Thursday, 27 March 2008

Health Education: Not for Health Professionals alone

by ndubuisi edeoga

I recently spoke with some of my colleagues in the teaching hospitals back home in Nigeria. They recently got some equipment supplied to them costing millions and millions of dollars. And you guessed right! There was no input whatsoever from the doctors on the "front lines" on the type of equipment or the quantity required. No consultation was carried out. Important questions like
...what do you need to make your patient care better? More CT scanners? more beds? more MRI machines, more exam couches, or more doctors?

The people "on the ground" would most likely know what they need to make the system work, what is needed in one hospital might no what is needed in another hospital. But our beloved Federal Government basking in an unprecedented oil boom placed a blanket ordering of equipment, for all our teaching hospitals, many of which still lies fallow in several places.

The hospital community, doctors, nurses, cleaners, patients should be involved in making these decisions...

The same situation is found in many public health programmes initiated by NGOs. How often are members of the community consulted on the services to be offered?

Gladly we are happy to report that one NGO has done just that....Water AID.

Using the principles of "Community Led Total Sanitation" (CLTS) developed by Dr Kamal Kar, Water AID is changing these dynamics. It would seem impossible to involve a whole village, adults, children, kids, women, in major health decision making. However with their results showing greater than 85% adherence rates ...WaterAid Nigeria ( WANG) has used these principles successfully in several communities. The experience from the Oju water sanitation project shows that a large proportion of the projects are still working ten years after they were established, even though there has been challenges of commitment from the government at both local and state levels, the communities who have been empowered through these processes have continued to work at sustaining these programmes.

Kar developed this dynamic principle due to the lack of success of NGOs in Bangladesh involved in sanitation. BUT MOST IMPORTANTLY ...This principle can be applied to any other health program!
The crucial common factor in all the above is the need to assure a "A SENSE OF OWNERSHIP"

Responsibility, care, maintenance all inevitably follow a sense of ownership. If the Federal Governments sends down loads of equipment that are not considered priority, it does not matter what they are worth in real terms, they will be worth little to the hospital's patient population. If an NGO provides condoms to a random population, it should be no surprise when teenage pregnancies persist and HIV prevalence soars...

The "simple" logic is to spend the energy at the beginning, so that people buy into an idea where they have an equal sense of co-ownership.

Who wants his/her own ship to sink?

Wednesday, 26 March 2008

Another false start...a chronology of reports

by chikwe ihekweazu

After days of rumours and anxiety, the Minister of Health, Prof. Adenike Grange resigned her office with this statement:

“I am leaving this cabinet because I consider my dignity, reputation and legacy -values that I have worked hard for and hold dearly. I am returning to my unblemished career which I have assiduously laboured for over the years with resounding success nationally and internationally and to the business of which I am familiar with – saving the lives of mothers and children across Nigeria and the world in general ~ Adenike Grange ."

It all started on Sunday the 2nd of March when Martins Oloja of The Guardian published a story that a female a ministry with an architect as Minister of State had been arrested....put 2 and 2 together

On the 3rd of March, THISDAY reported that it was confirmed that The Health Minister, Prof. Adenike Grange, who was arrested last Thursday on the orders of President Umaru Musa Yar'Adua over the handling of unspent funds in the 2007 budget.

On the 14th of March it was picked up by the Scientific press, when SciDev one of the most respected scientific journals when they reported that Nigerian health ministry was dogged by fund misuse claims — as a 'Christmas bonus'.

On the 15th of March The Independent reported on the details of how officials at the Federal Ministry of Health in Abuja intended sharing the unspent funds, totaling N300million in its possession prior to passage of the current budget has been revealed.

On the 18th of March, The Punch reported that Dr Iyabo Obasanjo-Bello, Chairperson of the Senate Committee on Health was named as one of the beneficiaries of the unspent budget of the health ministry, allegedly shared by ministry officials and senators.

Finally, on the 26th of March it is announced by the Special Adviser on Communication to the President that the Ministers have resigned. A detailed account by The Guardian can be found here.

Thisday reports that Professor Grange has insisted that while she has accepted responsibility for what happened during her brief tenure, she was not accepting guilt ...

It is no secret that we were excited about Prof Adenike Grange on this blog...obvious from this post, this one and especially this the Lancet Lecture.

There is obviously deep seated corruption in the health ministry. It is especially sad that public servants and Senators from the supervisory Committee on Health could be sharing money when millions are dying from lack of access to life saving drugs, lack of necessary equipment at public hospitals and incessant strikes by under-paid health professionals.

It is indeed sad that Prof. Grange has paid the price, BUT THE BUCK ENDS ON HER TABLE.

Prof. Grange now faces the challenge of clearing her name... when she does...we hope she shares her experience of being introduced to the turbulent corrupt world of the Ministry of Health from the quietude of a teaching hospital.

...and Nigeria faces a BIGGER challenge of looking for a credible, honest, capable, forthright individual to give health of Nigerians the attention it deserves.

...therein lies the challenge!

Tuesday, 25 March 2008

Breaking news - Nigerian health ministers "resign"

Just received the breaking news that the Minister of Health, Professor Adenike Grange and her collegue, the Minister of State for Health, Architect Gabriel Aduku whom we welcomed in earlier blog posts here and here have resigned

The news has been carried by a couple of websites and while we await further clarification, we reflect sadly on yet another unfulfilled in the journey towards better health for all Nigerians

Sunday, 23 March 2008

"With Patience, All’ll Be Well"

The Presidents Eid-el-Maulud and Easter message...

"I urge you all to remain patient in the firm belief that with your continued support, understanding and cooperation, our administration shall by the grace of God Almighty deliver on its promise of a better life for all Nigerians"

~ President Umaru Musa YaríAdua

...Thank you Mr President....we share your prayers.

Friday, 21 March 2008

Information is Power

by chikwe ihekweazu

A few years ago...I walked into the Federal Ministry of Health in Abuja in search of a specific report. After spending an afternoon being sent from pillar to post, I gave up. At the time...there was no library, no depository for the hundreds of reports written yearly on different aspects of health in Nigeria. Written by NGOs, development partners, states, consultants etc etc. No database of what has been written, where it is located...nothing! Bowed and subdued in shame, I accepted the sad reality of the institutional memory that is being lost . Thinking about all that can be done these days with so little resources. All it takes is the recognition of the need...and the barest minimum of skills and resources. But therein maybe lies the problem. It cannot be solved by awarding a contract as we tend to do in our beloved country

Of course...all that could have changed since. We might have a library in the FMOH, easily accessible to Nigerians. We might have a directory. We might even have online access to this directory. IF YOU KNOW...pls share this with us!

...until we hear from you...this blog will be posting not just news stories, but reports and research published on health and health care in Nigeria.

Find a sprinkling below, courtesy of Health, Education, Social Protection News & Notes, a bi-weekly newsletter supported by GTZ (Deutsche Gesellschaft für Technische Zusammenarbeit). An excellent resource. To subscribe, write to

A new study titled - Computer use among doctors in Africa: Survey of trainees in a Nigerian teaching hospital shows that in Nigeria’s premier and largest teaching and research hospital, the University College Hospital (UCH), Ibadan, ...38% of the respondents could not use a word processing software while 87% could not use any software for basic statistical analysis.

As the authors rightly conclude medical practice requires the use of computers for support in information processing, decision making and records keeping...we need to catch up with the rest of the world. FAST...

An interesting and thought provoking assessment of TB policy in Bangladesh, Brazil, Nigeria, Tanzania, and Thailand has just been published by the Open Society Institute.
Nigeria ranks fourth on the World Health Organization’s list of TB high-burden countries and has the highest TB burden of all African countries.
TB/HIV coinfection has made detection and treatment of TB even more challenging. Despite these alarming facts, TB awareness among political officials and health workers as well as the public at large is low, and this contributes to widespread misconceptions about TB and stigmatization of the people who have the disease…

Interesting statement of services in Nigeria
"remove the donor, and everything would crash"
The Open Society Institute works to build vibrant and tolerant democracies whose governments are accountable to their citizens....something we desperately need in Nigeria. It was founded by investor and philanthropist George Soros in 1993 as a private operating and grant making foundation.
The lead researcher on this was Olayide Akanni, of Journalists Against AIDS (JAAIDS) in Nigeria
More on TB in Nigeria here, here and here

Another thought provoking report titled Reproductive Health Knowledge and Practices in Northern Nigeria: Challenging Misconceptions by Pathfinder International questions all you pre-conceptions on knowledge and attitudes to child spacing, breast feeding and HIV/AIDS in Northern Nigeria.

We hope this has wet your appetite. But the success the depends on YOU. Lets find the reserch papers, reports, recommendations. Lets put them in the public domain. Lets ask the hard questions! Information is Power!

Sunday, 16 March 2008

Blogging on health in Nigeria..."a waste of time"?

by chikwe ihekweazu

Since Ike Anya and I started this blog after attending TEDGlobal in Arusha Tanzania last year, many friends, colleagues and strangers have been extremely complimentary, but there have also been a hand full of cynics, asking what difference does it make?

Generally, many of us have become pessimistic, skeptical, disinterested and disengaged from our country and live in some vague hope that we will become re-engaged when "things get better". Until siddon look we deh. Maybe rightly so....

Others have challenged us in subtle innuendo on our justification in blogging about health issues in Nigeria when we both live and work outside the country. Maybe rightly so...

Some have accused us of being too critical of the Nigerian health sector ....and being insensitive to "how things are done in Nigeria".
again...maybe rightly so....maybe...

How do we get our stories?...many have asked. Mostly from the popular press, many from our network of colleagues, etc. But our goal is not to take over the work of journalists, but to give a public health perspective to the reports and events...contextualising to Nigeria and Health.

But for what? ...a question we are often asked and we increasingly ask ourselves when we realise that 3-4 days have gone by and we should actually update our blog :)

Reading this week's edition of TIME International...we found a statement that gave us that nudge to go on... Written by Jeffrey Sachs, author of The End of Poverty who we had recently quoted on this blog in another context.

Great social transformations—the end of slavery, the women's and civil rights movements, the end of colonial rule, the birth of environmentalism—all began with public awareness and engagement. Our political leaders followed rather than led. It was scientists, engineers, church-goers and young people who truly led the way. If as citizens we vote for war, then war it will be. If instead we support a global commitment to sustainable development, then our leaders will follow, and we will find a way to peace.

OK...our aims can hardly be grouped into "Great social transformations". But YES we do want to push the "HEALTH" agenda in Nigeria. We are remain eternal optimists.
We believe that the Nigerian society is undergoing profound but subtle change. Some sectors that have been blessed with rare thinkers, ahead of their time like the banking sector with Charles Soludo, the Governor of The Nigerian Central Bank and the the financial sector with erstwhile Minister of Finance, Ngozi Okonjo Iweala . We pray history will judge current Minister of Health in similar terms. We need to build on the legacy of Prof. Olikoye Ransom Kuti...who is still fondly remembered with nostalgia for his revolutionisation of the Nigerian health sector by placing great emphasis on preventive medicine, particularly concentrating on preventable childhood diseases and encouraging continuous nationwide vaccination programmes.

We are convinced that growth and development in any country is an effort in futility if sectors like education and health are not prioritised. These sectors are obviously less attractive to the much sort after "investor". These sectors rely almost entirely on visionary leadership and an informed citizenry. While we have no influence on the former...we try to play our part in the later. In showing that there is a public demand for better health and health care, we believe we make it easier for the minister of health and heads of health parastatals to demand the requisite resources from our leaders.

Therefore we chose to ask the sometimes difficult questions no one else is asking. Why is Nigeria still one of the biggest threats to the eradication of polio? Why are outbreaks of measles still common, why do hospitals built with public funds lie unused for years and end up burnt and why Pfizer will not settle.

We also highlight the positives. The gradual maturation of health insurance, the stabilising of the HIV/AIDS epidemic, and the efforts of individuals and groups (like the Kanu Heart Foundation) play their role.

We still hope it is worth your time...and ours :)

P/s We are happy to welcome Ndubuisi Edeoga on our team. ND is an alumni of the College of Medicine of the University of Nigeria, and the MPH programme of Northern Illinois University, USA. He has already created significant interest with his series "Back to the Basics.

Tuesday, 11 March 2008

DDT and Malaria: Back to the Basics II

by Ndubuisi Edeoga

Every Nigerian doctor remembers the phrase from medical school “common things occur commonly”…always think of malaria!

The burden of disease of malaria on the Nigerian population is self-evident. At a recent event, our Minister of State for Health was quoted as saying that 110 million Nigerians are active malaria patients …don’t ask where he got his data...he does not say :).

The Roll Back Malaria Partnership was launched with pomp by African heads of state in Abuja in 2000 where they came up with the ABUJA DECLARATION. Despite the initial razzmatazz, many have described this as a failing health initiative. Many reasons have been suggested; one recent one is most poignant. by Mark Grabowsky in an article in Nature, one of the preeminent journals in the scientific community. Grabowsky says disease surveillance is the secret weapon behind the successes in polio and measles control, powering funding and informing decisions. But no such systematic surveillance data exists for malaria. He might just have a point! Without high quality data to show progress, it is most difficult to focus energy....
you cannot manage what you cannot measure!

Jeffery Sachs in his book The End of Poverty raised the profile of malaria…saying “one issue that has been tragically neglected for decades now is malaria. A disease that kills up to 3 million people every year. It's a disease that could be controlled quite dramatically and easily if we just put in the effort". He attributes extreme poverty in malaria endemic regions of the world mostly to malaria. Though we believe that it will rank behind a whole series of other self-inflicted causes in Nigeria, it definitely is one that can be solved.

Over the years DDT has gone through the waves of love and derision in public opinion. In the 1950s and 60s, DDT spraying eradicated malaria was used across Southern Europe, and it was used commonly in Africa until the late 1970s. At the same time, DDT was being used across the world as a farming pesticide. But widespread spraying was eventually shown to kill fish and threaten birds. DDT became a "pariah" chemical. But NO studies ever proved that it also damaged human health, yet it was widely believed to do so and was banned.

Now, however, some African governments are beginning to judge that the ecological risks posed by DDT do not compare with the danger of malaria getting a deadlier grip. The bottom-line is in the last 50 years of intense study no causal relationship between DDT and harm to human health has been documented. Now the pendulum has swung again…DDT is back in fashion! Some have called it a renaissance.
Maybe sometime in the future we will come to understand the forces that led to its ban in the first place and share with them the burden of death inflicted.
WHO has recently changed its policy governing malaria control and now endorses use of indoor residual spraying of insecticides (IRS) as a primary means of malaria control, to include use of DDT. Additionally the US Agency for International Development has changed its policy on use of IRS and DDT funding countries to use DDT. Presently DDT use in the South African Malaria control program is showing amazing results. Dramatic reductions in their malaria cases are being recorded and maintained. Many countries in Africa have reinstated the use of indoor spraying with DDT as the mainstay of their anti-malaria programs. These enormous changes in policy should not be ignored by the Nigerian Health Ministry. We expect our country to show leadership in the use of DDT in responding to malaria.

As we reposition to achieve the Millennium development Goals, I take us back to Mr. Sachs book were he says that “there are certain places on the planet that, because of various circumstances—geographical isolation, burden of disease, climate, or soil—these countries just can't quite get started. So it's a matter of helping them get started, whether to grow more food or to fight malaria or to handle recurring droughts. Then, once they're on the first rung of the ladder of development, they'll start climbing just like the rest of the world”. I suggest Nigeria is NOT one of those places. We have what it takes…but we need the will. In 2006 the WHO gave the country $180 Million in interest free loans to fund malaria programmes.

Non of this was for DDT....hopefully this will change

Sunday, 9 March 2008

Medical laboratories, health care infrastructure ...and update on the strikes

The delivery of laboratory services has witnessed a lot of activity recently. The Nigerian Institute of Medical Research (NIMR)’s HIV testing and Tuberculosis reference Laboratory has received ISO certification for quality management and services. Kudos to Prof. Oni Idigbe, NIMR’s Director General...who has raised the profile of the institute considerable since he has been in charge.

A similar laboratory for tuberculosis drug research and treatment, funded by the U.S. Government, was commissioned in National Institute for Pharmaceutical Research and Development.

Other infrastructure donations...China continues its charm offensive in Africa and offers to build and equip a comprehensive hospital in the Abuja metropolis to be donated to the Federal Government of Nigeria...

Lagos State Government builds a four-storey building ward complex and dental centre at the State University Teaching Hospital, Ikeja. The dental centre includes a recovery room, dental laboratories for making dentures, panoramic X-ray with two mobile X-ray units, 10 offices for doctors, among others. The most important aspect of this story is that it seems to be part of a comprehensive four-year infrastructural development plan for its health sector.

While we celebrate these...realise that in the health sector in Nigeria, we often emphasize large infrastructure projects (think VAMED...think Primary Health Centres). When it comes to health...infrastructure is a necessary step...but only a first one. Now lets make these work for the people.

...update on the strikes
Different reactions to the strikes in hospitals across the country...In Jos University Teaching Hospital it is reported that 60 members of the striking resident doctors were sacked, with private and faith hospitals bearing the burden. In Port Harcourt Teaching Hospital the strike has been called off. The CHAMPION reports that following efforts of the technical committee set up by the Federal Government to review a better welfare package for doctors, the Nigerian Medical Association (NMA) yesterday extended its earlier ultimatum which expires tomorrow to a new date, March 28. Nigerians hope for a resolution...noyt just in the short term...but in the long term. What no one wants to see are strikes by pharmacists, nurses, etc etc ...leading to further frustration for the patients.

Patients...remember them? is amazing how little they seem to feature in the public utterances of those negotiating conditions of services from all sides...


Monday, 3 March 2008

On Health: Back to the Basics

As we dwell on the current health issues plaguing Africa and Nigeria, and the initiatives already in place and planned for the future. We need to look over our shoulders and see if we are missing out some important details.

Recent reports show increasing trends in patients receiving Anti retroviral medication all over Africa, this is quite commendable. Even though the progress is tilted in the favor of the urban dwellers and ignore the rural dwellers that are most at risk, we still acknowledge progress.

The current administration and the current health minister in Nigeria give us hope, despite her recent troubles, we have seen a move towards more involvement of stakeholders in policy issues and advocacy. As we March towards more funding for all levels of health care, there is a growing tendency to ignore the pertinent public issues, and thereby lose ground already covered, if there’s anything like that in our case.

On HIV/AIDS are we focusing solely on the provision of ARV’s and abandoning the provision of condoms to people at risk. In the US and other economies that have succeeded in reducing the minimum the HIV scourge they have effectively combined both arms, primary and secondary prevention. In our case the primary prevention which is always cheaper should not be ignored.

My recent visit to my alma mater here in the US served as reinforcement of this need. The provision of free condoms in the health center waiting rooms, gymnasium atrium, residence halls, dining rooms, fraternity residencies, and other places that students are wont to gather, has even escalated compared to when I was there years back.

In Africa and Nigeria especially are we providing free condoms to our university students, are we providing free condoms to our prostitutes, or are waiting for more people to join the growing queues for subsidized ARV’s? “GlaxoSmithKline has urged the Nigerian government to implement a duty waiver on antiretroviral drugs to improve access to them by HIV/AIDS patients in the country”, says one headline, I have not seen any headlines urging duty waivers on condoms.

As we plan to build bigger hospitals, improve access to ARV’s, we need to continuously drive home the message of prevention and increased condom use simultaneously. That way our gains would not be eroded by us ignoring the basics.