Friday, 27 July 2007

Welcoming Adenike Grange and Gabriel Aduku

Finally after nearly two months of waiting, Nigeria has a new Minister of Health, Professor Adenike Grange. Dr. Grange has served as the President of the International Paediatric Association, a non-governmental organization with a membership of National Paediatric Societies in 136 countries and 10 Regional Paediatric Societies. Prior to joining IPA, Dr. Grange worked at the Department of Paediatrics of the College of Medicine at the University of Lagos Teaching Hospital in Nigeria. Dr. Grange represents Nigeria as a member of Applied Diarrhoeal Disease Research (ADDR) and has served as a Director at GAVI, formerly the Global Alliance for Vaccines and Immunisation. She has also worked as coordinator of Women's Health Organisation, Nigeria. Positions that she has held in the past include WHO Adviser on Reproductive Health Programme in Nigeria (1993 to 1999) and Consultant in Child Health and Reproductive Health Programmes to Federal Ministry of Health, Nigeria, WHO, UNICEF, UNFPA and USAID. Prof Grange has authored over fifty scientific papers in national and international peer-reviewed journals. She also served as Faculty on the 2006 Sexuality Institute of the Africa Regional Sexuality Resource Centre

With her broad range of international, national and local experience, in statutory and non-statutory sectors, it appears that Nigeria's health sector may experience a boost under her tenure. Particularly heartwarming was her acknowledgement during her screening session in the Senate of the importance of prevention and the dissemination of information.As a paediatrician, it is our hope that she will take charge of the National Programme on Immunization ensuring that it reaches its full potential

To support her as junior minister is Gabriel Aduku, a past president of the Nigerian Institute of Architects and subject of a biography by Nnimmo Bassey

Thursday, 19 July 2007

Notes from Nigeria: Akunyili @ 53, Luxury suites subsidising care for the poor in Garki Hospital and BUPA partners with Nigerian Hospital

From Chikwe in Nigeria:

Being in Nigeria at the moment, I picked up the papers to catch up on what is going on (online versions of Nigerian newspapers provide a small selection of featured articles everyday). Most of the papers over the weekend were filled with congratulatory messages to Prof Akunyili at 53!. I join millions of others in wishing her many more years of a fulfilled life. But, I could not help but wonder which of all those “well wishers” would still take the full page advertorials if she was to leave NAFDAC today. I thought back to when Prof Akunyili was my teacher in the University of Nigeria, Medical School. I do not remember any full page birthday wishes in those days. But, knowing Prof. Akunyili, I am sure that she will not be swayed by the attention seeking drug companies and other similar institutions. Her role in NAFDAC is primarily a regulatory one. No number of sweet worded, nicely coloured adverts should sway her from her mission. Else….people will die.

…as a footnote, it was also the birthday last weekend of the new Governor of Lagos State, Mr Fashola (SAN) He advised all those planning to take out newspaper adverts to visit charity homes on his behalf. They did! Enough said.

In a policy paper before the Nigerian elections, the Nigerian Public Health Network suggested the use of private paying rooms to subsidise the care of those that have to stay in the open wards in our public hospitals. Thisday newspapers report that Garki Hospital in Abuja, recently refurbished by the El Rufai administration, has done just that. 3 ward categories have been delineated A,B,C, “C” being the executive ward…which will provide a luxury environment. The hospital’s management promises that despite the differences in the physical environment, clinical services will be the same for all. The hospital, which was closed for close to 6 years is presently on concession to the Nisa Premier Hospital. If this arrangement does work…it will provide a model that can be copied by other tertiary health care centres.

Finally, BUPA, UK’s premier private provider of health care has partnered with Reddington Hospital , a multi specialist institution in Nigeria. This will make all those who buy extra health care cover from BUPA access these medical services while in the country without paying. At least one less excuse for not coming home!

Wednesday, 11 July 2007

Good news...Birth Registration Strategy! Health Minister - Not yet!

Good news for public health planning, evaluation and research. The Federal Government has said it would on July 24, formally launch a nationwide child birth registration strategy. OK…its just the strategy….but that's great. At least the government now seems to be planning.

We still await eagerly a new Minister of Health. Looking at the list sent to the Senate for screening, it is hard to pick an obvious choice. The one most taunted in the past few months, Prof Dora Akunyili, was not on the final list to the surprise of many. Reason? One making the rounds is that she was dropped because she closed down Aliko Dangote's factory in Kano over the Vitamin A issue. Wheat Semolina (Danvita) produced by Dangote' company was alleged not to have been fully fortified with vitamin A. THISDAY frames it thus: A woman very stubborn on principles, she reportedly told them that even if it was her blood brother that owned the factory, she would have applied the laws of the land in full. Therefore, fellow Nigerians, Prof. Akunyili is not qualified to be in Yar'Adua's cabinet!

While many Nigerians still scratch their heads to figure out how the health sector reforms affected their lives in the last 8 years, one article suggest that these said will manifest on the lives of the people in the years to come. But at this point, other than the efforts of NAFDAC, there was little else that the man on the street can identify with. But we are hopeful.

Saturday, 7 July 2007

Feedback on Restoring Health

The Nigerian Public Health Network published this just before the new Nigerian government came into power as a discussion document. As we still wait for President Yaradua's cabinet to be announced,here's a response from a Nigerian health professional based in Abuja which provides food for thought for the incoming health minister.

Thanks for this wonderful piece and I am glad health professionals are becoming more sensitive to issues that are outside the purview of our clinical leanings based on the biomedical model of our medical training which makes the average health professional in Nigeria oblivious of the social determinants of health.We need to start re-orienting health people right from medischool.Our consultants and teachers need to get into the flow and start teaching from the global health mindset so that we can become more aware of the issues at hand.Save for the heightened interest in public health which gives us opportunities to work with International NGOs and Donor agencies, we still have not imbibed the tenets of public health holistically.Health practitioners still have not championed the course of health promotion and let people become aware of their 'civic-health responsibilities". We need to start deconstructing that mindset that makes us overlook the eductaion of the populace on the need to take responsibility for their modification,knowledge of health risks for different population groups, etc. To be fair on the outgoing OBJ's government, a lot of reforms at the strategic level of policy formulation and implementation were effectively coordinated by Prof Lambo.he spear-headed the health reforms and has upgraded and improved the policy environment by providing sub sector policy guidelines which the incoming government should show enough political will to pursue.That is where we the health people should play our advocacy roles and engage in affirmative action to bring health to the fore of governance.The improved health policy environment has made it easier for collaboration with many donors to become possible, and many more are getting involved bacause of these positive changes at the Federal Level.But the sad thing is that the federal system makes health fit into the concurrent list.And the National Assembly has refused to give accent to the National Health Bill on the grounds that the Federal Ministry of Health cannot legislate for the state and LGAs.AS it stands, no one can legally delineate the roles that states and LGAs should play, and when to hold them accontable for dereliction of their duties...and it is at the state and LGA levels that health services are the poorest.And if our states and LGAs fail us...what hope then do we have? There has to be a way of making the citizens know that they have a right to accessible and qualitative health they can begin to push for it like human rights activities and gender activists have done to better the lot of the oppressed and minority groups.But in this case...we all are being oppressed healthwise! ................. Felix Obi is the Health Expert with the Nigeria office of ,Japan International Cooperation Agency based in

Thursday, 5 July 2007

Big Tobacco on trial , updates on Pfizer and Friends Africa

It's good to see that Nigeria is finally moving against British American Tobacco. A report in The Independent states that the Kano State Government has sued the tobacco giant over allegations that its marketing strategy deliberately targets children. This may be the wake up call that effectively challenges the image of tobacco companies in Nigeria as just another benevolent corporate entity, providing jobs, investing in the economy and building up society. The same article also reports on the court case against Pfizer. Read it here

Elsewhere, on, Roger Bate tries to defend Pfizer arguing that the children in Kano benefited from the flawed meningitis trial, albeit briefly. His analysis based on the supposed outcome makes light of the fact that the issue is that Pfizer, a large mutinational company appears to have flouted basic rules governing clinical trial. That the results appeared favourable is no excuse for this alleged abuse of power. Bate does however highlight the double standard at play with scrutiny of foreign players seemingly more rigorous than for local religious leaders, but fails to grasp the complex interplay between people's beliefs, the manipulation of politicians and the acceptance of seemingly simple beneficial health interventions.

This is clearly illustrated by the MMR and autism scare in the UK a few years ago which led vaccination rates for measles in the UK to plummet dramatically and is also touched on in this article on polio

While the debate about Pfizer and the ethics of clinical trials continues, a voice calls for more clinical trials to be conducted in Nigeria as a means of bringing advanced technology and interventions within the reach of those who cannot afford them. Read the report here There's a point there, but the challenge will be providing effective governance of these schemes.

Finally, Friends Africa is an interesting initiative that aims to build support for the Global Fund for AIDS TB and Malaria among African business and political leaders, a useful way of injecting African voices and resources into the global fight against the Big Three

Monday, 2 July 2007

HIV/AIDS stigma and other issues

Nigeria is estimated to have the 3rd largest number of people living with HIV in the world after India and South Africa HIV and the stigma that it carries within a Nigerian context has been the focus of some attention on Nigerian blogs and websites in the past few weeks. For an account of the furore which involved the editor of a leading society magazine, Genevieve, see here It is surprising that in spite of many years of campaigning, very little has changed in terms of attitudes. Another recent example relates to a man who has lost his job in what must certainly count as discriminatory circumstances and finally there is this e mail, allegedly sent from a Nigerian medical doctor in the United States to an HIV positive Nigerian activist who shares the same surname.

The area of HIV/AIDS is one where the government of President Obasanjo expended much energy with some results. The president was photographed very early in his tenure with HIV positive men, women and children and the photographs were splashed on billboards across the country. Last year the then president took an HIV test to promote testing during the World AIDS Day ceremonies. Nigeria was also one of the first African countries to commit to providing universal access to treatment for people with HIV, although transmitting this pledge into reality has proved more challenging than making the initial announcement, perhaps because of problems such as these

There is a good (if slightly dated) summary on HIV in Nigeria on the avert website

In addition to stigma, some of the continuing challenges include anecdotal reports that some of the US funded PEPFAR treatment programmes are cannibalizing staff and patients from each other in a bid to meet targets; the increasing unilateral focus on abstinence only programmes driven both by US government funding policies; the vertical nature of many of the HIV programmes which mean that the underlying absence of health service infrastructure remains a problem and the over-arching issues of leadership.