Tuesday, 29 April 2008
In my home I don’t have any third graders yet, but I happen to have a 3 year old daughter and 4 + old son, I played the video for them ..And the rest is history….play it again, and again and again. The feedback I got from my kids has spurred me to ask myself some pertinent questions. Are we really doing all that we can in the spread of health information to our loved ones. How many people have taken the time to explain to their kids and family members the causes of stroke, diabetes, diarrheal diseases, and how we can reduce our exposure to these ailments?
How many of us have taken time to explain to our kids and family members the link between salt and hypertension,and advised them not to add more salt to food after its cooked, or the link between too much sugar,obesity and the remote possibility of developing diabetes,or the number of chemicals contained in cigarette, including noxious everyday chemicals that children can relate with, the ever present acetone in nail polish remover, we all know that smell. Do we know that “Hand washing could prevent more than one million deaths a year from diarrheal diseases”, have we shared this information with our loved ones yet?
I was reading about the new recommendations for “untrained bystander CPR”, do you know that the “untrained bystander: could be your 10year old child and that the victim could be you , your wife, partner, mother , father, grand father and other loved ones. Do you know that “effective bystander CPR provided immediately after cardiac arrest can double a victims chances of survival” The American Heart Association (AHA) recently passed new and simplified guidelines recommending bystanders perform hands-only CPR for cardiac arrests in adults while skipping mouth-to-mouth breathing. This is aimed at encouraging more people to act in emergency situations.
In countries like Nigeria were there is no emergency service, the use of CPR becomes even more important. Have you talked with your children and care takers about what to do if someone in the house collapses, do you have a number that they can reach you on for further instructions, for people that are away from the home a lot?.
The importance of sharing health information with people around us cannot be over emphasized, can we lead the initiative in our various families…yes we can!
Friday, 25 April 2008
I admit! I make a blanket assertion that will cause considerable dissent…rightly so. It is a similar blanket assumption that categorises all Nigerians as incorrigibly corrupt…and we must resist this...not just by words....but by deeds. What better way to do so than by highlighting cases where my assumption is totally wrong.
A short while ago…I was introduced to an NGO called Education as a Vaccine against AIDS.
I initially dismissed this as yet another bright but far-fetched idea at conning a few good men out of their hard earned cash.
I admit…I was wrong.
In December 1999, they took a trip together to Nigeria from the US and with the help of a healthcare consulting firm they were able to conduct formative research and the results revealed that a majority of young people lacked basic life skills necessary to prevent infection. In order to make their vision a reality Adebiyi and Akinfaderin decided to apply to the Echoing Green Foundation and were awarded one of their prestigious grants. They were able, with this generous gift and their own confidence and convictions, to turn their program ideas into an established organization. With the dedication of its staff( of 20!), assistance of volunteers and support from the community, EVA has been continuously growing and has become one of the most prominent and respected organization in the nation's capital.The primary remit of EVA is to prevent the spread of HIV by educating youth about the disease and empowering them to avoid it.....and they seem to be doing a good job at it....for a peep into their work...watch this
I have interacted with Fadekemi extensively on how this NGO is run probingly seeking justification for my cynicism. I must confess, I was so positively amazed by not just her passion (which we all claim to have) but her competence. She gave as much as she got ...outlining her objectives, her means of achieving this…and progress made against each of these in measurable quantities. Small but very significant successes. She invited me to go on a field trip with her when I visited next (which) I will take up. I asked her if she was attending any of the major AIDS conferences in Mexico or Senegal later this year…and she said curtly but politely…"I don’t do conferences”. That was my final surprise…a Nigerian that does not want to blow her own trumpet.
Well…if she will not…we will! Her concept (although focused on priority areas like HIV/AIDS) is on of the basic foundations of all public health action; preventing illness by empowering our children through education.
Hopefully our children will learn….not only how to look after themselves and their health but how our generation has failed to provide the most basic opportunities to live a healthy life in a time a $100 barrel of oil. One day these children will hold us to account.
Monday, 21 April 2008
Its been a week now since you had to leave suddenly for Wiesbaden, Germany for what your able Special Adviser Olusegun Adeniyi described as a medical review of an indisposition believed to be due to an allergic reaction.
"We honestly wish you all the very best"Yes...we know a little about the health care system in Germany...and you will no doubt get excellent care.
However, the great thing is that you will get no better care than any other German citizen will get. You might have a bigger room...and a few more visits by the "Chefartz"...but that's about it. Every German citizen will get the same quality of medical care you got! Amazing isn't it?
Sir, we hope your experience in Germany will spur you into prioritising our health sector. It is in desperate distress. We do not have a substantive health minister. The legacy of the last 8 years is a cancelled contract to build primary care centres and a flawed contact to supply multi-million dollar equipment to our hospitals with no electricity to run them. The Chairperson of the Senate committee on health, no less a person that the daughter of our ex-president is on the run from EFCC while the Health Bill has been sitting with the National Assembly for 3 years.
Sir, if nothing else you will have heard about the measles outbreaks in your home state Katsina, and the Cerebrospinal Meningitis outbreak in the neighbouring Zaria. You will have heard that over the past few months there were a series of strikes by Doctors all over the country which have only been suspended...we are worried.
Sir, in the 8 years before you came into office, the term "Health Sector Reforms" was bandied around...and our development partners poured their "Aid" at us. Unlike in the banking, telecommunications or insurance sectors, Nigerians cannot identify any impact of these "reforms" in our lives. The famous declaration of our hospitals as "mere consulting clinics" now seems like praise rather than criticism...as they have become a lot worse.
Sir, while panels are reviewing the state of our power sector, our oil sector and our national security...the health sector never gets the attention it deserves. We seem to have accepted the status quo. Your able SA media might have mentioned how much the health and health sector is discussed in the German media. Watching the election campaigns unfold in the USA, one cannot help but notice how important the "health care plans" of the candidates are. Our health sector has benefited from little strategic thinking in the past years and our health goals are still enumerated in such simplistic terms as "how many clinics we intend to build"!!!
Sir, while we all remain Faithful in the Almighty, the nature of the earth we live in demands that we will need emergency health care sometimes. Sometimes even the short 6-hour flight to Germany might be too long to wait. When you do need emergency medical care. Sir...you will be surprised at what you will find...even in our finest. Like all Faithful Nigerians, I agree that God's time is best and if it His will...it will come to pass. But I insist that The Almighty does not have anything against Nigerians...so why would he allow us to keep dieing of diseases no one else is dieing from.
Sir, allow me to conclude by again wishing you well. When you return....with your experience in Germany fresh in your memory, the sparkling wards, the courteous staff, the competent doctors. We implore you to pay a few unscheduled visits to our hospitals. What you will see will negate the need for any further letters to you Sir.
Get well soon Mr President! Alles Gute!
Thursday, 17 April 2008
We had ring side seats ...listening to exceptional talks by Ngozi Okonjo Iweala, Patric Awuah, Euvin Naidoo and Eleni Gabri Madhin. ...quietly wiping tears from our eyes pondering the missed opportunities of the past and the enthusiasm of these heroes of the present.
One talk was particularly poignant. Dr. Ernest Madu was a few years our senior at the College of Medicine of the University of Nigeria. He runs the Heart Institute of the Caribbean in Kingston, Jamaica, where he proves that -- with careful design, smart technical choices, and a true desire to serve -- it's possible to offer world-class health care in the developing world.
Sadly....he is NOT doing this in Nigeria. he would love to... After the success of this he was building an equivalent center in Port Harcourt. That was just before the rise in violence in the Niger Delta.
While focusing on AIDS, Malaria and TB, Ernest asked that we should not forget all the other important causes of illness and death!
His question: What would happen if any of us had a heart attack here in Arusha, Tanzania at 11pm at night…...you know the answer :)
If you do not want to feel sad for Nigeria...do not watch this!
Sunday, 13 April 2008
by Chikwe Ihekweazu and Ike Anya.
Watching both AIT and the NTA's national network news (beamed around the world) on Friday the 11th of April brought extreme sadness to many in the health profession and to all those interested in the health of Nigerians. Prof. Adenike Grange, accomplished professor of paediatrics, president of the International Paediatrics Association and until recently Nigeria's Minister for Health was led to court to defend herself and 11 others on a 56-count charge of graft involving about N300 million (~$2.5m). She was denied bail and escorted by operatives of the Economics and Financial Crimes Commission (EFCC) back into detention. Face down behind dark glasses she must have been wondering how she got into this mess.
Her appointment in July 2007 brought hope to most of us Nigerians. For the first time in a long while a credible, obviously competent, apparently incorruptible Nigerian was appointed to look after the health of Nigerians. She had risen to the pinnacle of her career and was recognized as such by her peers, a most critical group. Like our president, she had obviously not sought this political position. The story was that a wife of one of the 2nd term Governors who was particularly influential in the emergence of the president had heard her speak at an international conference. Thrilled by the awe in which she was held by the international community, she and her husband eagerly nominated her following the unlikely emergence of President Yar'Adua.
At this point, our health indicators were as low as they have ever been. Nigeria's maternal mortality ratio (death during and around child birth), one of the most important indicators about population health had worsened from 704 to 800 deaths in 100,000 life births between 2000 and 2004, one of the lowest in the world. Epidemics of measles and meningitis have remained recurrent themes in Nigeria despite the existence of vaccines. Nigeria is still the biggest threat to the eradication of Polio. In addition, health services were in dire straits. A sitting vice president was flown abroad for a knee strain and the current president also had to undergo the minor inconvenience of a trip to Germany to treat "catarrh"….a good indication of their confidence in health services in Nigeria. South Africa became the favoured destination of Nigerians that could afford basic health care. What then was the fate of the average Nigerian? We celebrated the arrival of Professor Grange.
Listening to her at the Lancet Annual Lecture in 2007 she articulated her programme to an international audience. She identified her greatest challenges in achieving her goals as 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. So it was a breath of fresh air when the honourable Minister declared that:
How did this dream fall apart? The charges against the minister are mostly in the public domain. A "whistle blower" in the ministry, a civil servant, not satisfied after being "cheated" in the sharing of an unofficial Christmas bonus in the ministry was said to have leaked information to the EFCC. To further complicate matters, the money was part of the funds from the 2007 budget for which there was an explicit presidential order to return all unspent funds to the central treasury. Prof Grange is reported by the press to have admitted signing off on the payments as was submitted to her by civil servants in her ministry, without understanding the implications thereof. She has maintained that she knew nothing about the use to which the funds were put until they appeared on the pages of newspapers and insists that she has not benefited personally from the funds. The matter is in court and it is up to the judiciary to sieve through the evidence and assign blame, but we seek to discuss the wider implications of this to the anti-corruption campaign of the present administration.
Unlike in any previous corruption allegation in Nigeria, the consensus of most Nigerians, individually and in collective bodies has been one of sympathy to the travails of Prof. Grange; sympathy at her apparent naivety in the ultra-corrupt terrain of the Nigerian civil service. Sympathy that she is paying a price for not being good enough at "the game" and trusting her subordinates to be bound by the same principles that she is bound by. This naivety has cost her dearly, and maybe cost us even more.
Part of the disputed funds was allegedly used to fund a retreat by the Committee on Health of the Senate of the Federal Republic. One would wonder the Ministry's rationale in funding this? The senate has been sitting on "The National Health Bill" for close to over three years. The importance of the bill is thus: 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. Prof. Grange was desperate to get this bill passed and has argued severally that for things to move forward we need to address this legislative 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"
Now, Grange is in detention, the senate committee is being scrutinised, the health bill is in limbo and the health of Nigerians remains unchanged.
Yes in detention! Her application for bail was rejected. A strange decision, considering that many of our beloved ex-governors who looted the state treasuries with impunity seem to simply appear in court, get bail and go ahead to continue openly displaying the windfall of their time in "service" with effrontery. Of course these ex-governors "have" the resources to rent crowds to come and "express their solidarity". Our chiefs and traditional rulers travel to Abuja to plead their cases. Pages of newspapers are filled by write-ups of "concerned citizens" arguing about their righteousness. The present governors are in the majority their puppets and the state machinery is not spared in protecting their interests. What risks would be posed to the public by releasing Professor Grange?
There is no disguising the fact that Prof Grange made huge errors in judgment. By not giving the activities in her ministry the scrutiny it deserves, by letting these things happen under her watch, by not taking charge of affairs and allowing business-as-usual" she missed a huge opportunity for charting the course of the Ministry of Health. In politics the buck ends on her table. We all read about the authority with which Ngozi Okonjo Iweala changed the culture of both the Ministries of Finance and that of External Affairs, we expected nothing less from Prof. Grange. Her constituencies among Nigerian health care professionals, academics and technocrats and most importantly women will feel particularly sad at this lost opportunity.
However, Prof Grange is definitely not the epitome of corruption she is being made out to be. She is not. While we see and agree with the importance of the statement being made by her trial, we hope that she is not being made a scape-goat, an easy target for the political establishment. It is also pertinent to ask whether the Ministry of Health was the only Ministry that did not return unspent funds to the Treasury. Were others more adept at covering their tracks? While this does not excuse any failings, a thorough investigation should be carried out and the systems of financial control in place in all the ministries will need to be reviewed- if genuine reform and progress is to be made. We watch the trial with one eye on all the other trials.
But ultimately we hope that the vacuum in the leadership of the Ministry of Health does not last too long. This ministry is too crucial to be managed s a secondary department by another minister. It is desperately in need of focused leadership. There is too much at stake.
Friday, 11 April 2008
Have we left our healthcare in the hands of the politicians and health professionals for too long? Is it now time for us all to take back the dissemination of health information and performance basic healthy practices. Nigeria has one the largest collection of places of worship churches, mosques, shrines, and other places of worship, actually there is one on every street, some lucky streets boast of more than one! (...those loudspeakers :)!)
Is it possible that these places of worship can ask their parishioners to practice one healthy habit each week? Can we start with simple hand washing, and reduce the diahorreal disease killing our children. Can we tell them to check their blood pressure before they come to service next week, and reduce the number of people walking around with unimaginable blood pressures and the consequences on the eyes, kidneys, and several other organs?
Can we tell them to drink one bottle of beer rather than 4 or 5over the weekend. Can we tell the people that smoke to reduce smoking indoors due to health effects on the kids ( I know they might no longer care about themselves), and can we do this without being judgemental and just give them the necessary information. Most people might not be aware of the consequences of their habits; we can inform them and reinforce the information all through the year at no added cost, being that we will still print those bulletins with or without the added health information.
As we highlight the apparent failures of the political and health system we all can chip in, to affect some form of change, we all can be more aggressive in getting information for ourselves and pointing others to sources of information, as we all know “knowledge is power” (but only if you use it). If you are interested in helping in a cause if you are interested in empowering some one , if you are interested in advocacy, and if you just need more information about health and the development goals.
It is important that we learn what works in whatever part of the world that we live in and spread the good news to our beloved country. So today when you call to speak to your loved ones, ask them to talk to their pastors, priests and imams, about putting important health information in the bulletins or adding it to their sermons, incantations or whatever they use in the place of worship.
Working together we can make poverty, paucity of health information, poor choices and their ilk’s history.
Thursday, 10 April 2008
So the blind lead the blind and we keep re-inventing the wheel....
SO....we will regularly seek out these reports and put them up for you. Maybe there is something in them you are not supposed to hear!
by Olaide A. Gbadamosi Esq
Network for Justice and Democracy (NJD), 2005; ISBN 978-36965-1-3
This book is written to educate people by providing knowledge and skills to make informed decisions and increase awareness about the HIV/AIDS epidemic; change attitudes and adopt behaviours to reduce the risk of HIV infection. The book can serve as a valuable reference text to health care providers, general public, legal practitioners and those interested in researches and advocacy in the area of HIV/AIDS and human rights.
2007 Global TB Report Card for 22 TB High Burden Countries
The 2007 report card looks at the 22 countries which are home to over 80% of the world's TB cases, and shows the 15% increase since 2002 that they have made in curing infectious TB cases. It also juxtaposes the proportion of TB patients being cured with DOTS based services, with the proportion of patients in these same DOTS programs who have not completed their re-treatment because of defaulting and treatment failure.
Our beloved country is 2nd only to Russia FAILING to control TB worldwide...
Global Fund Grants for Malaria: Summary of Lessons Learned in the Implementation of ACT Policies in Ghana, Nigeria, and Guinea- Bissau
Grant agreements in Nigeria for rounds 2 and 4 were signed within two months of each other....the procurement process in Nigeria took over one year. The first consignment of ACTs arrived between 15–17 months after the grant agreement was signed and eight months after placing the order.
...if you find any reports on health in Nigeria out there....share your link!
Saturday, 5 April 2008
Channels TV - Declare State of Emergency in Nigeria's Health Sector- NMA President
President of the Nigerian Medical Association (NMA), Dr. Dan Gana has asked the government to declare a State of Emergency in the health sector. ...details here
...is the NMA waking up to its responsibilities? Compare its influence to the influence of the NBA over legal affairs in Nigeria.
Vanguard - Lassa Fever Kills Two Doctors in Ebonyi
...Federal Ministry of Health have confirmed that Lassa fever, a virus disease carried by rodents like rat, caused the recent death of two medical doctors at the Ebonyi State University Teaching Hospital (EBSUTH).As a result the state government has declared war on rats as a way of curtailing the spread of the virus. ...details here
...interesting public health response...one wonders who the soldiers were
Vanguard - 61 Percent of New HIV/Aids Infections Are Women-NACA
The National Agency For The Control of AIDS (NACA) has revealed that an estimated sixty one percent of Nigerians that are newly infected with HIV/AIDS are women and young girls. ...details here
Thisday - Lebanese Community Builds N1bn Hospital
Lebanese community in Kano, has commenced work on a 50-bed state-of-the-art general hospital in Kano, as part of its efforts to contribute to the well-being of the people. ...details here
China to aid Nigeria's health-care with hospital complex
THE Chinese government has offered to build and equip a comprehensive hospital in the Abuja metropolis to be donated to the Federal Government of Nigeria. ...details here
Banks, telecom firms, others to contribute pre-profit tax to NHIS
THE National Health Insurance Scheme (NHIS) has revealed a working arrangement that will make banks, telecommunication companies, and other corporate organizations in Nigeria contribute part of their pre-profit taxes to the scheme. ...details here
Guardian - Rising to the challenge of maternal, child deaths
Despite all measures being put in place, the statistics of maternal and child death in the country is still gloomy. Experts are however convinced that a concrete and practical public health policy would bring significant improvement in the health of Nigerian mothers and children. ...details here
Thisday - Govt Moves to Tackle Meningitis, VVF
Zamfara State government has ordered vaccines for cerebra-spinal-meningitis (CSM), worth N23 million, to curb the spread of the disease in the state and awarded N500million contract to combat Vesico Vaginal Fistula (VVF). ...details here
...did you expect to hear about systems ...maybe a rolling scheme to keep a constant stock of vaccine? ....well well....if that is done...there will be no contracts to award next year
Thisday - Nigeria: Fashola Unfolds Devt Plan for Health
Governor Babatunde Fashola of Lagos state yesterday said the state government has developed a comprehensive four-year infrastructural development plan for its health sector ...details here
no details of the plan in the article...not even the highlights...
Thursday, 3 April 2008
March 29 2008...Measles Outbreak in Katsina
March 28 2008...Cholera Outbreak in Benue
December 14 2007...Measles outbreak in Kano
WHAT IS GOING ON???
Probably no medical intervention has saved more lives than VACCINATION....and definitely nothing as efficiently and effectively.
It ranks with antibiotics as the two interventions that have had the most profound effect on medical practice.
New vaccines are being developed rapidly. In 2006 a new vaccine for pneumococcal infections was introduced in the UK after being a huge success in the USA. Most of the "developed" world is revelling in the introduction of the first mass vaccination initiative for a vaccine against Human Papiloma Virus (HPV)...the primary causative agent of Cervical Cancer. A vaccine for the rota virus, one of the major causative agents for diarrhoeal illness is in advanced stages.
In our beloved country Nigeria, we have found it impossible to raise vaccination coverage in for our routine EPI diseases in childhood. Every day we read about huge outbreaks of vaccine preventable diseases in pages of the newspapers.
Why is there no outcry by members of the public?
Now read this...The introduction of the Hib vaccine to Uganda has resulted in the elimination of deadly Hib meningitis in children under five, according to an independent study published in The Bulletin of the World Health Organization. Uganda was one of the first GAVI-eligible countries to adopt Hib vaccine and their results in disease control are similar to those seen in Bangladesh, Kenya, Chile, the Gambia, the United Kingdom and the United States.
Why do we accept that children should die from measles, a disease for which a vaccine costs less than a bottle of coke, while members of our parliament spend N10,000,000 on a retreat to discuss our health?
The GAVI Alliance was launched in 2000 to improve access to immunisation for children in developing countries and is sourcing huge amounts of funding from private and public sectors.It has raised over USD 1 billion to support vaccination in developing countries, USD750 million coming from the Bill and Melinda gates Foundation. Read an excellent summary of their work here.
For the really interesting stuff from Nigeria read the annual country report for 2006 here. Abstracts below...
Delays in accessing the fund was experienced in some States and LGAs due to their inability to open dedicated accounts with authorised signatories. GAVI fund utilization at the State level was poor due to the 10% counterpart funds required by States to provide for ownership.From GAVI alone for our "poor" country...we recieved:
2006 = US$ 2,292,176
2007 = US$ 2,060,306
Total expenditure on Vaccination activities in Nigeria are estimated as
2006 = US$ 267,385,480
2007 = US$ 213,915,811
Yet an immunsation coverage survey GAVI carried out in 2006 showed these shocking results...
Something isn't right here!
Fully Immunized child -18.1%
BCG - 40.5%
DPT3 - 36.3%
Measles - 32.7%
If your really want to feel bad...click here to see how other other African countries are doing in saving the lives of their children.
Most of these funds are spent on "vaccination campaigns"..the latest model is "Immunization Plus". This involves the delivery of vaccines in addition to commodities such as Insecticide Treated Nets (ITNs), de-worming tablets, paracetamol syrup, soap etc as primarily from door to door by health care workers.
Most Nigerians can see why this will be attractive...someone will have to "supply" the commodities!
But we know that while these periodic, intensive campaigns to vaccinate a entire populations over s few days are attractive and maybe effective as a short term response to outbreaks, eradication initiatives etc....They are not economically sustainable....and from the constant flow of reports of measles outbreaks...are not working.
Every country needs a strong routine vaccination services! This requires forward planning, supply chain management, organisation, systems, skilled leadership etc. These areas challenge us badly...not for their non-existence but their non-utilisation in appropriate roles.
We have had an entire agency responsible for this for several years...the National Programme for Immunisation (NPI. In the later years of the Obasanjo regime, this was subsumed by the National Primary Health Care Development Agency..and is presently managed by Chief Adelekan. Nothing is heard from this agency...not in the national press...not through their website. Not a word...not even in response to the outbreaks!!!
Why is no one complaining? Why are no questions being asked? Where is the National Primary Health Care Development Agency?
To end on a positive note...a story about the "Nigerian spirit"...the one thing that keeps most of us going...