is an infection associated with serious morbidity, stigmatization of the infected, high costs of treatment and care, significant mortality and a high number of potential years of life lost. Each year, many thousands of individuals are diagnosed with HIV for the first time, and tragically in 2011 - about 70,000 babies were born infected with HIV in Nigeria - a completely preventable situation.

But we talk about HIV/AIDS so much that no one seems to notice any more. So, I thought I'd spend today reminiscing about the moment I made the decision to leave clinical medicine, and pursue a career in public health; a decision initially driven largely by the emotions at one conference. I was halfway through my MPH programme (which at the time I considered a stop-gap measure) when I stumbled upon an opportunity to attend the XIII International Conference on HIV/AIDS that was taking place in Africa for the first time - the location was Durban, South Africa in the summer of 2000.

Nothing quite prepared me for this experience. It all started with the opening ceremony where a young man spoke. At the time, the political establishment in South Africa was in denial of the AIDS epidemic, and the world had accepted a situation that life-saving antiretrovirals would be out of reach to most people living in Africa. At the opening ceremony; Nkosi Johnson spoke 7 words that brought most of those gathered in Durban to tears - literally - when he said "I am a very lucky little boy." He had lost both his parents to the virus and was raised by foster parents. But he felt lucky because at the time of the conference he was South Africa's longest surviving AIDS baby. He stood on the stage at Durban that day and begged South Africa to stop stigmatising people with HIV/AIDS. On the day, he shared the stage with the then President of South Africa, Thabo Mbeki, who at the time refused to accept that HIV caused AIDS.

Then at the first plenary, the Jonathan Mann lecture was delivered by Constitutional Court Justice Edwin Cameron, who was the first South African in a senior official position to disclose his HIV/AIDS status as positive. On stage he held the audience spell bound with his speech ending with the profound words  ..."I am here because I can pay for life itself".  In 2005 Edwin published Witness to AIDS, described as a “part-memoir, part compelling analysis” of his struggle with HIV/AIDS in South Africa. These two heroes re-defined for me what leadership really meant.....

At the conference there was a meeting of Nigerians attending the conference, an initiative of Mr Omololu Falobi (RIP). Just a year into our then new democracy, with a HIV prevalence that had just crossed the 5% mark, a new “National Action Committee on AIDS” etc, we were enthusiastic about defining the way forward. A wide variety of issues were discussed…an innovative plan to place the first 10,000 patients on ARVs, a new strategic plan, our poor research capacity and then raging  “Abalaka issue”. In attendance at that meeting included Prof. Maurice Iwu, at the time, an active researcher on alternative medicines for diseases (before his foray into election management he later became the IEC Chair) as well as Professor Idoko (The current DG of NACA). We sat around that table, in a meeting chaired by Professor Akinsete, and we left…full of hope. 

Today, 11 years later...little has changed. The HIV prevalence has marginally decreased to about 4% of the sexually active population. While a lot more Nigerians are receiving life-saving antiretrovirals, 95% of these are funded by donor funds. But, the Nigerian Senate has been busy! In less than a year, they passed the Anti-gay marriage bill, while the Anti-HIV stigma and discrimination bill has been sitting in their offices for over 7 years now....In many ways ....I sit back and wonder about the theme of that epoch making conference when advocacy for antiretorivirals took the centre stage and wonder if we in Nigeria are any closer to "breaking the silence". Sadly not - we are still at a stage most countries were several years ago - clouded in stigma, looking for scapegoats.

Yet, the bottom line is that global leadership is nearly exhausted. Western countries are completely enmeshed in their own domestic politics and crisis management. Our government, professionals and our people must get beyond the soft money available “chop” from donor funds, as well as the short-sightedness of our stigmatising attitudes, prejudices and dogma, and face up to the challenges that lie ahead of us. It will not get better on its own, and we are simply not doing enough. Business as usual will not get us far....and that is all we have at the moment. 

Welcome to World Aids Day 2011.

A colossus at 80

Rarely in this blog do we celebrate individuals, as there are sadly not many people to celebrate in our health arena. We share a collective guilt in our profession of not (yet) fulfilling the hopes and aspirations of the Nigerian people.

But some of us are less guilty than others and today we will celebrate one - Professor Adetokubo Lucas as he turns 80! I met Professor Lucas after he had already retired but a more energetic, knowledgeable and humble elder statesman I am yet to meet. Prof takes every call, answers every email and responds with candour, honesty and engagement that is simply extraordinary in our Nigerian context. In the the course of the last few years I have met other senior colleagues who have been taught by Professor Lucas while at the University of Ibadan and beyond and not one has not been inspired by his teaching. He is rare, not only in what he knows but in his humanity and humility. That makes him special - very special to us,  a leader, an inspiration to a whole generation of Nigerian doctors.


As founding Director of WHO’s TDR programme (Special Programme for Research and Training in Tropical Diseases), TDR invested about US$200 million to combat malaria, schistosomiasis, leishmaniasis, leprosy, onchocerciasis, and lymphatic fi lariasis—achieving great success against the last three diseases. In his autobiography "It was the Best of Times", he recounts his struggle despite the odds to establish TDR, the innovations he introduced, and his navigation of the WHO environment. The book is reviewed in the Lancet.


Professor Lucas is an officer of the Federal Republic and Member of the Governing Board of the Global Fund for Fighting AIDS, Tuberculosis and Malaria. He has been a major force in scientific research whose deep life long interest in tropical diseases facilitated the advancement of the frontiers of knowledge in Leprosy, Onchocerciasis and other diseases. He is an international leader in the fields of preventive medicine and Tropical diseases who effectively deployed his knowledge and passion to human development in these fields. We wish him many more years in the service of humanity.

To celebrate his turning an octogenarian, his colleagues and friends invite you to 2 events - one at the University of Ibadan and the other at the University of Ife. Both functions are open to the public and invitations are included below. See you there!

7 Billion and counting - implications for Nigeria

A few weeks ago, the worlds' population was said to have crossed the 7 million mark. Apart from the normal ritual of sound bites in the Nigerian media, there has been very little thought on what this means for us. But the population growth has profound implications. Below is a diagram called a 'population pyramid' for Nigeria. You do not need to see the details, on the right side are females and the left males. The youngest are at the bottom of and it rises to the oldest at the top. Nearly 50% of Nigerians are under the age of 15. Our dear country Nigeria has been experiencing a population explosion for the last 50 years due to high fertility rates, quadrupling its population over this time.

Some Nigerians pride themselves as the 'Giant of Africa' based on a numerical advantage offered by the stroke of Lord Luggard's felt pen in 1914. Only recently, with the exponential growth of MTN has the country come to realise the potential economic value of its rising population. It is definitely a great market, but there is more to building a country than  market size, especially one like ours that consumes a lot and produces very little. 
 
So, what does this mean for Health? Firstly, let us look at the shape of our population? The Nigerian Population Commission tells us that there are now 167 million of us. These 167 million Nigerians are not evenly distributed. They are mostly young consumers of services. Across the country, while we have seen growth in the private sector driving sections of the economy, our public services, especially health have lagged behind. With some notable exceptions in Lagos and Rivers states, the health sector has received little investment. Our politicians do not find political capital in investing in health. So, we are sitting on a time bomb....failing public services and a burgeoning young population. Is any one listening? We are unable to provide for the health of our population, the same population that is growing exponentially - something will have to give. 


We are not the only ones worrying about this. On the day the Nigerian Population Commission announced that our population was now a staggering 167,912,561 and is projected to hit 221,392,163 by July 1, 2020. - hardly anyone paid attention. As described by the Regional Head of Research, Africa, Global Research, Standard Chartered Bank, Razia Khan, Nigeria's "big concern of course is whether sufficient employment opportunities can be generated to absorb the country's growing pool of labour, and whether this can take place rapidly enough.”


We have to prepare or be prepared to fail. Business as usual will not be good enough. Our leaders will have to lead...in no sector is it more critical than the health sector. 

Are we listening to the Mo Ibrahim Foundation

There are many reasons we should be paying a lot of attention to the Mo Ibrahim Foundation. It is funded and led by an African institution, and is Africa's leading assessment of governance. The Foundation provides a framework and tools for citizens, public authorities and partners to assess progress in governance.  It compiles 86 indicators grouped into 14 sub-categories and four overarching competencies to measure the effective delivery of public goods and services to African citizens, using indicators from 23 data providers. 

Nigerian health sector rated 51 among 53 African countries 

Maybe it is time we "woke up and smelt the coffee", seen as when we are benched against other African countries, we are at the bottom of the pile. I remember being in Harare, Zimbabwe in 2006, at the height of the crisis in that country. Despite all the political turmoil going on, ambulances still worked. In Nigeria, we have ‘normalised’ a disastrous situation in the health sector, one in which no one has any confidence in the public healthcare facilities, rich or poor. Scratching around at the edges will not help either. If our leaders have the courage to carry out a Sanusi Lamido like exposure of our health sector, will we come to terms with the extent on the challenges in the sector.  We can do better, and it is not just us saying it at Nigeria Health Watch.

And if you do not trust the Mo Ibrahim Foundation, we invite you to visit the World Banks's  Africa Development Indicators 2011, the most detailed collection of data on Africa. It contains macroeconomic, sectoral, and social indicators for 53 countries. It is a reliable dataset for monitoring development programs and aid flows in the region and an invaluable tool for analysts and policy makers. 

To know how bad things are, we must benchmark ourselves with other African countries....maybe then, the penny will drop. The health sector in Nigeria requires nothing short of radical transformation. This will turn the sector into one that  truly serves the best interests of the Nigerian people. Again, scratching around the edges will not help......

Reporting 7 - 8% GDP growth in Nigeria means absolutely nothing to the "ordinary" Nigerian if this is not reflected in the quality of service provision to the citizens. It will remain a figure reported on the pages of news papers until it affects peoples' lives.

However, we will not get the transformation we seek by sitting on our backsides. We will continue to have the health service we deserve... until we do something about it!

Medical and Dental Council of Nigeria awakens

In most advanced countries, among medical professionals, the fear of the self-regulatory body is the beginning of wisdom. Getting into trouble with the Registration Body has grave consequences for practising physicians. But the entire system depends on records being kept. So an offence, no matter how small that might affect your practice is always on record....always accessible to those that need to know. Every member of the public, from anywhere in the world, can go the website of the UK's General Medical Council to check on the registration status of a doctor....anyone. All you need is a name! Employers can request for more details and patients can lodge complaints right there on the website. It is for the responsibility that we take, more than the skills we possess that doctors are paid relatively good salaries around the world. Our charater failings therefore can have profound effects on our careers....rightly so.

Is it really too much then to expect a bit more from the Nigerian Medical and Dental Council? A few years ago, I went to the Medical and Dental Council of Nigeria (MDCN), at their former offices at 25 Ahmed Onibudo Street, Victoria Island....and the experience was one of the dark ages. Folders stacked in piles on the floor, no electronic payment platforms, months of delays to get even the simplest things done..... Subsequently, our regulatory body commissioned what I can only describe as simply the most horrendous website you have ever seen...here. (watch out for the flying objects)!

But things are changing!


MDCN has launched a new ONLINE Registration and Payment platform for various services by Doctors, Dentists and Alternative Medical Practitioners.

I have just successfully registered and renewed my registration online! 


With the relatively good functionality, now is the time to drive traffic, ensure compliance, keep the website up....and maybe finally move into the 21st century. 

But we can still improve on the website. I do not see the point of filling your prime space on the front page of the website of 4 irrelevant rotating pictures of guys in lab coats looking around. It is sometimes worth it while developing a website not to re-invent the wheel (and do it so poorly), but to look at what our neighbours in Ghana, Kenya or South Africa have had going for quite a few years now. We are way way behind, not the West but other African countries....sadly.

The new online registration portal is not the first new development at MDCN. Followers of the medical scene may have realised that until last year, under pressure from political and economic Godfathers our medical schools were admitting more people as medical students annually, many medical schools topping 400 students a set! Well after some lost their accreditation......that has now been reverted and none will not be admitting more than 150 per year.

Then came the introduction of compulsory continuous professional development from January 1 2012. It is still amazing that we have not had this until now.

The Medical and Dental Council of Nigeria (MDCN) rose from its 7th Plenary session on Friday 30th September, to announce another series of changes focusing on practice, quality, safety and ethics of doctors and dentists. The completely unregulated standards of clinical practice is the biggest challenge facing our healthcare sector in the public and private sectors. There is little incentive to be a good doctor...other that one's conscience. In the public sector, the greatest challenge is the conflict of interest between working in public service, and in parallel in the private sector. It is no secret that for many doctors (by no means all), working in a teaching hospital serves the sole purpose of a conduit to his private practice. I dare say that this is inevitable. As long as the system allows it. This is even more unconscionable with the increase in public sector salaries, and the constant strikes to insist that this is paid. Finally, this is hopefully about to end and we  must make the choice every other professional must make- to work in the private or public service, We cannot, should not have your cake and eat it. It has not gone all the way...but started in the right direction.

MDCN at the 7th plenary decided to remind all doctors and dentists of what has been in the handbook / code of ethics designed and released by the MDCN. MDCN says that since no one can be in two places at the same time, it is about time that the laws on private practice are enforced for the good of the doctor and dentists, the patient; the public, and the government.

The highlights of their decisions are that:

1. Only consultants with over10 years post qualification experience are legally allowed to engage in private practice, at the same time that they are full-time government employees;
2. This private practice must be only consulting clinics and any intervention or investigation must be carried out within the government hospital where the doctor is employed;
3. Private practice can only be engaged in the doctors free and non contracted time;

MDCN has given a period of grace of up to December 2011 for those affected to comply with the laws of the land. But the test of this will be in its implementation. Gone are the days of empty threats. Nigerians will be watching, and we at Nigeria Health Watch will be watching. December 2011 is round the corner. The doctors in LUTH, UNILAG, ABU and UNTH that run the biggest private hospitals around these cities are public knowledge. They have never hidden their practices. We will get back to you on this in January 2012.

But it can no longer be business as usual. If Nigeria is to change for the better, the change has to start from us.  Kudos to MDCN for taking on its leadership mantle under Professor Roger Makanjuola. We will get used to good leadership and we will expect nothing less in the future. We must hold ourselves to the very high standards that the Nigerian public rightly expects of us. ALUTA




The full text of the COMMUNIQUE from the meeting is below. Sadly...I could not find it on their website :)

The Medical and Dental Council of Nigeria has issued a press release which all doctors and dentists in Nigeria should read and, where necessary take appropriate action. The circular may come to you, and I am only helping in bringing it to your kind notice in case you miss it—Shima K Gyoh.

ON THE STATE OF MEDICAL AND DENTAL PRACTICE IN NIGERIA: THE ROLE OF THE MEDICAL AND DENTAL COUNCIL OF NIGERIA

The Medical and Dental Council of Nigeria has received information through a number of National Newspapers of critical comments made on the practice of medicine in our country during a lecture on September 27, 2011. The transcript of the lecture and the discussion thereafter are not available. However, it appears that during the address, the standards of practice of Nigerian doctors working in the country were heavily criticised and it was implied that the agency responsible for monitoring medical practice was not doing its job. The agency responsible for regulating the standards of medical and dental practice in the country is the Medical and Dental Council of Nigeria and the Council believes it is necessary to provide information to the Nigerian public concerning the actions it has been taking to enhance the standards of medical practice and to protect the people of this Nation from malpractice and unethical behaviour.

The Medical and Dental Council of Nigeria has four major functions;

1.     To ensure that medical and dental training in the country meets international standards

2.     To ensure that practicing medical and dental professionals provide health care of international standard.

3.     To ensure that medical and dental practitioners maintain the highest ethical standards and to protect the people of this Nation against malpractice by medical and dental practitioners.

4.     To maintain a Register of medical and dental practitioners, which should be published regularly.

In achieving these objectives, the Council has given priority to the following:

1. Ensuring that the facilities, both physical resources and personnel, in the medical and dental schools are of high standard and that they admit the numbers appropriate to those facilities. This is to be achieved by close monitoring of the training institutions and taking firm action in respect of those institutions that fail to meet the required standards.
2. Ensuring that doctors and dentists maintain the standards of professional practice through a compulsory programme of Continuing Professional Development (CPD), which was introduced in 2010. As from January 1, 2012, certification of having met the CPD requirement will be a condition for renewal of annual licences to practice.
3. Prosecution of medical and dental practitioners who have engaged in malpractice or unethical behaviour through the Council’s disciplinary bodies, the Investigation Panel and the Disciplinary Tribunal. 
4. Information and Communication Technology to be deployed for all the Council’s functions.

1. Over the past year, 11 institutions that failed to meet the required standards or which have admitted student numbers greatly in excess of what they can meaningfully teach have had their accreditations withdrawn. The accreditations of those institutions are being restored only when they have restored these standards. The disciplinary actions did result in them taking action to rectify their deficiencies and restore standards, and those institutions are the better for it. Also, all the training institutions now know that we mean business and are striving to ensure that they adhere to the standards that the people of our Nation deserve.

A number of these institutions have taken steps to rectify these deficiencies and had their accreditations restored. These will be carefully monitored by the Council. The remaining institutions stand suspended until the Council has satisfied itself that they have rectified their deficiencies.

2. The compulsory programme of Continuous Professional development has been established. Compliance with the CPD requirement is a condition for renewal of licences to practice as from January 1, 2012
3. The two disciplinary bodies of Council, the Investigation Panel and the Disciplinary Tribunal, have been working vigorously to ensure that cases of erring practitioners are dealt with promptly and firmly, while ensuring justice to those concerned. At its most recent session, the Disciplinary Tribunal suspended the licences of two doctors and struck off the name of a third doctor from the Register of Medical Practitioners.

4.     Arising from its concern over the tragic effects of the recent series of strike actions by members of the medical and dental professions, the Council organised a Stakeholders’ meeting on June 23, 2011. All the major groups within the profession participated in the meeting. We examined the problem from all angles and it is to the credit of our profession that we did not shirk from examining ourselves critically and identifying problems within our profession that needed to be addressed. The communiqué of the meeting has been published. It identified the steps that must be taken to put an end to the tragic loss of life and human suffering that has been taking place by all those concerned – the practitioners themselves, the Government and the Council. The most important is that, while the Code of Ethics of our profession allows medical and dental practitioners to down tools under extreme circumstances that will be quite rare, when such industrial actions occur, the care of our patients is protected. The Code stipulates that no patient can be abandoned in the midst of his or her treatment; a striking doctor must make arrangements to hand over the continued care of his patients before he leaves his post. Also, provision must be made for the continued provision of services for accidents and emergencies and the care of those with serious illnesses and life-threatening conditions. The communiqué also drew the attention to a number of other issues that need to be addressed by our profession and the Government.  The Council intends to ensure that the resolutions in this communiqué are fully complied with.

The Hippocratic Oath to which we all swear on entry into the profession includes two statements:

“The health of my patient shall be my first consideration”, and

“I will maintain the utmost respect for human life.”

The Council’s position is that all doctors and dentists must abide by this Oath. The people of this nation are hereby encouraged to report cases of malpractice and unethical behaviour to the Council at the address at the top of this release.

 

5.     At its meeting on September 30, 2011, the Council directed that the Code of Practice concerning Private Practice by doctors and dentists in Government employment should be strictly adhered to. The relevant portions of this Code are to be published separately, along with advice to the public on the procedure for reporting cases of malpractice and unethical behaviour to the Council.

6.     The Council’s programme of harnessing Information and Communication Technology (ICT) has made great strides. ICT has been integrated into all the internal and external functions of the organisation. As an example of this,  registration and licensing operations are now fully on-line. The Council’s website address is www.mdcnigeria.org.

7. For the first time in 10 years, the Register of medical and dental practitioners has been published, and is available both in hard copy and electronic form. The Register can be accessed on the MDCN website.

The Medical and Dental Council accepts that there are some medical and dental practitioners whose standards fall below those that the people of this Nation deserve. However, we believe that the majority of practitioners are dedicated and provide high standards of practice, standards that we can be proud of. The Council will continue to meet its responsibility to raise and maintain the standards of medical education and practice and to deal firmly with those practitioners who do not meet these standards.

Dr. Roger Makanjuola,

Chairman, Medical and Dental Council of Nigeria

01 October 2011

No ordinary webinar with Dr Ali-Pate Minister of State for Health

On the 7th of September 2011, there was an extraordinary meeting with the Minister of State for Health in Nigeria; Dr Ali-Pate and his team, were seated in the offices of the Federal Ministry of Health in Abuja Nigeria, with hundreds of Nigerian health care professionals around the world. No, they had not all flown into Abuja, but met via a  webinar (web based seminar), that was hosted by the Anadach group. Technology is bringing those Nigerian leaders that choose to use it closer to the people, and hopefully they can begin to reduce the perceived distance between the 'leaders' and the 'led'.

NHW asked Dr Pate the first question of the webinar – “What objectives he had set for the health sector”. Previous Ministers of Health have answered this question in dubious ways, listing the number of primary care centers to be built or CT scanners to be bought. So, we were quite excited when Dr Pate, probably for the first time since we started writing on health issues in Nigeria said explicitly that he will set health oriented outcome measures and process indicators to measure these. He went on to list the 4 strategic objectives that the Ministers of Health had set themselves during this tenure as

1. Improve basic service delivery at the front-lines focusing on consolidating the work begun in maternal and child health
2. Focus on the prevention agenda - immunisation, health education, tackling the growing non-communicable disease burden etc
3. Focus on clinical governance and improve quality of care in the Nigerian health sector from the chemist to the specialist hospital
4. Unlock potential of market forces to support and drive innovation and improvements in the health sector

To achieve this, the Minister called on the help and support of Nigerian health professionals in the Diaspora, especially in these 3 areas;

1. To hold the health sector and its leaders accountable with constructive criticism.
2. To be advocates for the Nigerian health sector
3. To leverage their expertise, resources, skills, and networks  to support the Nigerian health sector 

After his presentation, the Minister took questions on a range of issues. On cancer, he acknowledged that this is a growing challenge and a lot of work is going on to improve the capacity of our teaching hospitals to deal with these cases, but also advocated for the role of prevention. He acknowledged that sadly, apart from the register in Ibadan, there was no national cancer registry in Nigeria and that we have no way of knowing how big the problem really is – as you cannot really manage what you cannot measure. He promised to look into this. When asked on the Ministry’s work on supporting Nigerians with disabilities, he admitted that this was an area that had not received a lot of attention in Nigeria due to competing priorities. Questioned on the existence of a single cath lab in the country, he threw the question back at colleagues challenging Nigerians in the Diaspora to invest in these high end diagnostics, while government assures access and equity to the majority of the population.

Dr Pate made what was maybe the most important point of the session that the health Sector as it is presently structured was not not as pro- poor as it should be. He illustrated this using a slide on the inequity in health outcomes across the country, but also stated that within cities, with our meager resources - most public expenditure in health disproportionately favours those that need the least - the wealthy. The little access that the poor have in our rural areas is left in the hands of the weakest link of Government – the Local Government. This might sound good on paper, but it is terrible for the patients in real life!

Dr Pate illustrated the challenges around clinical governance, and quality of care with the example of his recent visit to a Teaching hospital in Nigeria, where a patient lost her life after she “fell” off the operating table during surgery. This team of Ministers will be prioritizing this to ensure that Nigerians that do go to the public sector for health care are assured of a standard and quality of care and know how to insist on this, when they do not receive it. This will come as good news to Nigerian patients who have gotten accustomed to often being treated as inanimate objects rather than humans in their care pathways.  

Finally, Dr Pate encouraged Nigerian professionals to develope domestic solutions to local problems, noting that we cannot afford to think in silos that are convenient for professionals, but bad for patients. Referring to innovative approaches he led on while at the NPHCDA, like the deployment of Midwives around the country, he challenged colleagues to imagine what would happen to our health indicators if we could mobilize 200 000 community health workers to support Nigerian mothers and children.  

While it is difficult to gauge the reactions of attendees in such webinars, our team that attended from Nigeria health Watch felt that there was indeed a “breath of fresh air’ in our Ministry of Health. We concluded that we have a team of competent colleagues as Ministers, one who had spent most of his life in the Nigerian public hospital scene, and the other who had spent most of his career working his way through the ranks in the tough US health system, and eventually through the ranks of the World Bank, before returning to turn around one of the most ailing parastatals in the country. If this team of Ministers does not get it right, then we will be at a loss as to who will.

Having said that, make no mistakes about it, our health sector is in a deep deep mess. The Minister has said all the right things….now its time to deliver. For those in the Diaspora, it is time to roll up your sleeves and contribute, with no expectations of a red-carpet reception.

It’s a murky world out there, but its home.