Friday, 26 December 2008

Random good news stories... the year gradually comes to an end and we take stock, find here a few good news stories. Enjoy...

    • Our new Minister for Information, Professor Dora Akunyili is reported by The Punch as making statements that has brought smiles to our faces...

    "Today, we live in an information age where access to information should be made readily available, and yet information about Nigeria from Nigeria is not easily accessible. I find it disheartening that the Ministry of Information and Communications does not have a website. It is also very discomforting that our flagship corporation, Nigerian Television Authority, does not have a website. It is unfortunate that the official government website, which was launched in 2005, has been shut down for many months. This website, which serves as a gateway to Nigeria, must be reactivated".

    Every parastatal must have an active and vibrant website up and running before the end of March 2009!".....YEAH!!!!!!!!!!!

    The only small issue Madam did not mention was that the excellent NAFDAC website...has been down for almost 1 year....

    • We are often critical of the quality of health reporting out of Nigeria...but here is one piece I would recommend. I am not sure what the circulation of Daily Trust is but I found this article very good. It is written by a colleague; Dr Dahiru of the Dept of Community Medicine, Ahmadu Bello University, Zaria...details here: Nigeria: Why Country Cannot Achieve the Health MDGs

    • Some State governments are evolving new ways of working...finally. The Kaduna State government says its roll back malaria programme has been successful due to its collaboration with NGOs. Details here in the Daily Trust:

    .....who says there are no good news stories out of the health scene in Nigeria....

    Tuesday, 23 December 2008

    ....Did you notice the 15th ICASA?

    ICASA? ...the 15th International Conference on AIDS and STIs in Africa did not notice?

    From the the 3rd to 7th of December Africans assembled in Dakar, Senegal to take stock of the science, political commitments, unfulfilled promises and actions and practices employed in the fight against HIV/AIDS.
    You will be right if you notice that this is an abnormal year for an ICASA (it is normally held the year between the International AIDS conferences). The conference scheduled for The Gambia in 2007 had to be cancelled when the Gambian President Yahya Jammeh announced he had discovered a cure for AIDS! (no joke). He made that announcement in front of a group of foreign diplomats, telling them the treatment was revealed to him by his ancestors in a dream.

    So the honour fell on Senegal!

    Sadly we hardly heard a wisper about the conference in the press, local and international.
    BUT ...the good news is that Nkem attended! ....and sent us her take on the conference from a very Nigerian perspective....ENJOY!

    Thoughts on the recently concluded ICASA meeting...

    I was recently in Dakar, Senegal to attend the International Conference on AIDS and STIs in Africa (ICASA). During the 5 day conference, we had beautiful weather in Dakar and we couldn’t have asked for better since the conference was both inside the Le Meridien President hotel and outside on its grounds.

    I must begin by sharing with you that this was my first ICASA meeting ever. I have no experience to compare it with other can my expectations and experience attending other conferences on HIV/AIDS and other conferences in general, in Africa. Prior to arriving in Dakar, I was impressed by the conference organization. Before arriving in Dakar, my interaction with the ICASA organizers was smooth especially given that I speak no French.

    However, on the first full day of the conference (the opening ceremony was the night before), December 4, I arrived early to check-in and pick up my conference goodies (bag and guides). That’s when the problems began. They had run out of bags!! It was 9:30AM on the first official day of the conference, I had pre-registered almost 3 months earlier, and there was no bag or abstract book for me. It turned out I was not alone. There were a few of my colleagues hanging around who had arrived earlier that morning who were also without bags or abstract books. The best we had were little foldable presentation sheets with the session names, but with no information about the topics being presented and who was presenting. As a result, I attended a session titled “Community-based involvement in prevention”, but the first two presentations were on “building stronger African civil society participation in policy advocacy in Africa” and “Primary caregivers – the critical but hidden hands in HIV/AIDS care”. After the first two presentations, I discovered that the session title didn’t exactly fit the presentations and not what I had expected to hear. If I had the bigger book with the presentations actually listed at this time, I would have been able to better select the sessions of interest to me. After this session, I went back again to the check-in desk in search of the book that listed the presentations in addition to the session titles.

    It turned out that the ladies at the check-in desk were hording the bags and books. It was the oddest thing. While I was standing around waiting for the bags to come (in a hour as I had been assured), I would see some people go up to check-in and come out with bags. I would go back only to be told there were no bags. Apparently depending on whom you spoke to (the ladies attended to different people according to the last names) you could get nothing, just a bag, or everything! And also, depending on how you smiled or asked. I am not sure. I checked-in about 9:30AM, got a bag about 1PM, and finally managed to get an abstract book, or rather presentation book listing the presentations in each session, at about 6PM. The book didn’t have the abstracts as we thought. Technology has taken over, so we got the abstracts in CDs, but if you wanted it in hardcopy for convenience, they were on sale for approximately $10 (5000 CFA). And this was only beginning on the second day as we discovered when we saw the stands open up on December 5.

    Despite this little frustration, the conference was a good one for me although I have a few comments regarding my impressions, good and bad.

    For one thing, there was a large representation of the disabled HIV/AIDS community at the conference. I have not been to an AIDS conference in a few years, but it was interesting and good to see this group so visible and well represented and participating, at the conference – in wheelchairs, blind, etc. There were also a number of interesting sessions on the topic. One I found particularly interesting which is related is the relationship between mental health and a person’s HIV/AIDS status.

    From what I was able to tell, most of the abstract submissions were accepted as poster presentations, with certain groups either being invited or organizing special panels to talk about their research orally. A number of the oral sessions were sponsored by groups such as Amref, Fogarty, Global Fund, etc. A couple were on actual scientific research but more on reports from interventions, but there were some really interesting results from scientific research being conducted by institutions in the West. Unfortunately, this is where most of the high quality research was presented. It struck me that African groups conducting high quality research might not choose ICASA as a forum to share their results and may want to attend more prestigious conferences which larger media coverage to disseminate their findings. I don’t recall ICASA being mentioned on CNN the week of the conference. The problem with this is that most of these conferences are held in countries that most Africans have difficulty traveling to easily due to travel restrictions, as well as the major issue of most of these countries, including the US, not permitting HIV positive people entry into these countries. So the African audience is very limited at these ‘prestigious’ conferences, when they might be the ones to benefit most from the results being presented there and should be the ones hearing the information for several reasons including the fact that their communities provide the subjects which are being studied.

    For my group, we were attending ICASA not to present any findings from our research, but rather to be challenged by what other researchers in Nigeria and Africa were doing. Unfortunately we came out feeling very good about our study methodology and progress, even though we know that there are a number of areas we can improve on. This does not say much for the research presented at ICASA, especially research from Nigeria. There were only one or two notable oral sessions on studies conducted in Nigeria. At one of these sessions, there were to be three presentations from Nigeria in that session titled “Determinants of the HIV Epidemic: where do we need to focus?”, however, only one showed up. A researcher at UCH presented on the “sexual practice among people living with HIV at the UCH, Ibadan, Nigeria” after they begun to receive ART. When he was challenged as to the point of the study, given that we all know that when someone is weak it can prove difficult to be sexually active and treatment that leads to feeling stronger could lead to increased sexual activity, the same with malaria or any other weakening illness, he could not defend the study. The study also found a slight increase in the use of condoms by the study subjects, but there were free condoms at the treatment center, so if people took condoms when they came for treatment, then it only seemed logical that they could see an increase and a very slight increase in use of condoms. A useful follow-up question in this study could have been for the researchers to find out where the respondents reporting increase in use of condoms where getting their condoms. Were they going out to purchase condoms or just using them when they happened to get a few free ones at the hospital?

    All other Nigeria presentations were poster presentations, of which more that half did not show up. At least they were not there when I did my rounds and I made sure to circle all Nigeria studies in the book before I went looking for the specific poster numbers. Some put up their studies and were not there to talk about them, while for most, the studies where not put up at home. There are a few pictures of some studies that were there. I won’t really comment on them, but I personally thought the topics were already over studied and provided nothing new, or that certain high government officials shouldn’t be presenting very simple poster presentations. That’s just me though.

    Back to the research sessions from the West, it was interesting to me that the audience was largely western. There were very few Africans in these sessions, which could be explained by the fact that a majority are still studying condom use and sexual behavior, and are not interested or aware of other more complex issues such as “how and why does infection with different subtypes impact on the neurological diseases associated with HIV-1 and HIV-2?” Even a great presentation by the APIN/Harvard group on the different types of HIV and their subtypes, only very few Africans were in the room. And I have to admit, this session was one of the most intriguing sessions to me and one I thought people could learn a lot from especially in understanding why sometimes ‘AIDS dey show for face’ and sometimes ‘AIDS no dey show for face’, or why you could have unprotected sex once, and become infected, or why in some cases people can get away with having unprotected sex on so many occasions. It could all come down to the HIV type or sub-type infecting the person’s partner and how easily it could be transmitted or develop to AIDS.

    Although I didn’t feel like Nigeria represented very well at the conference and some of the organizing could be better, I did enjoy the conference and took away a great experience from it. Learning can come in different ways, and I did learn that we could challenge ourselves more in Nigeria to study HIV/AIDS topics that move away from condom use, sexual behavior, awareness, knowledge and maybe try to find out more why someone thinks they are not at risk of becoming infected, but in the same breath believes that HIV can be transmitted by mosquito bites and touching PLWHA. One poster actually presented this and when I asked her how it was possible – did these people not take public transportation or live in an area where there were mosquitoes, I risked being a sarcastic audience member and I politely acted like it was a joke.

    Saturday, 20 December 2008

    Finally - Nigeria has a Minister of Health

    Nothing is ever straight forward in our country.

    Ten months ago, we lost our Minister of Health to what many believe is her naivety about playing "the game" in Nigeria more than any overt corruption. Prof. Nike Grange's appointment in July 2007 brought hope to Nigerians. For the first time in a long while we thought we had a credible, obviously competent Nigerian to look after the health of Nigerians. That quickly became history.

    Then came the nominations. The change of ministers was announced in May, the list of new ministers appeared "rapidly" after in November and contained the names of two prominent players in the Nigerian health sector...Professor Babatunde Osotimehin, Director General of the National Agency for the Control of AIDS and Professor Dora Akunyili Director General of the National Agency for Food, Drug Administration and Control.

    In my own naivety, I expected a vigorous debate on what each of them had achieved in their various national assignments and how that would help them in pulling the Nigerian health sector out of the abyss...rather we witnessed an infantile debate on whether a medical doctor (as Osotimehin) or a pharmacist (as Akunyili) would be best placed to do the job!

    All said, Professor Babatunde Osotimehin was announced as the new Minister of Health for the Federal Republic.
    Born in February 1949 in Ogun State, Prof. Babatunde Osotimehin, a professor of clinical pathology is the present Director General of the National Agency for the Control of Aids (NACA) and project head of the World Bank's $90.3 million HIV /AIDs project in Nigeria. Find his complete resume here.

    "Prof" has his work cut out for him.

    Things have never been this bad for the health sector.
    As usual we will give him our support as he takes up this challenge.

    But times have changed. Nigerians will no longer be taken on wild goose chases about...

    "who awarded which local government what contract to build primary health care centres" ...or

    "...which health committee colluded with which company to equip teaching hospitals with MRI scanners"....

    We expect health to be measure in health terms....and not by buildings or by machines.

    We want health measured by "Number of LIVES SAVED, number of children immunised, number of women "not" dying during childbirth, etc etc"


    The world around us is changing....and we are becoming wiser! We will be expecting the new Minister to make public his vision for the health sector soon. We have a health bill that has still not been passed. We are immunisation rates so low that children are dying from diseases no one else is dying of....our population has totally lost faith in our public children die from consuming "teething mixtures" prescribed by colleagues, registered by NAFDAC.

    Yet we all look forward to celebrating Professor Osotimehin as a HERO! As the man that brought back our health sector from the brink!

    President Yar’Adua
    while welcoming the new ministers said they were entering “a new dispensation – one which scrupulously demands pro-action, establishes definitive performance benchmarks, and insists on effective service delivery, strict adherence to due process, and unwavering focus on the policy objectives of this administration....

    We will do nothing more at NHW but to keep reminding Prof of these words in the context of our health sector.

    We wish you well Prof...we wish you well!

    Saturday, 13 December 2008

    "My Pikin" - The questions no one is asking

    If you follow the Nigerian health "scene" you would no doubt have heard of the story of "My Pikin"...said to be a "teething mixture".

    This "mixture" (not sure where this term came from...) contains paracetamol and Diphenhydramine Hydrochloride - an antihistamine. NAFDAC (sorry website is "down" (12/12/08)) is said to have revealed that the a batch of the teething mixture included lethal doses of a toxic chemical; Diethylene glycol. This is an organic solvent, also used as an engine coolant which upon metabolic conversion is toxic to the kidney. The Vanguard reports that ...the contaminated ingredient used in the formulation of the killer paracetamol drug, "My Pikin" was obtained in the open market at Ojota, Lagos. Dora Akunyili, director-general, National Agency for Food, Drugs Administration and Control, NAFDAC, confirmed that 15 children died at the Lagos University Teaching Hospital, LUTH, eight died at the Ahmadu Bello University Teaching Hospital, ABUTH, Zaria, and two deaths were recorded at the University College Hospital, UCH, Ibadan.

    We had the "normal" responses from the concerned parties in our beloved country as we have come to expect....

    ....and while the arguing has continued..there are to many questions here that no one is really asking...

    1. Simple question? What is a "teething mixture"? Is "teething" a medical condition that requires treatment? What are the symtoms of "teething" that requires treatment? I have been asking around if any of my colleagues in Nigeria or anywhere else in the world has been taught this as a medical condition in medical school...have not found any yet! I am priviledged to have been taught pharmacology by the present DG of NAFDAC in medical school...I have gone back to my notes and found nothing! Finally the Medical and Dental Consultants Association of asking the same questions.
    2. What are the procedures by which NAFDAC actually registers new medicines. Clinical trials are how new medicines as tested and approved around the world. Does NAFDAC carry out independent clinical trials or do they rely on trials carried out in other settings with more resources. If this is the case where and when were the trials for My Pikin conducted. The name "My Pikin"...literally means "my child". The bottle is a picture of a happy mother with her smiling baby. What regulatory agency will allow a medicine, any medicine be named "my child" ???

    3. When a child has fevers associated with teething, a most common condition in childhood he/she should be seen by at the very best a primary care physician and would not require anything more than paracetamol. What are our "best" tertiary institutions doing managing fevers during teething???

    4. Outbreaks are a fact of life...even in the most advanced countries. Often they result from infectious diseases but could be as a result of chemicals as in this case. Does the MoH have an emergency response plan, infrastructire and outbreak response capacity to investigate and respond to outbreaks beyond asking NEMA do deliver blankets.

    5. Finally....why is it that after the celebrated successes of NAFDAC are medicines still being openly sold in every open market in Nigeria.

    I bet is only a matter of time before we find the next 25 children that have died in another cluster! ...unless someone sits down to think of answers to the questions above..... you want to bet?

    Saturday, 6 December 2008

    Died Fixing Healthcare System

    Dear Readers,

    At a recent conference on health and health care in in Nigeria that held in London...Dr Seyi Oyesola asked the poignant question on what would happen to any of us if we had a medical emergency in Nigeria. The same question asked by Ernest Madu in his TED talk This story provides some answers. I am reproducing it verbatim as it appeared in "Thisday" as a public service. The piece speaks for itself on the tragedy of our country that has just experienced an era of 8 years of Oil selling at over $100 per barrel and how we have used this (or not) to improve the lives of our people.

    Copyright belongs to This Day. All rights reserved. Distributed by AllAfrica Global Media (

    Patrick Okigbo
    4 December 2008

    Lagos — Patrick Okigbo writes on the life and times of Dr. Enyi Okereke, a medical practitioner in diaspora who died trying to provide free medical services to the poor in Enugu State. Unfortunately, he died in a tertiary health institution that lacked equipment and drugs to save his life

    Dr. Enyi Okereke had no real reason to be in Nigeria doing what he was doing when the cold hands of death squeezed life out of him. He could have stayed back in his villa in the United States to enjoy the results of his hard work. He could have been in the warm embrace of his loving wife who now has to journey through life without her soul mate. His children and grandchild could have surrounded him, as they joyfully expect the newest addition to the family. But he chose, instead, to be in Nigeria doing what he loved best - caring for the needy in our society. Dr. Enyi Okereke, physician par excellence, died in Enugu on November 11, 2008 of what is purported to be a heart attack.

    Enyi, as he is fondly called was one of Nigeria's top physicians in the United States. He was an associate professor of orthopaedics at the University of Pennsylvania. He was also Chief of Foot and Ankle Services at the University of Pennsylvania Health System in Philadelphia. Enyi won many prestigious awards including the 2002 Jesse T. Nicholson Teaching Award from the department of Orthopaedic Surgery, University of Pennsylvania.
    He was named one of the "Best Docs" in 2004 and in 2005 was named one of Philadelphia's "Top Docs". Enyi held many leadership positions in many professional societies including serving as the 2004 secretary and 2005 program chair for the Philadelphia Orthopaedic Society. He served as the chairman of the New Jersey Chapter of the Association of Nigerian Physicians in America (ANPA). He was recently elected National Treasurer of ANPA.

    ANPA represents the professional, political and social interests of the 4,000 plus physicians, dentists and allied health professionals of Nigerian birth, ethnicity or empathy in the United States, Canada and the Caribbean. ANPA's vision is a healthier Nigeria in a healthier world and it seeks to achieve its vision through medical missions to provide free healthcare to the medically indigent in rural parts of Nigeria.

    ANPA's vision was Enyi's vision. As has become routine for him, Enyi was in Nigeria with a team of US-based physicians to conduct free medical examinations and train student doctors in our universities. Enyi and his team were in a teaching hospital in Enugu imparting knowledge to medical students when he died.

    The autopsy results are yet to be released; however, it is believed that Enyi suffered a heart attack. This is hard to believe because Enyi was very health-conscious. At 54 years, he still ran four miles every morning. He ate healthy, preferring salads to red meat and alcohol. It is difficult for anyone who knew Enyi to believe that a heart-attack would be the way he would exit this stage.

    But that is beside the point. The point is that the heart attack happened in a teaching hospital in Nigeria, where he was surrounded by some of the best physicians in the world, but they could not save him. Why? The hospital didn't have the basic equipment to provide alternative support for the heart while arrangements where being made for proper care. The hospital did not have the drugs needed to stabilise Enyi while arrangements where being made to fly him out of the country.

    Both the Nigerian and Diaspora physicians looked on helplessly as life gradually drained from the body of an excellent gentleman. Enyi, a man with a passion to help the medically indignant became one himself because he found himself in a country that has squandered $350 billion in oil revenue but does not have the drugs and equipment found in every ambulance in the United States. Giant of Africa!

    However, this story is not really about Enyi. Neither is it about my friend, a radio presenter in Enugu, who lost his wife and child a few weeks ago at childbirth. It is about the millions of Nigerians who die every year in this country for totally preventable reasons. According to the World Health Organisation (2004), of two million registered deaths in Nigeria, 1.43 million were as a result of communicable, maternal, prenatal, and nutritional conditions, 0.44 million from non-communicable diseases (such as cancer, diabetes, cardiovascular, congenital anomalies amongst others), and 0.13 million from injuries (including road accidents and other forms of violence).

    We, as a nation, do not value our people. We do not value the lives of our people. We believe that people are dispensable. If not, why is it that we have not been able to fix the healthcare sector in Nigeria? Why do we delight in eating our own?

    Scary Diagnosis
    Enyi is no longer with us because of the challenges with Nigeria's healthcare system. A review of these challenges can be quite daunting and with varied ramifications in terms of human capital, infrastructure, funding model, and policy. These challenges are compounded by other socio-economic challenges that are common across all sectors of the economy. A comprehensive and integrated healthcare strategy is needed, as none of these challenges should be solved in isolation. The government bureaucracy, as usual, has proved that it cannot solve these problems. It is time we turned to the markets to provide answers.

    Human Capital
    According to the World Health Organisation Country Cooperation Strategy for Nigeria covering the period from 2002 to 2007, Nigeria's key health indicators have either stagnated or worsened. Life expectancy dropped from 1991 to 2000 by 10 per cent (48.2 years) for females and by 11 per cent (46.8 years) for males. This deplorable trend is consistent for infant mortality rate, under-five death rate, maternal mortality rate amongst others. The report attributes the trend to shortage of skilled medical personnel at the primary healthcare level. For instance, the report indicated that only four out of every ten primary health facilities provide antenatal and delivery services or have a midwife on location.

    Nigeria is one of the major health staff exporting countries in Africa. According to 2008 research by C.J. Uneke published in The Nigeria Health Sector and Human Resource Challenges, about 20,000 health professionals are estimated to emigrate (legally) from Africa every year. Using 2002 data, about 21 per cent of this number comes from Nigeria. The data was not corrected for population size. However, the story is still poignant. Nigeria suffers severe brain drain as its medical professionals leave for greener pastures in foreign lands. Nigerian health professionals earn less than 25 per cent of what their contemporaries make in the developed world. Standards in our hospitals are so low that any medical professional desiring quality experience could be seduced by the facilities in the developed world.

    According to the latest available data from the Federal Ministry of Health (1999), there are only 18,258 registered primary healthcare facilities, 3,275 secondary healthcare facilities, and 29 tertiary facilities shared by 140 million Nigerians (less the rich who can fly abroad for their own services). Although this data is ten years old, one does not expect any significant improvement in the numbers. It is important to note that the fact that a healthcare facility physically exists in a community does not mean that they operate. Most of these facilities are poorly equipped, lack basic diagnostics equipment, skilled human resources, and are usually in deplorable sanitary conditions.

    Financing Model
    The financing model is in two broad ramifications; development and delivery of health services, and payment for healthcare services. The financial resources for the development and delivery of health services in Nigeria come from government budgetary allocations, contributions from multilateral agencies, and the private sector. The Nigerian government spends a disproportionately lower percentage of its expenditure on healthcare than most nations.
    According to the 2005 World Health Organisation report, per capital government expenditure on health was $14 compared to $32 (Ghana) and $2,861 (USA). In the same period, total expenditure on health as a percentage of gross domestic product was 3.9 per cent compared to 6.5 per cent (Ghana), 15 per cent (USA). Furthermore, the total government expenditure on health as a percentage of total government expenditure in 2005 was 3.5 per cent compared to 6.9 per cent (Ghana), 18.7 per cent (USA).

    Nigeria did not fare much better on the World Health Organisation measures for individual contribution to healthcare. Out-of-pocket expenditure as percentage of private expenditure on health is 90 per cent compared to 79 per cent (Ghana) and 24 per cent (USA). This data shows the nascent state of health insurance in Nigeria. Patients bear the full and direct brunt of their medical expenses without any significant assistance from the company or institution they work for.

    Nigeria's national healthcare policy is based on a philosophy of social justice and equity. The policy is bureaucratic, cumbersome, and quite inefficient. The Federal Government is responsible for policy formulation, strategic guidance, coordination, supervision, monitoring, and evaluation at all levels. It is also responsible for operational roles such as disease surveillance, essential drug supply and vaccine management.
    By the way, given the current governance arrangements, the Federal Ministry of Health does not have sufficient leverage over the State Ministries of Health to ensure compliance to the agreed policy. As a result, there is a visible gap between policy formulation at the Federal level and implementation at the State and Local Government levels. Herein lies the challenge. A government that cannot repair roads has assumed responsibility for the complicated management of healthcare systems and institutions.
    Government, working closely with the private sector (owners of healthcare facilities, think tanks, health insurance providers and others), should develop policy for the healthcare sector. Monitoring of adherence to policy should (ultimately) be the role of the government, however, in the interim; the private sector should be involved in this effort. The profit motive for the private sector, which should be tied closely to the goals the government - which is to provide accessible healthcare to the populace, will ensure that the standards are maintained. Government cannot do it on its own.

    Possible Cures
    The real challenge, however, is not the intent of government to do the right thing for the people. Instead, it is the size of our bureaucracy and the absence of institutions and process that act as safeguards against inefficiencies and excesses. Given that most governments (even in more efficiently run countries) have shown that they cannot do better than the markets in terms of healthcare administration, it becomes imperative that Nigeria must redefine its policy to healthcare administration. The private sector must be allowed (indeed, encouraged) to lead development in this area.
    Government's role should not be in the provision of healthcare; instead, it should be to work with the private sector to ensure that policies are designed to meet the needs of consumers. By the way, bureaucrats should not design these policies. Instead, they should be designed by private sector operators with input from the regulators and bureaucrats to ensure that profit motives are not allowed to run amok. Research by Cato Institute, a liberal think-tank in Washington DC, shows that in terms of healthcare administration, markets are better than governments at cost-control. This is evident in private sector funded healthcare centres, and medical insurance programs that are available in deregulated markets.
    For providing the patient funds, government can demand certain service levels including caps on tuition for students. The challenge for the school administration will be to ensure across-the-board efficiency that enables them meet the different conditionality attached to the facility. This can only bode well for society.
    The National Health Insurance Scheme created by the National Health Insurance Scheme Decree No 35 of 1999 is a welcome development. The downside is its operation within the bureaucratic structures of government and its overly socialist leanings. Market driven health insurance programs have been more successful in other countries; however, they too run the risk of abuse if the profit motives of the insurance executives are unfettered.

    Ultimate Price
    As the Okereke's commit their son to earth, one can only hope that his death will count for something more. Will it get the government to take a more critical look at the healthcare sector and seek pragmatic solutions? Will it shed more light to the plight of the medically indignant whose plight Enyi spent his life working to alleviate?
    The Federal Government of Nigeria, under the leadership of President Umaru Musa Yar'adua, on behalf of the thousands who have received care from Enyi and all the other Nigerians physicians in ANPA, should confer a National Merit Award on this fine gentleman who died in the line of selfless duty to his country.

    Enyi, journey well, my dear friend.

    Wednesday, 3 December 2008

    HEALTH in Mr Presidents budget

    The 2009 Budget as presented by Mr President to the National Assembly 2nd of December.

    The full text can be read here:

    Health was mentioned in a few places....find a summary below.

    ....The 2009 Federal Budget is to deliver on our promises to reduce poverty and attain our Millennium Development Goals.

    ...By investing in human capital development through education and healthcare delivery, we can create a better future for the next generation.

    ...Health to get N39.6billion (~$214M) out of the N796.7 billion for Capital Expenditure (~5% of capital budget)...

    ...This includes....N6.5billion on the sector's response to HIV/AIDS, N3billion on Midwifery Services Scheme, N7.7billion on maternal and children's health, and N6billion on polio eradication;

    ...The Ministry of Health is completing the modernisation of the Teaching Hospitals in Calabar, Awka and Ife ; completing the modernisation of 7 Specialist Hospitals in Kaduna , Lagos , Kano , Calabar, Enugu , Maiduguri and Abeokuta ; and scaling up investment in its polio eradication programme.

    The one disapointing aspect of the allocations to health was the lack of targets for the Ministry to deliver.

    For whatever they are worth ...these appeared in other sectors as:

    ... the Ministry of Agriculture and Water Resources will increase land under cultivation by 5%...

    this Administration can deliver 6000 MW of power by the end of 2009.

    ...complete the construction and rehabilitation of 3,293km length of roads.

    even the NIGERIAN POLICE have a target to reduce crime by 40% in 7 cities over the next year!!! (dont ask me how this will be measured ...or who will be doing the measuring...the police ??? :))

    For the health sector....nothing...just spend!

    Monday, 1 December 2008

    Restoring Health to the Agenda in Nigeria- report from a conference

    On a cold morning on Saturday the 22nd of November, over 200 professionals with a commitment to improving the health of Nigerians met at the Gustave Tuck lecture theatre of University College London. The one-day conference, "Nigeria - Partnership for Health" with the key theme "Restoring Health to the National Agenda" drew participants from across the United Kingdom, the United States of America, Germany and Nigeria to meet, debate and chart a way forward in confronting the many challenges that face the Nigerian health system. The event organized by the Nigerian Public Health Network, MANSAG (the umbrella organization for Nigerian doctors working in the UK), the Institute for Global Health at University College London, the Tropical Health and Education Trust and Africa Recruit was the culmination of many months of diligent planning.
    As early as 8 in the morning, delegates began to arrive- with 150 delegates registered, the first sign of how the day would go was when more than 200 delegates turned up. From Nigerian doctors, nurses, pharmacists and other health workers in the United Kingdom to representatives of voluntary sector organizations working in Nigeria to academics, to Nigerian medical and public health students, the cloisters of University College London were filled to capacity.
    The morning kicked off with a presentation from Dr Abdulsalami Nasidi, Director of Public Health at the Federal Ministry of Health

    who outlined a dismal picture of Nigeria’s current performance on many health indicators. He also shared vignettes from his personal experience working in public health in Nigeria over the years. Professor Phyllis Kanki of the Harvard School of Public Health spoke next on the opportunities and challenges of working in Nigeria, based largely on the work of the Harvard backed AIDS Prevention Initiative Nigeria which she has led over the last 8 years and for which she will receive an honorary doctorate from the University of Ibadan shortly.

    She was followed by Dr David McCoy Senior Associate at the Centre for International Health and Development in University College London who spoke on the role Nigeria could and should be playing in the international health scene. He made a strong point in not prescribing a solution but leaving this to the ingenuity of the hundreds of highly skilled Nigerians working at the highest levels in the health sectors of most Western economies.

    Moving and poignant was the verdict on the presentation from three eminence grises- Professor Eldryd Parry, Professor Umaru Shehu and Professor Adetokunbo Lucas all renowned health professionals with years of experience behind them in improving health in Nigeria. They shared their experiences of what progress had initially been made in the Nigerian public health sector from the 1960s when they started their careers to the present day when many of the initial gains have been lost. Their sadness was transparently deep, their sorrow profound as they reminisced on the time spent on reports and advisory committees on the Nigerian health sector, mostly wasted. Their presentations were a stark reminder of what was at stake and helped to highlight why the health of the Nigerian population is in the dire state that it is in today.
    Some hope for the future was expressed through the presentations of emergent leaders in the health sector such as Mrs. Fola Laoye of Hygeia, one of Nigeria’s leading private sector healthcare organizations. She spoke eloquently of the innovative approach to healthcare financing that the organization is pioneering, empowering communities to vote with their feet on which health service provider to use. Dr. Seyi Oyesola, a UK based consultant anaesthetist described the exciting new Delta State Teaching Hospital project which he was going back home to lead: an example of one man walking the walk.

    Following the keynote speeches, the delegates then went into 4 break-out sessions, having first been primed by the ebullient Dr Lola Dare, who urged the delegates to focus on solutions instead of rehashing the problems and challenges. The four breakout sessions focused on building research collaborations, addressing the health workforce issues, building partnerships and linkages with institutions internationally and the role of the private sector. The sessions which were facilitated by members of the Nigerian Public Health Network supported by resource persons with experience in the area were so lively that they had to be extended beyond the time allocated to enable the rich conversations to be captured. Delegates shared their experiences and put forward practical tangible solutions that often provoked heated debates. There was no mistaking the passion and engagement and the experienced facilitators played an important role in ensuring that the groups maintained focus. From the community programmes that Hygeia are developing, to the innovative child health programme in a village in Enugu State pioneered by Dr Edith Okolo, focusing on giving mothers the skills to help and support each other to ensure improved child health, there were stories aplenty to inspire and to suggest that many were putting their words into action. Considering the significant number of Nigerians working within the NHS and the new incentives to strengthen global health links, it was felt that more could be done in building links and partnerships between their institutions in the UK and in Nigeria and delegates were challenged to go back and explore how they could set up links between their organizations in the UK and similar organizations in Nigeria.
    Following the break out sessions, the groups fed back and Dr Dare then challenged many of the key partners to say what they would do differently as a result of having been at the conference and listening to the contributions. Dr Nasidi of the Ministry of Health asked delegates to challenge him with specific issues and that he would respond. He shared his contact details with the audience to facilitate communication and bravely agreed to work with the Partnership for as long as he was in a position to do so.
    Fiona Duby of the Department for International Development attending in her personal capacity as a friend of Nigeria spoke of the need to engage constructively with partners and to seek examples of areas where other developing countries have been successful, mentioning initiatives from Ghana as an example. Toks Sangowawa spoke on behalf of the UK Faculty of Public Health and promised to continue the work already begun through working with the Nigerian Public Health Network and the recent memorandum of understanding signed between the Faculty and the West African College of Physicians. He stressed that the Faculty would be willing to support Nigeria in standard setting and training, areas in which they have a wealth of experience. Professor Stanley Okolo of MANSAG committed to continue giving Nigerian doctors the organizational framework to deliver on their activities as it relates to Nigeria.

    The final contribution in this section came from Chikwe Ihekweazu of the Nigerian Public Health Network who enjoined all the delegates to ensure that the momentum gained from the conference was not lost. He asked that they continue to engage with the emerging Partnership for Nigerian Health to act as a vehicle for advocacy, accountability and partnership for improving Nigerian health. He promised that the learning from the day would be captured in a document that would be shared with whoever is appointed Minister of Health for Nigeria in the next few weeks and would then be developed into a plan for action. He asked delegates to sign on to the conference website by emailing HYPERLINK "" in order to be kept up to date with future developments and to spread the word among their networks.

    Delegates expressed appreciation for the forum and there were demands that it become a regular affair and that a similar forum in Nigeria be explored to facilitate the sharing of the learning.
    The conference proceedings which had been chaired by Stanley Okolo, Jimi Coker and Titi Banjoko ended with a cocktail reception during which there were opportunities to continue networking. Leaving the venue I was struck by the many amazing incidents of the day, from the Nigerian nurse who had initially decided that she could not stay because the hall was overcrowded but whom I still saw engaged in hearty conversation with a group of young Nigerian public health students late in the day, to Muhammed who wrote us from Sokoto State in Northern Nigeria, to say that he would be attending and we initially dismissed as a joke. Linda who had only signed up for a couple of hours but ended up staying the whole day, coordinating the registration desk. Nkem who stepped off a plane and immediately went to work producing name cards for the delegates; the many Nigerians from the United States who came specifically for the conference, one of them having only heard of it days before; Professor Lucas who arrived in London at 5 am and was at the venue by 8 30, ready for his presentation; The members of the Nigerian Public Health Network and their friends, many of them senior professionals, who stayed up till midnight the previous day making sure that all was in place and who were ever ready on the day to step in to help and assist with whatever was needed, no matter how seemingly small or menial to keep the day going. Seeing the passion and dedication was moving.
    The energy in the room was exhilarating. It showed the energy and passion that many Nigerians and friends of Nigeria have, raring to be released to support the country’s renaissance. The health sector is crucial in the nation’s development. Nigerian health professionals and all with an interest in Nigerian health owe the millions of ordinary Nigerians that cannot afford to fly abroad for basic health care their best effort. We have taken the first infant steps in removing the cloak of mediocrity that has clouded our activities. By coming to this conference and committing to play our roles in holding ourselves and our government accountable, we believe that this could presage a new dawn for the Nigerian health sector. The challenges ahead are great and it is only the dawn, and now the long march begins to a new future.

    Ike Anya is a Nigerian public health physician, member of the Nigerian Public Health Network and member of the organizing committee of the conference.

    Originally published on

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