Wednesday, 29 July 2009

What the Minister said ...contd.

Recently we blogged on the unfortunate state of reporting health in the Nigerian press without context, without nuance and without analysis. In the last few weeks...nothing much has changed. Below are some reports of in the press ....unedited for your reading plaeasure.

The Independent - Medical Workers' Demand Beyond Our Ministry -Osotimehin

The Sun - 1.2m Nigerians blind, 4.8m visually impaired – Osotimehin

Triumph - Osotimehin wants more tax on cigarette, alcohol

Thisday - FG Moves to End Overseas Medical Treatment - Osotimehin

Vanguard - FG to stop tobacco smoking - Osotimehin

Vanguard - Osotimehin seeks better response to epidemics

Guardian - Nigeria would not continue to be in the polio belt for long.

Thisday - Malaria - Country, World Bank Sign $100 Million Pact: Osotimehin - we will show results and ensure that there is transparency and acountability in our way of doing business.


If we are to believe our press...lots of challenges, lots of promises ...lots.

In the next blog...we will share with you our thoughts on Hajia Turai Yar'Adua's new pet project...

Thursday, 23 July 2009

Strike called off - but challenges prevail

Last week we blogged about the strikes in the health sector. One thing has been obvious over the past few days are the efforts of the Minister for Health to avert the first major crisis in his tenure....Now the strike has been called off.

The Minisiter was hard at work last week...

...negotiating with the NMA as described here

...appearing before the House of Representatives as described here

...and explaining the intricacies as in the press statement below.

The truth is that there are fundamental problems with the way we run our tertiary health institutions. After the 8 wasted years of the Obasanjo regime spent on white elephant projects we now need to really re-evaluate our teaching hospitals. These large institutions, with huge budgets are managed by colleagues with often no managerial experience prior to the appointment. They are managed as huge bureaucracies with no incentives to preform and no consequences for failure. We have refused to do the critical thinking required in order to reform, and we keep throwing more money, more equipment, and more of the same...New MRI machines are not the answer...never have been. You do not need to have an MBA to figure that out.

The
Vamed project was the most colossal waste of time, energy and money witnessed by the health sector in my lifetime, and I doubt it has saved a single life.

Several years ago Albert Einstein told us that if you want different results, do not do the same things.

I remember studying the history of the NHS in the UK and the THINKING that has led to the different reforms to maintain the ideals of the founding fathers in 1948 to provide a health service to the citizen - free at the point of care - from the cradle to the gave. It is important to reflect on this as this was the colonial experiment we inherited.

The attempts at reform since 1948 can be summarised as:

1. 1950 - 60: Realisation of finite means despite infinite demands for health careleading to the introduction of a spending ceiling, charges for dental /optical services and prescription charges.

2. 1960 - 62: Introduction of “Hospital Activities Analysis” - to pressure consultants to consider the economics of their practice. The Hospital Plan for England and Wales - first attempt to take comprehensive view introducing national norms for adequate hospital beds e.g. 3.3 acute beds per 1000 population.

3. 1962 - 69: As the NHS is a monopoly supplier of health care for the vast majority of the population, it suffered no consequences of failure and managerial inefficiency was endemic. Management was identified as the fundamental problem for the NHS.

4. 1974: 1st major re-organisation of the NHS. Introduction modern management methods - New layers of management: districts and areas.

5. 1984: The Griffith’s report: The “managerial revolution”. Griffith was Head of “Sainsbury's”, supermarket chain famed for it’s financial success. A single general manager was introduced at each level of management with real power. A new doctrine of “general management” was introduced using performance indicators. Manager's salaries were linked to performance.

6. Late 80s: Introduction of the Internal market legitimising seeking value for money within the NHS and introduced accountability for outputs by attempting the introduction of market forces.

7. Early 00s: Collaboration replaces competition. Introduction of targets, performance indicators and league tables.

8. Late 00s: Darzi review leads to the introduction of the "Quality agenda" and polyclinics.


By now you will have noticed my point - every single major reform is around MANAGEMENT.

My thesis - Healths systems are complicated and despite the resources to a country like the UK, they are constantly THINKING about how to make it more efficient. Since we inherited our present system from the British in 1960, nothing has fundamentally changed. The National Health Bill is still stuck at the National Assemble after 5 years. A Tertiary Hospital Commission that could lead to some change in the managerial arrangement of our hospitals is also stuck in the system....

The consequences - Consultants hardly come to work, hospitals hardly generate any income, patients have no confidence in the health services, health care workers are not motivated to provide the service...- A VISCOUS CYCLE

The Honourable Minister has his job cut out for him....and we wish him well. We really do!








Press Statement from the Ministry of Health

Strike Action by Federal Medical Workers
It has come to the notice of the Federal Ministry of Health that Medical Workers in Federal Health Institutions have embarked on a strike action to press home their demands for the implementation of the Monetization Policy of Government. We therefore wish to state as follows:
The current strike by medical / health workers in federal government institutions is very unfortunate because it will inevitably lead to loss of lives and care of patients will be impaired in the least. The strike is based on the demands of the workers for the implementation of the monetization policy of government. The issue is a service wide issue which is being addressed by the Office of the Secretary to the Government of the Federation (SGF). In this regard, it is beyond the Federal Ministry of Health because it affects all Federal Government employees.
Nevertheless, we hasten to state that given the sensitivity of the issue of health care to our population and citizenry and the negative consequences that would result therefrom, one would expect that this will be the last option that the workers would consider. As it is, lives are being lost right now and the hospitals are left with no choice than to discharge patients, even as new patients are not being attended to. Inevitably, this will affect all and sundry, including the relatives of the striking workers themselves.

Very importantly, it is expected that since it is an issue that affects all federal public servants, (not just health workers alone), health workers would be the last to take this course of action in realization of their noble call to service of humanity.
Thus, the Honourable Minister would like to seize this opportunity to call on the health workers to go back to work in the overriding interest of their patients and most importantly because the office of the SGF is doing its best to address their grievances.

Thank you.
Sincerely,
Niyi Ojuolape
Special Assistant (Communications) to the Minister of Health

Friday, 17 July 2009

A "Giant" ignored....

by guest - Iruka N Okeke

On the 2nd of July, the UK Wellcome Trust announced a new and exciting program, which has the objective of developing biomedical science at African Institutions. Unlike many programs with this objective, the Wellcome Trust’s African Institutions Initiative. is focused on supporting Africa-led consortia, giving African clinical and biomedical scientists the opportunity to drive their academic development.

The maiden list of projects is impressive and offers considerable potential:

By now...I am sure you have got my point. Perhaps you noticed it too…not one of these projects is based in our self-styled ‘giant of Africa’, in the country that houses the most medical schools, trains the greatest number of health care professionals, and serves among the greatest number of patients - Nigeria.

Nigeria will of course be a major player and participant. For example the CARTA program, based in Kenya, includes 8 African universities and 3 research institutes and (thankfully), one of these is our own University of Ibadan. UI is of course one of Africa’s earliest and foremost medical schools and four decades ago was a renowned world center for virology and primary health care research. It however becomes difficult to deny that for health research tomorrow, rather than leading, we are following.

Read more about the initiative at SciDev.net

Wednesday, 15 July 2009

Strikes in Nigeria: playing with fate....

Since we started out sharing our views on health in the Nigerian polity, one issue has bothered and challenged us....Why does health, so important to all of us ...have so little political capital in Nigeria?

A bit of lip service is paid here and there...but not more than that. Can you imagine what the outrage would be if the banking sector is paralysed? if the telecommunications systems went off? if all the roads in the country were blocked? the airports were closed... I suspect there would be an uproar...

So when almost the entire public health care delivery system in Nigeria is paralysed by strikes...why is there no reaction? How can we normalise so much? Medical care is the most essential of all the essential services...so how can we as a society tolerate so much?

Why do health care professionals find it so easy to strike...

Why does it take a strike to force the government to engage...

Why do the people find it so easy to look away...


THESE QUESTIONS CHALLENGE US DAILY...

Find below a few reports...but maybe our problems are too many and too large to bother with "health"and in the wake of the bombing of the Atlas Cove, the release of Henry Okah and Obama's speech...you would hardly notice...until it is your own child that you need to take to hospital!

1. Daily Trust: The Federal Medical Center (FMC)Gombe has been forced to discharge all patients on admission following the industrial action embarked upon by the National Association of Nigerian Nurses and Mid-wife and National Association of Medical and Health Workers.

2. Daily Trust: The House of Representatives yesterday mandated its committees on Health and Legislative Compliance to investigate the death of many Nigerians at the National Hospital, Abuja due to the strike being embarked upon by the National Association of Nigerian Nurses and Midwives.

3. Thisday: Following the multiple industrial unrest that has gripped three key sectors of the Nigerian economy namely, education, health and information, the House of Representatives yesterday summoned the ministers in charge of education, health and information and communication, Dr. Sam Egwu, Professor Babatunde Osotimehin and Professor Dora Akunyili.

4. Next: The University College Hospital (UCH), Ibadan on Friday July 10 rejected new patients and is hurriedly discharging in-patients, as its nurses and non-academic staff embark on strike.

5. The Sun: Daily Sun visit to the hospital on Friday and Saturday revealed that virtually all the wards at Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile Ife were empty while the hospital was unable to admit new patients who came to the hospital oblivious that the strike persisted.

6. The Guardian: Minister of Health, Prof. Babatunde Osotimehin, is pleading with the doctors not to go on strike because there will be needless loss of lives.


My final thesis on this is that NIGERIANS are willing to tighten their belts and sacrifice for our country; our doctors will work for peanuts and our teachers will teach for less....

BUT BUT...they will NO LONGER DO THIS if our "LEADERS" do not do the same!

Our representatives in parliament take home millions of dollars and drive around in jeeps with tinted screens, local government chairmen move around with a retinue of aides that will make the Mayor of London jealous and while Universities are closed, OUR Minister for Education is alleged to have spent
120 Million Niara on a 25th Wedding Party...


Me says...pay the teachers and doctors...

Monday, 13 July 2009

TRANSFORMING EMERGENCY CARE IN NIGERIA

We are always excited to read about Nigerians actually walking the walk despite an environment that does not seem to encourage innovation in any form. Today we bring to you this interesting report from VESTA Healthcare on a most important workshop that recently help in Abuja.

On the 1st and 2nd of June 2009 at the Abuja International Conference Centre the Honourable Minister of Health, Professor Babatunde Osotimehin formally declared open the first in the series of “Transforming Health” International Workshops & Exhibitions titled, “Transforming Emergency Care in Nigeria”, organised by Vesta Healthcare Partners Nigeria Limited.

The positive tone of the Workshop was set by Professor Oladipo Akinkugbe, one of Nigeria's most respected and distinguished academics and physicians. He particularly welcomed the participation of the UK-based Faculty, the majority of who are Nigerians, adding that this was a practical demonstration of their commitment to improving the health systems at home. Also speaking at the occasion, one of the organisers, Dr Folabi Ogunlesi noted that building capacity in workforce in Emergency Care was crucial for achieving a reduction in the unacceptably high mortality and morbidity from road traffic accidents, gunshot wounds and natural disasters in Nigeria.


The programme, over two days, was a rich mix of formats ranging from morning lectures featuring thought provoking speakers to intense, highly interactive skill stations and tutorial sessions in the afternoons. A total of 122 delegates from all over Nigeria attended. The Workshop Programme was developed and delivered with the support of an 18-strong UK and Nigeria-based Faculty comprising Consultant Physicians, Consultant Surgeons and Emergency Medicine Consultants, Senior Nurses and Paramedics.

Topics covered included strategy and planning, service delivery, hands-on care, disaster management and a host of others. There were robust discussions during the plenary and breakout sessions.


The tutorials and skills stations afforded opportunities for delegates to practice their resuscitation skills, interpret and respond to ECG’s, analyse x-rays, CT and MRI images, discuss a range of clinical scenarios as well as try out equipment such as ex-vivo laparoscopic training jigs. The feedback received at the end of the workshop from formal evaluation forms was overwhelmingly positive.

The Workshop was complemented by an Exhibition featuring 19 major medical equipment vendors, service providers and companies. Participants circulated through the Exhibition area throughout the Workshop, learning about the latest services and products, speaking with representatives from exhibiting companies and using the space as a central meeting and networking point. A very well attended and enjoyable Networking Reception took place on the evening of the first day with music provided by the Nigeria Police Band. With the Emergency Care Physicians visiting from the UK interacting with their colleagues in Nigeria, the first Nigerian Society of Emergency Care was launched during the workshop.

Look out for the next in the series of “Transforming Health” Workshops coming up on the 8th and 9th of June 2010, in Abuja.

Vesta was formed in 2007 by three doctors (Folabi Ogunlesi, Efunbo Dosekun and Niyi Ade-Ajayi) to ........“do for medicine, what KPMG has does for accounting”......... The firm is fast developing a reputation as a platform and focus for the step-change that would be necessary to bring Nigerian healthcare delivery methods into those of the 21st century.

Vesta Healthcare Partners is a medical professional services firm, dedicated to addressing the challenges and issues of the health care sector in Sub-Saharan Africa and the Caribbean. Find out more at www.vesta-hcp.com

Friday, 10 July 2009

Stepping Stones: The "witches" fight back

On the 12 November 2008 Nigerians living in the UK were shocked and traumatised by a documentary on "Saving Africa’s Witch Children" broadcast on ITV. As if we did not have enough problems fighting our image crisis and constantly trying to prove our innocence to our skeptical hosts. Now we had to explain the film below....available 24/7 around the world via youtube... (pls note - images are very disturbing)




When I attended a MANSAG dinner recently and heard Gary, the man that set up Stepping Stones in Nigeria speak....I wondered about our country, I wondered about my own two young children and how much I loved them..naturally. This incredible gift of life. I thought about these children in the film, of their parents and siblings. Of their circumstances. Most importantly ...I thought about OUR society. On how we could possibly let this happen. On how we could possibly remain quiet. On how the individuals involved are still on the streets of our county.

I thought ...maybe I am being too emotional. I am now too sensitive....I might be percieved as having joined the "other" side. I had lost the "hardness" of being Nigerian...as we pride ourselves...

BUT our country never stops to amaze you!

On Friday 3rd July 2009, in the afternoon local time, a group of men appeared at the Child Rights and Rehabilitation Network Centre (CRARN) in Eket, Akwa Ibom claiming to be donors who wanted to donate goods and toys to the children. Shortly after, the men identified themselves as police officers, and unlawfully arrested two CRARN staff members and mercilessly beat many of the children whilst searching for CRARN’s Founder and President, Sam Itauma. Details here...

In response to the international outrage that greeted this incident, the Governor of Akwa Ibom State,Godswill Akpabio, has visited the CRARN and ensured the staff and children that there security and safety was guaranteed by the Akwa Ibom State Government. In addition to this the Governor donated 10 Million Naira (around £40,000) and numerous other food items to CRARN and the children. Details here...

Stepping Stones Nigeria are organising a symposium on Witchcraft and Child Rights. The event will be held at Cross River State State Library Hall on July 29 2009. Details here...

thanks to naijablog for all the links!


well....what can I say...like many fellow Nigerians...maybe the most I can do is pray and wait for my own personal miracle....until then...its business as usual!???

As my friend Kalu Aja says...it's our problem and we can fix it!





Wednesday, 8 July 2009

Lagos State - continues to set the pace

Sometimes..out of the quagmire of the Nigerian political space....a leader emerges that is head and shoulders above his peers.

When he shes does, we really do not care if that person is Igbo, Yoruba, or Hausa. We do not care if he/she is from the east, west, north or south. We do not care if he she is Christain or Muslim.

This is why almost all Nigerians in my generation will continue to celebrate Nasir El Rufai, Nuhu Ribadu, Ngozi Okonjo Iweala, Oby Ezekwesili. We saw ourselves in them.

If a leader emerges that provides security to Nigerians, peace in the Niger Delta and Electricity across the country...most of us will honestly not care that the Minister of Finance, Minister of National Planning, and the Governor of the Central Bank of Nigeria are all from Kano. We will not care less!

So today...Ill celebrate with you the one Nigerian leader putting the rest to shame. Showing that you do not need years to plan. A leader that has shown that being a SAN does not make you any less sensitive to the needs of the guy hawking at Ojuelegba. Managing the city fastest growing city in Sub Saharan Africa and making it work. We have blogged on it before and we will continue to....

It is slow....but it is happening in our life time. LAGOS is beginning to work again, thanks to inspirational leadership of Raji Fashola

Read the following developments in the health sector:

1. Daily Trust: No fewer than 11,000 people resident in five local government areas of Lagos State have benefited from the free ambulance boat services, designed to improve health care services in rural areas...

2. Vanguard: Newly procured Field Hospital into the Lagos State Eko Free Health Mission is yielding fruits for less privileged Nigerians...

3. BusinessDay: Lagos - Battle against fake drugs

4. Vanguard: Lagos to establish immunisation posts for children


Now to really understand the contrast in governance in Nigeria - read this article in Leadership; one of our favourite Governors - Isa Yuguda of Bauchi State, a former Aviation Minister, former Managing Director of Inland Bank and brother in-law to our President. He has concluded that the best way to address the health sector's challenges in his state is to import doctors from Egypt!


I rest my case!

Eko O ni Baje!

Monday, 6 July 2009

Reporting health in the Nigerian Press....

Recently I was involved in a conversation with a colleague who writes on health issues in South Africa. We discussed about the healty and vibrant debate that went on in the South African press during the tenure of the erstwile Minister of Health in South Africa. Dr. Mantombazana 'Manto' Edmie Tshabalala-Msimang will be remebered for her emphasis on treating South Africa's AIDS epidemic with vegetables such as garlic and beetroot, rather than with western antiretroviral medicines. We talked about the debates about acces to anti retrovirals and to Mbeki's stubborn stance on HIV/AIDS. I felt her pride in the role of the South African press in shaping the discourse.

She asked me...how the press reported health in Nigeria.

...mmmh....well...sadly Apart from Chukwumah Muanya who writes for the Guardian, I cannot point to any other journalist in the Nigerian press who has consistently reported health stories and put the often difficult issues into pespective.


So for all its worth, I looked for the stories that have appeared over the past few weeks. Sadly ...at least 95% of press stories in the Nigerian press report what our public officers say. No critical analysis, no context, no perspective....just what the Minister says!

Find below a small fraction of what the Minister of Health has said...courtesy of the Nigerian press:

1. Vanguard: Osotimehin Enjoins Nigerians to Donate Blood Voluntarily

2. The Sun: Health minister declares war on tobacco

3. World news: Osotimehin - Sustained Funding Will Hasten Elimination of Malaria

4. Thisday: Osotimehin - Nigeria's Battle Ready for Malaria

5. Vanguard: Oshotimehin advocates for community participation in health

6. Vanguard: Professor Babatunde Osotimehin has tasked the media to sustain the high level of awareness about the A(H1N1) Influenza among the citizenry of the country.

....
if the the purpose of a free press in a democracy is to guarantee free and open debate and discussion...it is not happening in Nigeria....and it is NOT the Minister's fault!

Sunday, 5 July 2009

I am Hungry, Please Re-brand me

New voice out of our troubled country...If you have not...bookmark this blog - Suleiman's Blog

Now read this excerpt...

I am Nigerian...I have millions of acres of arable land and billions of cubic litres of water, but I cannot feed myself. So I spend $1 billion to import rice and another $2 billion to import milk. I produce rice, but don’t eat it. I have 60 million cattle but no milk. I am hungry, please re-brand me.


....Malaria, typhoid and many other preventable diseases send me to hospitals which have no doctors, no medicines and no power. So my wife gives birth with candle light and surgery is performed by quacks. All the nurses have gone abroad and the rest are waiting to go also. I have the highest maternal and infant mortality rates in the world and future generations are dying before me. I am hopeless, hapless and helpless, please re-brand me.

More here....


If you like it, read When the Ivory Towers Came Crashing Down...


Have a good weekend!


Thursday, 2 July 2009

A visit to the Nigerian High Commission

In a recent posting about the annual MANSAG dinner, I promised to share with you the promise made by the High Commissioner of our Federal Republic, His Excellency Dr. Dalhatu Sarki Tafida, OFR, MBBS, MRCP, FNMCP, FWACP, former Honourable Senator of the Federal Republic of Nigeria.

In his usual calm, collected and eloquent nature Dr Tafida spoke passionately about how he tracked down the producers of a film that aired on Channel 4 in the UK "Saving Africa's Witch Children". He described his initial skepticism of this film, set in Nigeria, it evolved as he met the producers and understood that their motivation was nothing other than the best interests of our children. (viewing this movie is not for the faint hearted!)


To end his address, he offered his colleagues the opportunity to phone him whenever we needed the services of the consular section of the Nigerian High Commission in order to ease the process for us.

I had an appointment with my family at the Nigerian Consular section a few days later so I thought hard about the High Commisioner's offer. But in the end....I remembered the words in Achebe's book, "The Trouble with Nigeria", which I had coincidentally re-read recently-

"...that precisely is the view which Nigerian elite groups foster in their private and public behaviour. The queue is for the littl
e man, the big man has no use for it"


So...no...I will not take advantage of the privilege of being acquainted to His Excellency, I gathered courage, packed my family and we headed to
9 Northumberland Avenue.

But before that we went to the website - http://www.nigeriahc.org.uk/ - Now... this website is a complete disgrace. There is no politically correct way to put it. There are more flying objects on it than you will find airplanes over the skies of Heathrow. Compare this to the excellent website of the Nigerian Immigration Service. Now if you really want to weep, look up the website of the Ghanain High Commision in London. What does it take to put up a decent website in 2009?

When I did manage to navigate my way through the site, and hit the usual stumbling blocks, I decided to call the High Commission on their advertised number of 0207 839 8746. Try it yourself...and enjoy the soothing voice of a prerecorded message giving directions to the High Commission, and opening times. Nothing else. Nothing.
What does it take to answer a phone in 2009?


So..off to # 9 Northumberland Avenue. On the previous day, I had gone physically to the High Commission to find out what documentation I needed before I packed my family for the journey. Then we arrived the next day, bright and early and joined the long queue that forms from 6 am every morning. Not of tourists,businessmen etc, but of Nigerians...Nigerians of all manners, and walks of life looking sad at the prospects of a day of pain.

In the High Commission itself, we were faced with officials, completely out of their depths on how to manage the crowd. Confusion prevailed. "Officials" shouting at the top of their voices. People wondering what queue to join. Toddlers crying, children running around. A TV blaring in the corner, showing a Nigerian production with its volume set at the loudest. We look at each other and seek mutual support. Nobody is smiling. Every single person in the room is looking upset. Upset at a country that treats it citizens like they were irrelevant. Upset that there is apparently nothing we can do about it. We collect our emotions, endure the pain and hang in there. The pictures below tell the story.










Having said all this, it is obvious that those at the embassy are actually working hard to serve to the best of their capacity. BUT the world has moved on, and Nigerians expect that its High Commission moves on too.

Until the new generation banks came on the scene in Nigeria, we thought that getting your money normally required a full day at the bank. Until MTN came to Nigeria, we planned a full day to visit NITEL. We need someone/group with the competence on managing processes to support our High Commission. We also need a few Nigerians that understand what customer service is. It is a pity that the High Commission has a monopoly on the issuance of visas and passports...else we would long have moved on.


Having said this too, I know that Dr Tafida means well. I know he wants the High Commission to work. But he really needs to focus on this issue. Nigerians' deserve better in the one place they can call home in the UK. For now...all I can think about, are the mothers and their children that struggled up and down the stairs, with their prams and children as they moved from one queue to the next. As I finally got out of the embassy at 3 pm on the day with my family, we made the sign of the cross and thanked God things money can't buy....the Green Kpale!

But for the website and phone...there is no excuse!

We can do better! We definitely can. Accepting the status quo is accepting that there is something inherently wrong with us. I thought back to my recent experience at the Embassy of Tanzania and how efficiently I was served...

So this is obviously not a resource issue. So if we cannot get our High Commission in London to work, then how can we get our health sector in Nigeria to work. The general feeling at the High Commission amongst the various visa and passport applicants was that there was nothing anyone could do, well this is mirrored in people's attitudes to the various failures our health sector...........WE CAN DO BETTER....Yes...we can do better Dr Tafida.