Tuesday, 28 August 2007

Is your health digging an unhealthy hole in your pocket?....

The provision of private health care in Nigeria is changing. This change is most profound among staff and dependants of the public and organised private sector.

Previously …this was the deal. A company would have a “retainership” with one or more private hospitals. The hospital would bill the company for services provided at the end of every month. The "catch" is that staff had to sign off the item on the bill as it relates to them. Thus creating an ideal opportunity for mutually beneficial “deals”. Therefore a simple formular emerged…patient agrees with doctor to receive N10000 worth of treatment. Dr takes N5000, patient takes N5000 company looses N10000. Great for doctor, great for patient (until he really gets ill) ...terrible for company.

No surprise that most have embraced the principle of managed care, where a health care service provider agrees to provide a pre-defined package of care for employees at a fixed amount, irrespective of if the employees access care or not. The public service part of this is managed by the Nigerian Health Insurance Scheme. This is the principle on which most of the medical care in the USA is provided. similar schemes are at different levels of incubation in Ghana, and Uganda
It has been a hard sell in Nigeria, and many have greeted it with scepticism but it is finally catching steam

The Punch newspaper of 01/08/07 reports that an estimated 2 million Nigerians (2% of the organised sector) are enrolled. The NHIS has 27 HMOs and about 5000 providers.

Monthly premiums are about N1000 ($4) /per month.

Recently… the Pharmaceutical Society of Nigeria kicked up a big fuss…describing the scheme as “yet to ensure harmony among providers”. In a thinly veiled attack on the physician dominated schemes...They claim that in the scheme “prescribers” are also the “dispensers”…..They seem not pleased at being sidelined. Not pleased at all....

The greatest challenge facing the NHIS is how to improve access to the scheme and get members of the unorganised private sector on the scheme. TWhat is the strategy and logistics for covering a sizable proportion of our 140 million Nigerians. Yet, we must not wait until we get it all perfect to start. This in principle is a good scheme...the challenge as in many programmes is scaling up. It is obviously not-yet-Uhuru but we seem to be on the way. Some of the of the big players among HMOs are Multishield and Hygeia

Beyond all this is the need for a parallel scheme to provide some succour to the poor, the elderly, children those in the rural areas that cannot pay any premium.....or do we just let our poor die?

How will things evolve??? Watch this space...

Find below some interesting advertising in the popular press...

Thursday, 23 August 2007

Why you should give blood

Found this extremely important posting on Naijablog. Just as important is to ask Nigerians and Africans in the Diaspora to become organ donors. I know quite a few country men on waiting lists for kidneys etc. No easy wait...our people do not donate blood, and do not sign up to be organ donors. Who pays the price? You guessed right!

Africans have a greater-than-average need for organ and tissue transplantation because of the relatively high incidence in this population of certain medical conditions that can cause permanent organ damage, such as high blood pressure, diabetes, heart disease and kidney disorders.

Read this and act...now!


Please help me save lives.

By donating blood.

Because people are dying daily from unavailability of blood. And it is not for want of our trying.

A high percentage of maternal deaths (i.e. death during pregnancy and childbirth) is as a result of bleeding that could easily have been treated by prompt blood transfusion. Just last weekend, I had 2 very ill women who needed blood, whose blood group was not available in the hospital. It was only by the vigilance of the head of haematology (blood services) who called all over the state to get blood that these women's lives were saved. I have hundreds more of such
stories of women who were not so lucky.

How can you help?
Please make a date to come and give blood. A healthy adult can give a pint of blood (500ml or one third of a big bottle of Eva water) every 6 months with no problems whatsoever.

Also, please mobilise friends, family, employees, colleagues, church members, mosque members, etc to donate now AND REGULARLY. The muslim associations in the Luth community are excellent and donate blood on a regular basis.

Will it disturb your schedule and is it safe? It takes less than 45 minutes and is also done on a
Saturday. The hours are Monday - Saturday 8am to 6pm, Blood Bank Lagos University Teaching Hospital, Idi-Araba, Lagos. If you can organise more than 10 people in your location, arrangements can be made for people to come out to your office, etc.

I gave blood on Wednesday the 22nd and i went on to continue working for the rest of the day. You need to drink a lot of fluid after and refrain from strenous exercise or activity. The only discomfort is the slight pain from an initial finger prick (to ascertain you have enough blood in you) and the needle that goes into your to take the blood. I am sure you will agree that the benefits far outweigh the inconvenience.

Sorry about the long email but please give your blood and save lives. Because you can.

Please contact me if you have any questions. Thank you.


Dr Bosede B Afolabi
Consultant/Senior Lecturer
Department of Obstetrics & Gynaecology
College of Medicine/Lagos University Teaching Hospital
Lagos, Nigeria.

Wednesday, 22 August 2007


Things have never been this bad. Our epileptic industrialisation is leaving problems we cannot cope with. If I told my son that as early as 1970s a refuse disposal van drove past our neighborhood in the campus of the University of Nigeria Nsukka collecting refuse, and that the Estate Department would come round once a month to cut the hedges…he would think I am a clown. We have normalised the sight of refuse heaps at our door steps. How did things get this bad. This image is from my street! In a "middle class" neighborhood in Owerri, that was famed at sometime in the past as a quiet, clean and serene town. Not any more….

The story is the same all over the country. Calabar…also called the Canaan city was often used as an example for what a city should be like. By the time the new government of Cross River state came into office, Calabar was literally swallowed by gabage. The Governor, Liyel Imoke spent weeks on his “sudden impact clean up campaign to restore the cleanliness of Calabar metropolis”...yet the heaps keep reappearing....

The residents of the sprawling city of Lagos, with its over 10 million people who dump refuse indiscriminately. Some defecate and urinate in open places. The city is regarded by many as one of the dirtiest in the world. But the end is in sight! The Commissioner of the Environment recently announced “illegal dumping of refuse to attract six months imprisonment”!!! …He boldly continued…”We cannot continue to fold our hands and watch people desecrate our environment…bla la bla…”. Having laws has never been the problem in Nigeria, we have them a‘plenty, neither are long speeches.

Kano State is actually doing something about refuse disposal! A workshop! …organized in collaboration with InWent, a German based organization. His Excellency, Governor Shekarau told participants that government has invested millions of naira in trying to control refuse dump in the state...no surprise there...

Not to be left out, the National Orinetation Agency (NOA) at the weekend flagged off the South West Zone of "Keep Nigeria Clean" campaign in Oshodi, Lagos. NOA is launching this campaign in all the states.

Governor Ohakim brought the Senate President all the way from Abuja to Owerri to launch his “Imo State Clean and Green programme”. Ohakims’s goal… "working together, we shall recreate Imo State to become a Garden State and Owerri, the jewel in its crown, into a sparking clean and alluring metropolis, where flowers bloom and the fields chlorophyll green all year round". Imo is on the march…

At least the Governors seem to have recognised the problem. Refuse disposal is not rocket science, but it is not an easy endeavor either! It needs strategic thinking and planning beyond once-in-a-month “clean-up” days! It needs investment and expertise. Until we go beyond the rhetoric…we will keep drowning in our own filth.

But with all the noise the Governors are making…can we be hopeful? What role do we have to play? What is the use of building all the mansions from Lekki phase 1 to 100 when we step out unto heaps of refuse and pools of dirth? Can Nigeria be clean again? We can...if you want us to... If you do not like the picture below...do nothing!

Thursday, 16 August 2007

MCDN awakes…Kerosene explosions continue

NTA news....reports the Medical and Dental Council of Nigeria is holding its annual congress in Abuja and has made a strong statement against the advertising by alternative medicine practitioners promising a treatment for every possible ailment. They also made some positive noise about medical education and the importance of medical schools not to admit more than they have the capacity to train, as well as the reconstitution of disciplinary panels across the country. All these are welcome developments. MDCN has a huge role to play. Without a functional website and with most of its records still paper based it is difficult to see how it can live up to the demands of self regulation in the medical profession for Nigerian doctors in the 21st century.

Memories of the last time I tried to renew my license to practice still haunts me…but in this era of Servant Leadership, we remain optimistic.

As if there are not enough problems in the Niger Delta, we are blowing ourselves up with contaminated kerosene . Gory pictures have filled the pictures of newspapers of burnt children
and mothers (men normally stay away from the lamps and stoves ) (no laughing matter!). The worrying thing is the apparent silence of the authorities while this product seems to remain in circulation. There has been no attempt at a recall, or at any public enlightenment. Sadly, there is hardly any alternative to cooking with kerosene as even the middle class has since given up on trying to find cylinders of cooking gas, and of course no one is still waiting on electricity…many have returned to fire wood. Even for the kerosene…one has to queue and fight for hours…only to be burnt. At least in other countries one can call an ambulance!…But newspapers report that at least the victims have been visited by the Governor of Delta State..himself!

We have gotten used to stories of kerosene explosions in our country and have almost normalised it. Speaking to colleagues in London recently…I had to explain to them firstly what kerosene was…and secondly…what it is used for!

I was surprised they didn't know...my bad :)

Saturday 18/08/07... The Guardian reports...Killer Kerosene Spreads To Makurdi

Tuesday, 14 August 2007

In memory of Dr Ihekweazu, health centre controversy and health as cash cow

Avid followers of this blog would have noticed that Chikwe was off to Nigeria for a while recently. This was due to his bereavement, his father Dr Umelobi Ihekweazu having passed on a few weeks ago. I'm sure our readers join me in expressing our condolences. There's a tribute to the late Dr Ihekweazu here

Health in Nigeria was the focus of attention recently, for perhaps the wrong reasons as the new President Yaradua suspended the contract (awarded by his predecessor earlier this year) for a comprehensive health centre to be built in every local government area. Yaradua suspended the contract because the legality of deductions from local government funds by the Federal Government had been called into question. Interestingly, the contract was said to have been awarded to a company linked to a former aide of Obasanjo. There have been interesting reactions to the suspension from this editorial in the Vanguard to this from the charity Save the Children. While the debate about the propriety of the contracts rages, one wonders whether the building of the health centres were part of a cohesive strategy. Hospitals and health centres have been opened with fanfare in the past only to suffer from a lack of drugs and trained personnel to enable them function. It is time the Nigerian people began to look beyond rhetoric and ask, how does this actually improve the health of our people? The furore over the centres also underlines the need for partnership in improving health, as a unilateral approach is unlikely to be successful. That said, part of what is actually at stake is money and who gets to control it. The sooner politicians stop eyeing the health sector as a source for money to share, the sooner the health of Nigerians will improve.

It is alleged that the recent merger of the lucrative donor-funded National Programme on Immunization with the National Primary Healthcare Development Agency may not be unconnected with an attempt to corner these resources. The National Primary Healthcare Development Agency is headed by Mrs Titi Koleoso-Adelekan who is said to be a close relative of the former president Obasanjo. Interestingly it is this same agency that had as far back as the year 2000 awarded contracts for the building of health centres in every local government area. This is certainly an area that may be worth further scrutiny. Stewardship of health funds in particular should be sacred as misappropriation means simply that people die.

Saturday, 11 August 2007

1st Set of Graduates from a Private Medical School in Africa

On the 31st of July 2007, the Igbinedion University , Nigeria's first private university graduated its first set of 29 medical students. Established in 1999, it is located in Okada, 30 minutes by road from Benin City. Having been granted their first accreditation for the basic medical sciences in 2002, these 1st set of students have been in university for 8 years. There was widespread celebration in the school in February 2007 when the Medical and Dental Council of Nigeria granted them final accreditation for their MBBS programme, becoming the first private university in Nigeria and probably Africa to graduate students. Kudos to Ewemade, Amaka, Olayemi, Titilope, Mimi etc etc for holding it out.

The challenge for Igbinedion and other private universities is to maintain the standards. Nigeria needs doctors...but only good ones.

Remember... "to preserve the finest traditions of your calling and long to experience the joy of healing those who seek your help".....as well all other aspects of the Hippocratic oath.

Thursday, 9 August 2007

Testing is free, drugs are free, go for voluntary counselling and testing!

Flipping through the dailies in Nigeria, it is good to note how HIV/AIDS prevention messages have evolved and developed ....from the days of "AIDS KILLS!".

Kudos to NACA...and their communications department.

Tuesday, 7 August 2007

Still on Covenant Univerity's compulsory HIV testing

The insistence of Covenant University, believed to be Nigeria's best private University to justify their policy of pre-graduation compulsory HIV and pregnancy screening as a pre-requisite to graduation has continued to generate fury on Nigeria's foremost HIV/AIDS egroup; hosted by JAAIDS.
The Vice Chancellor Bishop Oyedepo is quoted by Thisday newspapers to have said that these tests inculcate good morals, discipline and leadership qualities! Wow...

Surprisingly too Thisday Newspapers, one of Nigeria's most respected dailies has come out defending Oyedepo in an editorial on the 3rd of August. This shows that the complexity of HIV, its causes, complications, and implications are not yet fully understood by many. A coalition of NGOs has given the university a 14 day ultimatum to rescind its decision. The count-down has started.

While the achievements of Covenant University in providing a sane learning environment said to be devoid of cult activities that have plagued Nigerian public universities is to be lauded, its management should seek advice from experts in this area on how best to prevent HIV/AIDS. The most instinctive approaches have often been shown not to work.

One question...Have the VC and Staff all been compulsorily tested? Annually? If the students are expected to do this, why not the VC? ...especially in an era of servant-leadership.

Wednesday, 1 August 2007

Challenges for the new team, radiation in Niger Delta & Covenant University

The appointment of Professor Grange as Minister of Health continues to draw plaudits as many commentators compare her appointment to that of another paediatrician Professor Olikoye Ransome-Kuti in 1985. Professor Kuti, brother of the iconoclastic Nigerian musician Fela, was deeply committed to primary health care. I remember him particularly for leading by example, giving up his twenty cigarettes a day habit when he was appointed Minister and maintaining a lowkey style throughout his tenure.

The challenges that Professor Grange and her team face are numerous as looking at recent Nigerian health stories show:. The report that people in some parts of the troubled Niger Delta may be facing health risks as a result of radioactivity in abandoned oil wells raises the challenge of environmental health.

Child health and immunisation should also be high on her priority list, taking advantage of donor support as this story and this story indicate

Meanwhile there's been a new turn in the Pfizer case as Pfizer has been allowed to apply for an injunction stopping the Nigerian government from relying on the report of the panel it set up in 1996 to investigate the alleged drug trial. The report was never officially released and only became public via an article in the Washington Post. Pfizer is now relying on this failure to argue that the findings of the panel cannot be admitted in court. The question of why the report was never released is an interesting one which should interest any Nigerian investigative journalists- that would make a prizewinning story!

The Medical and Dental Council of Nigeria recent move to overhaul the undergraduate medical curriculum to include medical ethics, information technology and health economics is welcome, as is the plan to make Continuing Professional Development a condition for renewal of medical licenses, but the challenge will be in the implementation - does the Council have the capacity to monitor and do the medical schools have the capacity to deliver these changes? Yet another task for Professor Grange and her team...

Meanwhile the move by Covenant University (a private university owned by the Nigerian Pentecostal church Winners Chapel) to subject all final year students to mandatory HIV and pregnancy tests has caused a furore in the HIV sector of Nigeria's civil society with mass action being planned, led by the formidable activist Rolake Odetoyinbo of the Treatment Action Movement and complaints being made to the National Universities Commission. Apart from the human rights and other concerns that this action raises, it indicates a failure of some of the HIV awareness campaigns to actually reach the people who need it. We wait to see what the response will be.Interestingly the university website is silent on the matter.

Meanwhile, a blog, Bush Doctor in the City by Dr Wilson Orhiunu a Nigerian general practitioner in the UK has been brought to our attention. It's a lighthearted attempt reflecting on practice in Nigeria and the UK