Sunday, 30 August 2009

CORRECTION!: The contradictions of Abuja

In our last post "The contradictions of Abuja" there were three important points.

1. That our government that has shown that building a ten lane expressway from the airport to the city in Abuja is an absolute priority.

2. This is so important that the funding to do this was derived from funds previously allocated to health and education.

3. And finally that unless we push health up the political agenda, our people will continue to suffer.

In making these points I put up a picture of a hospital I had come across in Abuja which the people living around had told me we was Utako General Hospital. I found it in a derelict state, yet the quality of the building suggested that it was built to the same high standards of many other buildings in Abuja.




I WAS WRONG...this is NOT Utako General Hospital!

This used to be the Abuja International Diagnostic Centre in Utako built in the late nineties. It was apparently the brain child of Dr Benjamin Ohiaeri of First Consultants Medical Centre Lagos, built and initially managed by the International Hospital Group (it is still advertised as one of their projects). The picture below was sent to us by a member of staff who worked there for the few years that it functioned.



You will remember the International Hospital Group. It was brought in from the UK in 2003 to manage our National Hospital in Abuja for 10 years. It was sacked a year later for incompetence following a report that concluded that "The National Hospital was a bottomless pit, with little to show for it by way of palpable improvement in the quantum and quality of care".

The Abuja International Diagnostic Centre (don't we love BIG names?) project was financed inter alia with a World Bank IFC loan of 2.5 million dollars (find details in 1999 annual report on their website here).

It is said to have thirty something single large rooms (obviously not intentioned for the average Nigerian...) and I am reliably informed that is full of the same "high tech" medical diagnostic equipment similar to those apparently procured by Obasanjo's government via the Vamed project ....including a CAT scanner that is said never to have been used!

What is IFC? From their website...the International Finance Coorporation "fosters sustainable economic growth in developing countries by financing private sector investment, mobilizing capital in the international financial markets, and providing advisory services to businesses and governments. IFC helps companies and financial institutions in emerging markets create jobs, generate tax revenues, improve corporate governance and environmental performance, and contribute to their local communities. The goal is to improve lives, especially for the people who most need the benefits of growth."

BUT it is difficult to blame the IFC! This is not the only IFC project in Nigeria as in 2007 they reached an agreement with Hygeia Nigeria to upgrade hospitals in Apapa and Ikeja and the reconstruction of a third hospital, on Victoria Island. The most well-known project financed by the IFC in Nigeria is "The Palms Shopping Centre" in Lekki, Lagos....

So why would a health care venture as big as this fail in a country like this where even our very own president has to go abroad to receive basic health care. Another contradiction of the country we call our own.

At least we will have our 10 lanes into Abuja!

Thursday, 27 August 2009

The contradictions of Abuja

There is a huge project going on in Abuja at the moment. The beatiful trees that lined both sides of the motorway from the airport to the city in Abuja have been mowed down. The plan is to expand the current 4 lane express way into a 10 lane super express! The cost, quoting the FCT Minister; Senator Aliero is N224.5 million as reported by The Independent. For such important projects - we do not waste time in Nigeria. All hands are on deck! Equipment has been mobilised to the site....Julius Berger of course. Only the best is good enough for our federal capital.


Yes....this is the project that led to an uproar in Nigeria when it was approved by our beloved Senate. Try as hard as Senator Victor Ndoma-Egba (SAN) tried, he could not convince his colleagues, that it did not make sence to cut the budgets for health and education for a project to massage our egos.....but there you go.

Below are pictures of the Utako General Hospital in our Federal Capital City, over grown by weeds, inhabited by our non-human friends.






My thesis - until we put health back on the political agenda, nothing will change...nothing



Friday, 21 August 2009

Pfizer and Kano - Heads or Tail...the people loose

Reuters - KANO, Nigeria, July 27 (Reuters) - Nigeria's Kano state and drugmaker Pfizer Inc have reached a final court settlement in a multi-billion dollar lawsuit over a 1996 drug trial, lawyers for both parties said on Monday. The northern state of Kano sued the world's largest drugmaker in May 2007 for $2 billion in damages over testing of the meningitis drug Trovan, which state authorities said killed 11 children and left dozens disabled. The lawyers would not describe the settlement, but a source close to the deal said it obliges Pfizer to pay $75 million.

Here’s how the $75 million will break down:

- $35 million of the settlement is slated to go to a fund that would provide payments to eligible people who participated in the Trovan study.

- $30 million of the settlement would be set aside for healthcare initiatives chosen by the Kano State government.

- $10 million of the settlement would be used to reimburse Kano State for legal costs associated with the lawsuit.

Pfizer says there will be some oversight on the Kano State initiatives and seeks to name a separate six-member board to oversee the $30 million allocated to support healthcare initiatives designated by Kano State. Kano State government does not want any interference and are calling for self determination in managing the disbursal of the settlement funds...

Naija....we know what that means :) Aluta!


Credit to BNET for links.

Wednesday, 19 August 2009

The new "Mega hospitals" and how they are going to save your life...maybe

Health in the Nigerian polity is often discussed in terms of "hospitals built"....

While all these are important to some extent...no building has ever saved a life...on its own. We will not be able to avoid the critical thinking required to build a health care system. But in the typical Nigerian way...we are trying to build our way out of a problem...

Apollo one of the largest healthcare groups in Asia and best hospital in India is planning to invest $175 million on five new specialty hospitals for children (four in India and one in Nigeria) . I hope that this is good news for the country, and that specialist care will become more accessible to Nigerians. It will not be cheap but it will at least open up a few opportunities for those of us that cannot afford to go to Germany for common colds or strained knees.

Thisday reports that work has commenced on the $150 million Justice Karibi Whyte Mega Specialist Hospital in Rivers State. The state-of-the-art mega specialist hospital that is expected to be one of the best in sub-saharan Africa on completion, is being built by the Amaechi-led administration with Clinotech Diagnostics and Pharmaceuticals of Canada as the project consultants.

Daily Trust New health diagnostic centres worth about N1 billion will soon be constructed across the Federal Capital Territory, Abuja, the FCT Minister, Mohammed Adamu Aleiro

Silva's promise to Bayelsa....





Nigerian in Britain Hopes to Build Hospital in Homeland


Afam Onyema's singular goal: to build a hospital in Nigeria


Foundation laying ceremony of the much publicized American Hospital to be built in Abuja


Even Imo State claims to have built the first e- tertiary hospital at Imo State University Teaching Hospital.

...success depends on how it is measured...in the beauty of the hospitals or in terms of "lives saved"

Monday, 17 August 2009

A sign of things to come?

You will might have read from the new and rich newspaper in Nigeria 123Next of the first coronary angioplasty and stenting procedure performed in Nigeria.

The procedure was carried out be by a Nigerian cardiologist, Dr. Adeyemi Johnson, of First Cardiology Consultants, who returned to Nigeria after practising in the United States for over 25 years.

Dr. Johnson is quoted as saying that believes that angioplasty has come to stay in Nigeria, because his team is now based here. The team is made up of a British-trained Nigerian nurse, a Lebanese-trained nurse and Indian-trained nurses, while the Reddington Hospital is providing the high-tech equipment being used.


Reddington hospital is presumed to be the best tertiary medical care facility in Nigeria. Newly built on nine floors, it provides care in all fields of Internal Medicine all supported by the latest technology. The CEO says that they will not relent in our quest to pursue medical excellence....

There is just one small catch....wait for the bill!

But ...we celebrate this first step...and hope that our colleagues with similar expertise all over the world will move from their "jobs", and "careers"...and seek their "calling"...at home in Nigeria.

Friday, 14 August 2009

Hajia Turai's £40M Cancer Centre in Abuja

Our country is an interesting place.

In a single afternoon in Abuja N7 Billion (£28 million) was raised in a single day to finance HajiaTurai YarAdua's pet project - A state of the art cancer centre in Abuja. The plan is to raise N10 Billion (£40,000,000)! Hajia Turai's project is reported by the Vanguard "to be born out of her utmost desire to contribute her little quota to achieve a focused delivery of health care. She said the centre is meant to render services to women and children, especially the rural and urban poor". Read a full report in the Vanguard.

Hajia YarAdua is reported to have gotten the idea after a visit to the MD Anderson Cancer Center in Texas in 2008.

Reading the reports on the launch has been interesting. Our politicians falling over themselves to commit funds to this project, while they cannot keep the few general hospitals in their states working. Legislators coming together to "donate" huge amounts while the National Health Bill has been stuck in the National Assembly for close to 5 years. The most comical was the Minister for the Federal Capital territory, and former Senator of our Federal Republic quoting health statistics - "disclosing" that in 2005 alone, 89,000 Nigerians lost their lives to cancer. Wow...where did he get his stat from? From the National Health Information Management System?

Since we are obviously passionate about health and health care in Nigeria...why are we not celebrating? There are several reasons....

1. We have several "centres of excellence" for medical care in our teaching hospitals. The last government spent most of its health sector budget in renovating them. Would £40 million pounds not be enough to set up a moderate cancer management centre affiliated to it. You would already have the doctors, nurses etc in place?

2. Nigeria extends 1,127 km (700 mi) E–W and 1,046 km (650 mi) N–S. How will the the rural women and children Hajia is targeting find their way to Abuja?

3. If Cancer Centre's site had to be in Abuja, why not add it onto the National Hospital?

It turns out that we are not the only ones worried. Salisu Suleiman on 123NEXT advises that the worst killer disease in Nigeria today is not cancer, but poverty.

BUT having said all this, we still hope that the project works.

We really do. We hope she is being advised by professionals ready to see this to fruition, ready for the long haul. We hope that her advisers also advise her how to build cancer education programme across the country to inform people how to detect early tumours.

We hope that her advisers are planning a screening programme. We hope that her advisers are planning on the referral mechanisms from primary health care centres to Abuja. We hope that she is being advised that it is necessary for the knowledge, skills and equipment necessary for Pap smears, Mammographies, Chest xrays and other means to detect tumors etc...We hope that they are advising her on the skills and capacity to manage this centre. We hope that there is a clear strategy on how this center will interface with the rest of the country's health system....


We hope...we hope...what else can we do?

Wednesday, 12 August 2009

Finally the Ministy of Health's website goes live....

We have blogged several times about the lack of credible information collected on the website for the Nigerian Ministry of Health. We have argued that a website is not an exotic appendage, but an absolute essential in today's world to get your message out, and to engage with the people we claim to serve. The Ministry has responded and recently developed a website @ http://www.fmh.gov.ng/

Okay, not all the links are working yet...but this is really a good start. I am truly impressed by the words of the Minister on the start page of the website:

"We want feedback to ensure this dialogue is dynamic, vibrant and continuous"

Nigerians it is your website. Use it! Send in your comments...engage with the Ministry!



We have also wondered why very few Nigerian ministries, parastatals agencies have a decent website. In 2009, it is difficult to see how information management can work without one...even in Nigeria. This seemed to be moreso the case in the health sector.

So our relief has continued when we also found that the Nigerian Primary Health Care Development Agency had set up a decent website recently here http://www.nphcda.gov.ng/



Okay....looking at the events page , it is obvious that it could be updated a lot more often...There must be a few more events related to primary care on the website, but I guess it is work in progress....

It will be great if this most important site can be developed into a knowledge pool for primary care in Nigeria.

The web pages for other health agencies in Nigeria -

National Agency for the Control of HIV/AIDS (NACA)

National Agency for Food and Drug Administration and Control (NAFDAC)

Nigeria Health Insurance Scheme (NHIS)

National Institute for Pharmaceutical Research and Development (NIPRD)

Nigerian Institute of Medical Research (NIMR)


...we look forward to a better future!

Monday, 10 August 2009

"Born Again" - reviving childhood immunisation in Nigeria

Immunisation has been one of the primary drivers of this blog.

The reason is simple. Childhood immunisation is widely recognized as the most effective public health interventions in modern history. It requires relatively straight forward systems of delivery, and the cost of the measles vaccine, for instance is less than 100 naira. These vaccines have been available for the past 40 years, and yet more children die from measles in Nigeria than in any other country in the world.

National Primary Health Care Development Agency (NPHCDA), the agency currently responsible for delivering on immunisation has had a tortured history. It was established in 1992 to provide leadership that supports the promotion and implementation of high quality, and sustainable primary health care (PHC). This would be for all through resource mobilization, collaboration, partnership and development of community-based systems and functional infrastructure. In addition, it would ensure that infants are fully immunized against vaccine preventable diseases before attaining the age of 12 months. Expectations were high as the late Olikoye Ransome-Kuti was asked to lead the agency....But he was literally the last credible leader this most important agency has had in its 20 odd years of existence. To make matters worse, the Obasanjo administration merged two failing parastatals - NPHCDA and NPI under the "distinguished" leadership of Chief Titi Koleoso-Adelekan.

To understand how bad things have been, I recommend a book - Academics, Epidemics and Politics by Prof. Idris Mohammed, former Chairman of the board of the National Programme on Immunisation when the national coverage for childhood immunisation fell to 13% (no..this is not a typo!).


Sadly...for years NPHCDA has simply not delivered on its mandate. The reasons for this are not hard to find
. Suffice to say that a lot of the failings of this important agency in the past 10 years can be put down to a failure of leadership.

Sadly the consequence of failure of this type of agency is that CHILDREN DIE...yours and mine.


BUT there is some good news...

This is the vision of the Nigerian Primary Health Care Development agency under the new leadership of Dr. Muhammad Pate -


"Nigeria will be a nation of healthy people with equitable and affordable access to primary health care through a system that delivers quality, integrated services with the participation of all stakeholders"
Gratefully ...for the first time since Professor Ransom Kuti left the agency, NPHCDA has the leadership it deserves in the former Director of the World Bank, and Adjunct Professor at Duke University, North Carolina, United States, and and for the last few months Executive Director of NPHCDA - Dr. Muhammad Ali Pate. On this blog, we have been careful not to follow the path of several media outlets and celebrate individuals, but we have to celebrate the emergence of credible, competent and honest leaders in the public space in Nigeria. In the midst of the past rot at NPHCDA as made lucidly public by one of its...past board chairman; Idris Mohohammed in his book Academics, Epidemics and Politics.

Find some recent quotes in interviews in the Nigerian press especially the first one. Maybe ...there is hope after all.

The News
Corruption In Health Sector Is Unacceptable

With Chukwuma Muanya - The Guardian
...my third objective is to see the agency repositioned internally, meaning our strategy or structure, our systems, our people actually well positioned to deliver on our mandate. We are now going to have a retreat, and we are having consultations internally as to this major configuration of the agency collectively and then position our staff and build their capacity, so that they are able to play an effective part in making us move forward.

Vanguard
...he described actions taken to raise operational efficiency within the Agency, with routine immunisation and in the field during campaigns.

Daily Trust
Why health care delivery should target rural dwellers

What a difference it would make to the lives of of our children if he succeeds...what a difference

Thursday, 6 August 2009

Kidnapped - after spending his whole professional life serving Nigerians in rural areas.

If we blogged about security issues in Nigeria - we would write at least one story on people we know personally that are kidnapped in South Eastern Nigeria every week. This is just people we know!

But this story literrily broke our hearts. I have thought back to all the experiences of when we have gone the extreme extra mile to show hospitality to our guest as part of our culture. What has become of that? Read here the story of a colleague that has spent 34 years serving rural communities in Abia state 34 years!....kidnapped. This is what our country has become. What do you think will happen next...who surfers? who pays the price?

...and you say there are leaders in Abia State?


Story culled from the Christian Chronicle.

A leading Christian doctor was abducted from his Nigerian home and shot in the arm by kidnappers who are holding him for ransom.

Dr. Robert Whittaker was at his home on the compound of Nigerian Christian Hospital with his wife, Annette, and son, Ozioma, when a vehicle of armed men pulled up to the compound Sunday, Aug. 2. The kidnappers shot one of the compound’s security guards and entered the home. Whittaker was shot once in the arm during the attack, said Jerry Canfield, chairman of the board of Searcy, Ark.-based International Health Care Foundation, which operates the hospital.

The kidnappers took Whittaker and left his wife and son. Annette Whittaker received minor injuries in the attack and the security guard was expected to recover from his injuries.

Canfield asked for prayers for the Whittakers and the staff of Nigerian Christian Hospital, which is negotiating for Robert Whittaker’s release.

The hospital, launched in 1965 by missionary physicians including Dr. Henry Farrar, is located near the border of Nigeria’s Abia state, near the southern Nigerian city of Aba.

Tom Carr, executive director of International Health Care Foundation, led a team of American medical missionaries on a campaign to Nigeria recently and was in transit back to the U.S. when he learned of Whittaker’s kidnapping. Two American nurses working at Nigerian Christian Hospital also are returning to the U.S., Canfield said.

Whittaker went to Nigeria in 1975 after reading an article by Dr. Henry Farrar in the church publication Firm Foundation, encouraging physicians to spend vacation time at Nigerian Christian Hospital. The West End Church of Christ in Nashville, Tenn., sent Farrar to serve as the first located doctor at the hospital in 1964 and continues to support his work.

Read details here


If I could comment further I would...but for now...all I can really do is weep for the country, and the part of the country I call mine...

Monday, 3 August 2009

National Child Health Week in Nigeria

The 1st to 8th of August has been declared National Child Health Week f by the Ministry of Health in association with UNICEF.

They plan to vaccinate 30 million children around the country. Find details here and here.
The plan is to hold these weeks twice each year...

It was interesting watching the usual visit of the UNICEF country representative; Ms Veneman brief our VP on the aspirations of the programme....on our very own NTAi (i for international!)

Just in May 2009 there was a campaign across the country, primarily for Polio but integrated with other vaccines called the "Supplementary Immunisation Days (SIDs)/Immunisation Plus Days (IPDs)". This extended to 11 other west African countries immunized by in a synchronized response to a wild poliovirus (WPV) outbreak from northern Nigeria that has swept as far westwards as Guinea.

Now this appears to be an ingenious plan to merge campaigns and routine immunisations in Nigeria. We seem to be already very addicted to campaigns as a means of vaccinating our children rather than ongoing sustained routine programmes.

BUT yes... if that is the only way to reach most of our children....so be it.

So...here at Nigeria Health Watch - we will also focus this week on new interesting developments related to immunisation in Nigeria.

Find some interesting resources here:

USAID - Immunizations Today and the Way Forward: The review team remains concerned about the support for and understanding of the needs for strengthening routine immunization. Priorities to reduce measles mortality, introduce yellow fever and meningitis vaccines are all campaign based and in their initial stages. Campaigns as demonstrated in the desegregation data undermine routine immunization services.

Household Baseline Survey on the Factors Affecting Routine Immunization in Northern Nigeria - 2007: Report of Pertinent Findings.