Thursday, 29 November 2007

Nigeria and the Global Fund

One of Kofi Annan biggest legacies as Secretary General of the UN is the The Global Fund. It was created to finance the fight against AIDS, tuberculosis and malaria. These diseases kill over 6 million people each year, and the numbers are growing. To date, the Global Fund has committed US$ 9.9 billion in 136 countries to support aggressive interventions against all three diseases. The success of the Global Fund is still up to much debate.

Of the US$9.9 billiomn committed worldwide, US$400,000,000 has been approved for projects in Nigeria. Find details of individual project allocations here.

The Global Fund has also just announced that the eighth round of proposals, to be launched on 1 March 2008, will be particularly well funded; and apparently there will be enough money to approve every proposal in which the need is clearly established, the design is good, and the ability to implement is proven.

Proposals are sent in by every country's County Coordinating Mechanism (CCM). we can expect from Nigeria.

Nigeria has had 5 proposal appoved(25%), and 15 (75%)rejected. Interestingly its very first application for funding HIV/AIDS was accepted in the first round. 2 Malaria grants were accepted in the 2nd and 4th rounds. This was followed by one each for HIV and TB in the 5th round...and we all thought that the quality of our applications and level of implementation was getting better.

Then our next 6 applications were rejected! Is there a conspiracy against us or have the quality of our applications been poor? That is the question Nigerians would like to hear from our CCM!.

2 years ago, inconsistencies in data provided by NACA, including the number of people taking antiretroviral drugs have previously led to Nigeria's suspension from recieving support from the Global Fund. This was eventually resolved.

Nigeria is not only a recipient but also a donour country...being the the highest of only 3 donors among African countries (South Africa gave $8,141,312 , Uganda gave $1,500,000).

...Of course I tried searching the website of the National Agency for the Control of AIDS for some data of how the funds disbursed to them have been used and got excited when I found a link "National Response Data" on their website....eagerly I clicked on it to find "THIS SECTION IS UNDER DEVELOPMENT & WOULD BE AVAILABLE SHORTLY"

HIV prevalence surrently stands at 3.9% among adults aged 15 to 49 HIV prevalence giving an odd 2,600,000 Nigerians infected. Reuters reported in September that there are about 140,000 Nigerians recieving antiretroviral therapy.
DECEMBER 1 is WORLD AIDS DAY....think about the 2.6 million Nigerians infected and if there is more we could all have done to prevent this....and can still do.

Saturday, 24 November 2007

"Health" websites from Nigeria

That the Ministry of Health in Nigeria has not had a website of any substance over the past years is a tragedy and we appeal to the new Minister, Prof Adenike Grange to make this an operational priority.

It is near impossible today to get any information on policy and strategy, disease prevalence, organisational structure, or contact information
without physically walking through corridors of the Federal Secretariat and asking a kind official to manually search files, or by writing a formal request through the "ever efficient" NIPOST.

How do we empower people to ask for health if there is no access to the most basic information? How do we empower health professionals to engage with the health sector when there is no information on the services provided.

Ok yes, but this is Africa, internet access is slow, power is erratic and who really cares. We are after all the Giant of Africa!

But is Ghana not in Africa?
OK yes, but it is "small" and easily manageable.
OK...what of South Africa?
Stop always comparing us to South Africa, they are not at our level in development terms...
OK..but what of Kenya, Botswana, even Malawi ...we could go on and on?
Ok, OK...we are "trying"...

Where the Federal Government has faltered, some state governments have picked up the gauntlet. Akwa Ibom for instance ...ok it is not great, but it is something. Same with Ogun State, with the ever present picture of the Otunba, and Ekiti State. The MOH in Lagos State also seems to have a site but in popular Nigerian Internet is "down". :)

Also where the Ministry has faltered some of its parastatals have stood out...

As usual the website of the National Agency for Food and Drug Administration and Control (NAFDAC), stands out. Simple, informative and user friendly.

The National Agency for the Control of AIDS in Nigeria, NACA has a relatively good website, although when you click on "National programmes and activities" it tells you that "THIS SECTION IS UNDER DEVELOPMENT & WOULD BE AVAILABLE SHORTLY".

Try searching for the National Primary Health Care Development Agency (NPHCDA) - Nigeria....which has been building the famous "virtual" primary care centres around the country for the past 8 years of the previous government. For all its good work, the National Programme for Immunisation (NPI) was recently merged with NPHCDA (sorry no websites). Maybe there it might be better not to have one than to tell us how many of our children have been vaccinated for measles!

There were some surprises in my search for good public sector websites on health in Nigeria, one was that of National Health Research Ethics Committee.

However some good news, what the government fails to do, the not-for-profit private sector has taken up and is delivering in many areas. This will be the focus of a different blog. But the Ministry of Health must rise to its resppnsibilities...Nigerians are hopeful!

Be well!

Friday, 16 November 2007

Health news out of Nigeria...some positive signals in the air

BBC - Nigeria's government says it has begun legal action against three leading international cigarette companies. Surprisingly I have not found this picked up by any of the local papers? Don't ask me why....Details here

Guardian - In addition to the above, a policy on Non-Communicable Disease is under consideration by the FG and Lagos State government intends to establish a state cardiac centre through public-private partnership which would be a landmark step in promoting heart care in Nigeria...Some of this seems to be driven driven by colleagues in the Nigerian Heart Foundation. Details here

Guardian - The Federal Government has declared that it would soon start offering free medical health services to pregnant women and children under the age of five years.
Sounds great! ...but the questions are...what is free?, the consultation?, the drugs? the admission if required? the surgery? what quality of care will this include? How soon is soon?. The Guardian's editorial rightly concludes by saying The Federal Ministry of Health may mean well but beyond the focus on pregnant women and children, it must come up with a blueprint for a result-oriented, integrated national healthcare plan that is driven by the goals of efficiency, quality and ownership. Details here

Thisday - Minister of Health, Professor Adenike Grange, restated Nigeria's commitment towards eradicating polio by next year. She said the prospects of achieving the 2008 target on polio were bright, as the country for the first time since 2002, recorded a decline of 80 per cent in the number of children affected with wild polio virus between January and August 2007, compared to the same period in 2006. Grange, who spoke at a ministerial briefing on the progress recorded on immunisation in Nigeria....etc etc etc OK...progress is being made, but I would not be as optimistic until I see a consistent decline...but we all need to continue to encourage those working hard on this. What I missed from this report was any mention of "routine immunisation!" Details here

Thisday - At least one million children born in Nigeria die before their fifth birthday, with most of these deaths occurring in the Northern states. The number of women who die due to pregnancy and related causes is also alarmingly high, with a disproportionate percentage of the maternal deaths occurring in the North. Finally someone is paying attention to where to where the need is most... Details here

Thisday - Senate Committee on Education yesterday faulted the Ministry of Education over expenditure of N220 million on HIV/AIDS sensitisation programme. Emordi said “there are many schools in Nigeria without desks and chairs which such huge money spent on HIV/AIDS sensitisation in the past two years could have adequately assisted.” She thus demanded for a breakdown of the expenditure. While as public health professionals we would theoretically happy that such huge funds are spent on HIV/AIDS...but we also know why it is being "spent" on areas like "advocacy" and "sensitisation"...try accounting for that!!! :) Spot on Emordi! Details here

Vanguard - Anambra State Association, ASA-USA, a non-profit, non-partisan Association with the main purpose of moving Anambra State forward Politically, Educationally, Socio-Economically and also to tackle the basic Healthcare issues in the State plan to set up an Ultra Modern Hospital in the State, which will provide for continuity of care after their Annual Medical Mission has come and gone. Details here

Vanguard - THE Federal Government in collaboration with the United Nations International Children’s Education Fund (UNICEF) and Unilever Nigeria Plc, have launched a Hand Wash Campaign to promote personal hygiene among pupils in 222 primary schools across the country at the cost of N78.6 million. HOPE THEY ARE PROVIDING WATER TOO! Details here

Have a good weekend

Tuesday, 13 November 2007

The Budget for Health

Find below the budget for health as presented to the Joint Session of the National Assembly in Abuja, Thursday, on November 8, 2007 by President Umaru Musa Yar’Adua

....For the Health Sector, we propose an allocation of N138.17 billion for 2008, a 12.57% increase over the 2007 allocation of N120.8 billion. The capital component of this amount is N49.37 billion, out of which funds have been provided for, among others, the following projects:
· Refurbishing and equipping all Federal Tertiary Health Institutions
· National AIDS/STI Control Programme, including the procurement
and distribution of ARVs and test kits
· Rollback Malaria Programme, including the procurement of new
drugs for malaria case management and insecticide treated nets
· National Programme on Immunisation for routine immunisation
· Capacity building and training for 5,000 health workers on
integrated management of childhood illnesses.

Read the full speech here

For more details on the budget, click here for the website of the Ministry of Finance.

Some of the allocations to other sectors are
• N444.6 billion for Security and the Niger Delta, which is 20% of the total Federal Government Budget, up 6.5% from 2007 allocation;
• N210 billion for Education or 13% of the total MDA spending;
• N139.78 billion for the Energy sector, excluding National Integrated Power Projects which will be implemented through alternative funding; and
• N121.1 billion, that is 7% of total budget, for Agriculture and Water Resources.

Sunday, 11 November 2007

Health must be seen, felt and palpated in every household

With these words the new Nigerian Minister of Health, Professor Adenike Grange started of her the talk titled "Implementing Health Sector Reform for better Performance" delivered at the the annual lecture of THE LANCET, one of medicines pre-eminent journals. Her primary objective would be to get health care to those who need it most in the most cost effective way. Professor Grange made no apologies of her pedigree in service, teaching and management of her peers (President of the International Paediatric Association), describing herself more as a technocrat than a politicican. This is probably the most exciting aspect of her emergence as health minister. Listening to her speak, one could feel an openesss about the sad situation we have sound ourselves in and a genuine intention to turn things around. Maybe there is a realisation that the health of 140 million Nigerians can no longer be left in the hands of politicians. She started by by elucidating her perception of problems facing the health care sector in Nigeria. The divergence between policy formulation and implementation; the rigidity of the civil service; the challenges of managing a sector where the lines of management are poorly defined between the different tiers of government; a sector where the most crucial arm of health care delivery (primary health care) is in the weakest arm of government (Local Government); and a low consumer awareness of what to expect and demand in terms of their health.
The saddest single statistic that she presented was that, maternal mortality ratio (death during and around child birth) in Nigeria had worsened from 704 to 800 deaths in 100,000 life births between 2000 and 2004.
However, she went ahead to state 6 priority areas for her tenure: 1. Reduce the disease burden 2. Improve availability of health resources and their management 3. Improve access to quality health services 4. Quality assurance 5. Improve the stewardship role of government 6. Strengthen the national health system While these are not necessarily new, they do mark a departure from the past where goals in the health sector in Nigeria were always made in terms of health care centres to be built (or not), or teaching hospitals to be refurbished. While these huge infrastructure projects were attractive to our politicians for obvious reasons, no mention had hitherto been made on health and health care indicators! In 2005 only 35% of Nigerian children had been vaccinated against measles, a vaccine that costs less than 30cents per dose, the scandalous maternal mortality ratio mentioned by the Honourable Minister. She termed these relics from the past as "Poverty-determined decision making"...I would term them as "Greed-determined decision making" So it is a breath of fresh air to have a Minister that seems to understand that health must be counted and delivered on health terms. She introduced a few new concepts; the establishment of a National Council for Health; made up of all the stakeholders in the health sector that will meet once a year to advice the Minister on priorities for the sector. A National Health Investment Plan, to harmonise the flow of funds towards health improvement projects, the establishment of a National Hospital Commision to regulate not only public but private hospitals.

Finally when asked to give 3 priority health targets on which the Nigerian people can evaluate her tenure, she listed;
1. An improvement of routine immunisation rates
2. An improvement of maternal mortality ratios
3. A continued reduction of HIV prevalence ...although the minister would not be tied down to be more specific in what size of measure of improvements to expect (yes...she is learning the art of politics :))

...she obviously has her eyes on the ball. She has a good chance of making history, and affecting the lives of millions of Nigerians as she does so. We wish her well. Richard Horton, editor of THE LANCET, concluded the evening eloquently when he declared the time for talking is is now time to "GO DO". Therein lies the challenge for Prof. Adenilke Grange.

Find more information about Prof. Adenike Grange's career here

Wednesday, 7 November 2007

Grange takes centre stage

The Lancet is one of the preeminent medical journals in the world.

Every year it invites someone whose work has had, or has to potential to have a profound effect on public health to deliver an annual lecture. Recent lectures have been delivered by the Prime Minister of Norway in 2006, and 2 Nobel Prize lauretes in 2005 and 2004.

This year it is being delivered by the Honourable Minister of Health of Nigeria; Prof. Adenike Grange. Professor Grange, has served in several capacities, most importantly as the President of the International Paediatric Association. She has authored over fifty scientific papers in national and international peer-reviewed journals. Now she has been given her biggest responsibility yet; to improve the health and manage the health care of the 140 million people in Africa's most populous nation.

But why would The Lancet be interested in hearing from Nigeria's minister of health? The Lancet seeks to be...and probably is the authoritative voice in global medicine. It has taken a proactive stand in recent years in highligting the challenges of health and healthcare in Africa. In population health terms, for Africa to make progress, Nigeria must engage.

The eradication of polio, a programme into which the international community has spent about $5billion, primarily depends on success in Nigeria. The first outbreak of Avian Influenza was reported in Nigeria. Routine immuisation coverage remain below 50%...challenges abound. While other sectors that affect our existence in Nigeria have undergone profound change in recent years, the health sector has basically remained still. While it is now easy to draw cash from ATMs, to make calls from the remotest village, it is still normal for a child to die from measles or to wait for a full day to be seen in a public hopsital, only to be given a list of medicines to buy privately.

But this does not have to be the case, and in Prof. Grange, Nigerians have put thier trust to change things. Prof. Grange has been making all the right noises. She recently announced a plan to set up a National Public Health Agency, and a Commision to manage our disparate teaching hospitals. She has set a target for the elimination of polio in Nigeria in 2009. For the first time in decades, we are hearing about health targets from the ministry of health! (as previous ministers chose to focus on the number of primary health care centres built, with no comment on how many are actually providing health care). Nigerians are hopeful.

Tomorrow, the international public health community will have the priviledge to listen to Prof Grange outline her plans. Her talk is aptly titled "Implementing health sector reform for better performance". "Health sector reform" has been bandied around for years in Nigeria, but not many people can identify how it has affected their lives other than the 1% of the population that are part of the National Health Insurance Scheme. Tomorrow we will go to listen in hope to Prof Grange as she outlines her plans for reform. We hope that that in a few years time we would no longer be speaking about the times of Prof Ransome Kuti but the times of Prof Adenike Grange. Nigerians are hopeful...

For details on how to attend...CLICK HERE

Monday, 5 November 2007

Health news in October

The quality of some of the health reporting in the Nigerian press is still extremely poor. It is obvious that most of those reporting health stories apart from the few that have benefited from training on HIV/AIDS issues from JAAIDS founded by Omololu Falobi have no contextual knowledge of the issues. But we will continue linking you to the health stories...while we work towards some improvement in quality.

Again, positive noises coming from the Health Minister, Prof. Adenike Grange, as she announces that the main thrust of government's plan in the health sector in the next four years will include eradication of polio by next year, reduction of maternal mortality and reduction of diseases burden on Nigerians, especially the vulnerable groups....and announced free medical care to pregnant women and children under five years of age. Details in the Guardian

To the general public, especially those who have not had any personal experience, LUTH is not only an apex health institution in Lagos where doctors and nurses are trained but also a place where the best medical services are supposed to be provided....however for more than three weeks between the months of June and July surgery appointments had to be canceled or rescheduled. Why? Lack of oxygen! Read an astonishing personal account in the Guardian

Infrastructure is crucial in maintaining health care services. But health infrastructure is less the buiding but the small things that matter; a working stethoscope, clean beds etc. Finally the Nigerian Medical Association is waking up and advocating for more in the Champion

The Federal Neuropsychiatric Hospital, Enugu says they are setting up outposts in every local government in the region...about time! But seeing is report in the Champion

The Pfizer Trovan controversy runs and runs. 2 reports here and here.

A group called the Association for Good Clinical Practices in Nigeria, a non-governmental organisation, which comprises health professionals called for local clinical trials for drugs before granting license for their registration. AGCPN frowned at a situation where NAFDAC would approve some herbal drugs for sale in the country without any evidence of clinical trials either abroad or in the country. Details in the Guardian

Finally, medical doctors in the country have been able to surmount a two-year major hurdle in the realization of their dream to have their own housing the Sun reports.

Thursday, 1 November 2007

125,000 people living with HIV are accessing antiretrovirals in Nigeria

In 2001, the Nigerian Government government declared an ambitious national treatment antiretroviral target (the drug treatment for HIV/AIDS) to reach 100,000 people by 2003, scaling up to 250 000 by the end of 2006. The ambitious aim was to have 1 million people in treatment by 2009.

A recent report by the The Health Reform Foundation of Nigeria, a non government organization in Nigeria showed that there are currently 124,572 PLHAs accessing antiretroviral drugs (ARVs) in various centres across the country. Although this means that the number of people on ART has multiplied ten fold since 2002 in Nigeria, but this represents only about one in five of the number who actually need the drugs.

The report also says that the delivery of ARVs response is still predominantly donor driven i.e most of the funds come from development partners.

Hardly any guidelines were found in centers delivering ARVs...implying a diversity of practice depending on the provider. Many sites lacked adequate space for counseling....and did not stock second line drugs for patients failing the first line drug combinations.

The full report can be found here.

The Health Reform Foundation of Nigeria aims to support and help to sustain Health Reform Agenda in the country. The origin of the Foundation was the Change Agent Programme (CAP) which was funded by the UK Department for International Development (DFID). Last year it organised a conference on the state of health care in Nigeria. The report of this conference can be found here.