Thursday, 31 January 2008

Doctors on strike - who will save the patients

We learnt as medical students that striking will always be the absolutely last option. Yet strikes have dominated the landscape of medical practice in public service in Nigeria. My entire set (like many others) lost one year of our lives to strikes. But that is nothing compared to the memorries of the frail and elderly being carried out of our hospitals in makeshift stretchers in search of private hospitals when the next strike started...or the accident and gunshot victims that died in casualty because doctors were on strike. How do we live with this?

But...on the other hand, why do our governments go into aggrements that they cannot meet? Are we doing the best we can to provide the best conditions we can as a society for our doctors to function?

STRIKES...What are the cost in lives? What is the cost in money? What is the cost in the motivation of doctors? What is the cost in confidence in the health care system?

WHY is there no public outcry? Does nobody care?

Read how it has been reported by the Nigerian press...basically as if it is the most normal thing in the world...

Leadership: CLINICAL activities at the University of Calabar Teaching Hospital (UCTH) have been grounded as the Association of Resident Doctors (ARD-UCTH) has commenced a three-day warning strike to demand for the full payment of their Consolidated Salary Structure.

Champion: Resident doctors in Nasarawa state have again embarked on an indefinite strike to press for full implementation of their demands from the state government.

Punch: The Minister of Health, Prof. Adenike Grange has ordered striking resident doctors of the Jos University Teaching Hospital to go back to work immediately.

Tribune Medical activities were on Thursday paralysed at the Federal Medical Centre (FMC), Abeokuta, Ogun State, as the Association of Resident Doctors (ARD) embarked on indefinite strike action following the refusal of the hospital management to heed to their demands.

Thisday...and in Kogi...strike has just been called off!

Vanguard: Doctors under the auspices of the National Association of Resident Doctors (NARD) will Friday, February 1, 2008 embark on one-day solidarity strike with its parents body, the Nigerian Medical Association (NMA) over Federal Government’s inability to effect the Medical Salary Scale (MSS) being demanded by the doctors, amongst other demands. This is coming on the heels of a recent 21-day ultimatum issued by the NMA to the Federal Government to resume serious talks on the MSS.

Champion MEDICAL doctors working in Federal Government hospitals yesterday made good their threat of embarking on a seven-day partial strike for the non-restoration of their old-salary structure, even as the government has pleaded with the doctors to suspend their action.

Leadership....and everything is paralysed!

Punch but...The Federal Government and the Nigeria Medical Association have appealed to resident doctors not to embark on a nationwide strike scheduled for Friday (today).

Aluta Continua....

Wednesday, 30 January 2008

How the Nigerian Senate fights for our health

Those that follow the Nigerian health scene will be aware of The National Health Bill that has been with the National Assembly for close to two years.

There are fundamental problems with the organisation of health care delivery in Nigeria. One of the most important lapses is that the most critical aspect of health care delivery; primary health care is left in the arms of the weakest part of governance in Nigeria (the Local Government). The Minister of Health, Prof. Adenike Grange has argued severally that for things to move forward we need to address this legistlative dilemma.

To quote her...

"....the absence of a National Health Act to back up the National Health Policy has been a fundamental weakness which needed to be tackled frontally. This weakness means that there is no health legislation describing the national health system and defining the roles and responsibilities of the three tiers of government and other stakeholders in the system. This has led to confusion, duplication of functions and sometimes lapses in the performance of essential public health functions"

This Bill has been lying with the National Assembly for 2 years.

Health care workers in Nigeria have been literally begging lawmakers to pass the bill. The WHO made it top of the agenda in a recent meeting with Nigerian Health care Professionals. A Nigerian National Health Conference (NHC2006) begged for our National assembly to pass the bill.

After all the public hearings retreats and the reaction of YOUR SENATE

Today Thisday reports...

The move to have a National Health Bill for Nigeria suffered a setback in the Senate as the consideration of the report was suspended during plenary session yesterday.

The bill was read the second time and referred back to the Senate Committee on Health for the final legislative work before the end of the last senate tenure in June 2007.
To conclude legislative work on the bill yesterday, the Chairman of the Senate Committee on Health, Senator Iyabo Obasanjo-Bello presented the report as scheduled for consideration in yesterday's Senate Order Paper.
But the Senate Leader, Senator Teslim Folarin immediately moved a motion for the report to be suspended until the senate revisits its standing rule 111.
The motion was seconded by the Deputy Minority Leader, Senator Olorunnimbe Mamora, who was a member of the Health Committee that worked on the bill in the last senate.
The rule states: "The Legislative business of the Senate which remains undetermined at the close of session or the life of the Senate shall be resumed and proceeded with in the same manner as if the session or life of the Senate has not ended."
Not even the argument of Senator Obasanjo-Bello that the nation is in dire need of a National Health Bill and that so much work has gone into the bill including public hearings, retreats and discussions with various stakeholders could make the senate change its mind yesterday
She said: "The bill before you today is probably the most important bill on Health that will be passed by this distinguished Senate and probably the most important health bill passed by the Senate in our country's history concerning the health of the people."
"The need for this bill arises because the Constitution is silent on health. Health is not mentioned on either the exclusive or concurrent list. The only area related to health mentioned is Drugs and Poison on the exclusive list." She stated.
"Being healthy is mainly preventive medicine, which is why Primary Health care is important and should be the focus on our health delivery system. Solidifying primary Healthcare is the only way to improve health for most Nigerians.
She went on: "Yet on born Nigerians will benefit from the impact of this bill. It provides funding for Primary Health Care, regulation for carrying out human clinical trials, regulation for transplanting, rights of health care workers and patients, division of health responsibilities of Federal and State Governments among other details."

Saturday, 26 January 2008

Random health stories in the media out of Nigeria

The quality of health reporting in Nigeria continues to leave so much to be desired. It got so bad this January that when The Guardian could not decide if the outreak in Zaria was measles or rubella, they called it "rubella measles".
A few days later, The Guardian, arguably Nigeria's most respected daily ran with the headline "Rubella, another deadly disease on the prowl" It claimed that ... no fewer than 600 people are feared to have died of the deadly Rubella measles in various parts of the country even as health officials battle to contain the scourge. If true, this would be extremely surprising as rubella is a lot less contagious than measles and less severe in the illness it causes and deaths associated with it. The major risk associated with rubella is that if a pregnant woman is infected with rubella there is a risk of damage to the unborn child. Is this risk mentioned in the article?? Guess!.

However we are told that
Consultant Specialist Grade One, Epidemiology and Health in the Federal Ministry of Health, Dr Jide Coker, told The Guardian that the ministry, states and the NPHCDA officials are now collaborating to prevent further outbreak of the virus no cause for alarm!

Hospital Refurbishment seems to be the vogue this days....with little said about how to manage and maintain. The Champion reports that in Lagos State the commissioner for health, proudly states that he has spent N5B (40 million dollars) on refurbishing Lagos State University Teaching Hospital! I wonder how much money it takes to build a new one these days in Nigeria! The Punch reported that contrary to a popular belief, the last administration did not refurbish the critical units at the University of Nigeria Teaching Hospital, Enugu. Read more on the Ile Ife Prince given the contract to refurbish our teaching hospitals by the Obasanjo administration.

Last week, several newspapers reported a 3-day warning strike by doctors in the University of Calabar Teaching Hospital. . Early in January, The Guardian reported a strike by doctors in Kogi State.....a few days later Thisday reported it was suspended. You will not want to imagine what happens to all those patients that are in critical situations. What if YOU were brought to the hospital at just that time? When do we get the TERTIARY HOSPITALS COMMISSION promised by the new Minister of Health?

When BBC reported in 2001 that BAT announced to invest $150m in Nigeria building a factory making ...what of the Minister of Health? What did he say? internationally-recognised cigarette brands, and developing the country's tobacco farms, it was welcomed by Nigerian Industry Minister Kola Jamodu as a signal that Nigeria was "on track"...many of us wondered...As reported in our last blog posting ...the same government is now taking the companies to court. While it is interesting to note the Governments sudden interest in seeking compensation from the cigarette firms, we only wished they invested a bit themselves in prevention initiatives, i.e. anti smoking campaigns. How do you counter BATs huge resources spent on advertising ...using catchy phrases like "EXPERIENCE IT".

Tuesday, 22 January 2008

DFID Programmes in Nigeria

Have you ever wondered what health programmmes and projects are ongoing in Nigeria, what their aims and objectives are and how well they are doing (or not)?

We have often looked forward to a situation where the national health strategy and programmes were put in the public domain in order to enable Nigerian citizens to hold health officials and donors to account. Ngozi Okonjo-Iweala, while she was Finance Minister blazed the trail by publishing on a regular basis how much revenue was accruing to government coffers and how they were disbursed.

The UK Dept for International Development is one of the key donors to health programmes in Nigeria, and an outline of their programmes in Nigeria (not just in health) is published here

The International Development Committee of the UK Parliament as part of its oversight function, is holding an inquiry examining DFID programmes in Nigeria and is currently calling for submissions from interested parties, especially organizations based in Nigeria. The deadline is the 8th of February. More information is available here

Friday, 18 January 2008

Nigeria takes on tobacco companies

I’ve blogged before about the challenges of tobacco control in Nigeria. The fact is that with the increasing effectiveness of anti-smoking policies in the Western world, the tobacco companies with their usual level of sophisticated and not-always-ethical marketing have turned their attention to developing countries. With Nigeria’s huge population, it’s not surprising that it has been one of the targets- witness the lavish music concerts, fashion shows and glamorous events sponsored by various cigarette manufacturers in the last few years.

There has always been a sense of challenge in relation to tobacco control in Nigeria. Not long into his first term in office, President Obasanjo was guest of honour at the official opening of a large British American tobacco factory in Ibadan, an event that was hailed as a triumph of the search for foreign investment in the country, with the jobs that were created. Yet there was little mention of the huge health costs that could result from this, and the weighing up of costs and benefits. The factory was apparently opened following the closure of a smaller one in Ghana

Similarly I’ve heard of people who were jobless for a while after leaving university, finally getting a lucrative job with a tobacco company in Nigeria and have struggled with my personal feelings- to insist that they reject the job because of the damage that I know smoking can cause to public health or be relieved that they have finally got a job. But in the long run for the Nigerian society, the expansion of tobacco companies cannot be a good thing.

The history of Nigeria’s leaders and smoking is also interesting- Shehu Shagari was said to be an avid smoker, as is (was?) the current president Yaradua. Professor Olikoye Ransome Kuti who spearheaded the ban on smoking in public places and restrictions on advertising in the late 80s was also said to have been a chain smoker who quit smoking as a matter of principle on being appointed Minister of Health.

The recent news that the Nigerian government is suing the Big Three tobacco firms for 44 billion dollars for marketing to children and putting pressure on health services is certainly welcome news. Apart from serving as a warning shot across the hatches of the tobacco companies, it also raises awareness and debate about the hazards of smoking and the techniques that the tobacco companies have employed to grow their businesses. There is also the potential for a financial settlement which could, despite the skeptic assertions from some Western media pundits be applied towards improving the health of the Nigerian people.

While we wait for new developments in the case, the Nigerian government’s willingness to take on first Pfizer and then the tobacco companies in the law courts is admirable, even if only for its symbolism

Similarly, the launching of the Coalition Against Tobacco and the government challenging the setting up of a 9.6 trillion naira tobacco factory in the country are good signs and evidence that the government and the health ministry are willing to stand up to their responsibilities as a signatory to the Framework Convention for
Tobacco Control

Friday, 11 January 2008

National Hospital Abuja: Unrealised Expectations

From the outside, our National Hospital does look impressive. Lush green, well-manicured lawns, with sprinklers, clean surroundings, cleanish corridors, and a sprinkling of computers. I always thought that this would be an attractive place to work in Nigeria.

During a recent personal experience on the paediatric ward...visiting a friend whose 4-month old child was being treated, I stood on the sidelines and watched the slow paced, almost lackadaisical pace of work. My friend cursed at his wife for coming here rather than the private hospital they normally attend. To prepare the oral rehydration fluid for the child...we were sent to the mamimarket near the gate of the hospital to buy "Eva water"...I finally bulked and introduced myself to the colleague managing his child; he asked…"why I had kept quiet all this time?" Now things started to move...I was happy for my friend ...and sad for my country.

The National Hospital was initially established by our "beloved" ex-president General Sani Abacha and his wife, Maryam as FEAP Hospital for Women and Children. Concerned that Arab Contractors, the original contractor might not be able finish the project as scheduled, Hajia Mariam Abacha promptly revoked the contract and gave it to Julius Berger. After the Obasanjo administration was sworn in, the hospital was renamed National Hospital. Since then the Presidency has been directly running through the office of the Secretary to the Government of the Federation.
This means that Federal Ministry of Health does not supervise Nigeria's Apex Hospital. The Hospital is also NOT a University Teaching Hospital.

In 2003 The International Hospital Group was brought in from the UK to manage the hospital for 10 years. It has similar contracts with 25 countries around the world. It was sacked a year later for incompetence following a report that concluded that "The National Hospital was a bottomless pit, with little to show for it by way of palpable improvement in the quantum and quality of care".

After the sacking of IHG, an Interim Board for the Hospital was appointed in April 2003 headed by a lawyer and his Special Assistant, Hon Musa Elayo to turn around the Hospital within three months. Obasanjo charged Elayo to
"fix the hospital to a standard where I, the Vice President, the secretary to the Government of the Federation, the ministers and top government officials will receive treatment instead of going abroad."

A new management was appointed led by the President Obasanjo's personal physician Dr. Olusegun Ajuwon OON. He remains the medical director, read a recent interview…aptly titled "I Owe My Success to God".

Where is the due process in all these. What type of recruiment process is it where Chief Executives and Board Chairman are appointed from among personal aides? Why is the management of the National Hospital so politicised? What has improved since IHG was sent packing?

And the saga continues...It was widely reported here and here in 2006 that the National Hospital had been listed for privatisation by the BPE, although it is not listed on their website.

There have been a few "good news" stories. The one in most newspapers at the moment is about our belowve ex-governor James Ibori charged by EFCC for fraudulently enriching himself with millions of dollars is ill, he was transported by helicopter from prison to our National Hospital...I wonder what how his co-inmates in the Kaduna prison felt.

The Punch writes that the National Hospital, Abuja on Thursday, said it had "produced" (sic) six test tube babies in 2007 through its newly consolidated In Vitro Fertilisation Centre.

Intel is also publicising a telemedicine project that utilizes two-way video conferencing which allows the doctor examining the patient in a hospital in Bida to share data with doctors located at the National Hospital. Intel is also providing training to medical staff, technicians, registered nurses, and IT.

Several people have complained about the failure of the National Hospital in Abuja to meet their aspirations as here and here and here. Allegations of fraud in the hospital management have also been reported.

Nigerians would really like to know why is there no single world-class tertiary hospital in the entire country to negate the continued need to fly patients to South Africa, India or the United Kingdom? What exactly is the role of the National Hospital in Abuja? Why is it not meeting its objectives? Why is it necessary for a sitting vice president and a leading aspirant in presidential elections to be flown abroad for a knee strain and to treat "catarrh"? So much so that when the ex President went for a routine check-up at the hospital, it made the news. What needs to be done with the National Hospital in Abuja to make it meet these challenges? Is it the absence of learning incentives through the lack of a comprehensive postgraduate training scheme for doctors in training? Is it the absence of a financial incentive due to the lack of specific health outcome targets tied to the huge financial resources being invested?
If our most pre-eminent have no confidence in our premier health care facility, what can the ordinary Nigerian expect? Nigerians deserve a genuine centre of excellence. Our politicians should prioritise this, if not for the sake of the ordinary man but out of self-interest - it could save their lifes!

Many will argue that this is not a priority but the creation of such a centre will raise standards in the provision of health services and therefore boost the general quality of services. In addition it can act as a magnet to draw highly qualified Nigerians from all over the globe as well as provide education and training to healthcare professionals within the country.

The good thing is that Nigerians are not initaitives to build a centre of excellence by private individuals are being announced every day...such as The American Nigerian Institutes of Health