Sunday, 27 September 2009

David Morley - a career of service that started in Nigeria

It was in 2007, at an event at the Institute for Global Health at the UCL, I sat on a table at the back of the lunch room with my sandwich. On my table, I met an elderly English gentleman in a sweater who asked my name, and we did the usual small talk. He was a bit frail and spoke of his days in Nigeria with warmth and affection. He spoke about how his work in Nigeria was the first time the measles vaccine was tested in West Africa. In truth I did not take him seriously, but all the same I got back and searched for his work on PubMed.....and I found 2 links:

Measles in Nigeria: Am J Dis Child. 1962 Mar;103:230-3

The severe measles of West Africa. Proc R Soc Med. 1964 Sep;57:846-9.

These articles are so old that abstracts are not available on Pubmed, so I ordered them from our library. At  that point I understood the depth of this man's work in Nigeria! At this time, 40 years after his work in Nigeria, we are still experiencing outbreaks of measles, and children continue to die. I then invited him to a conference we organised on health in Nigeria, in London in November 2008. He did not reply to my emails, or letter in the post. Now I know why....

Professor David Morley, died at the age of 86 on the 2nd July 2009. A paediatrician whose life was dedicated to transforming the chances of survival of children born in the developing world.

We asked a dear friend; Bryan Pearson, Publisher of Africa Health to provide some insight into David's amazing contribution to our country....his piece;

Sad news from the UK last month was the announcement of the passing of Professor David Morley, aged 86, ex head of the Institute of Child Health, and founder of the remarkable Teaching Aids at Low Cost (TALC) charity which had provided millions of slide sets and books all over the world... and still does. His seminal book 'Paediatric priorities in developing countries' is still a standard text. In many respects he was the father of Primary Health Care... and his origin of his work? Nigeria.

In the mists of time, many forget that his inspiration was from working from the Wesley Guild Hospital (WGH), Ilesa, in the old Western Region back in the 1950s and early 60s. His pioneering work in the local Imesi-Ile community revolutionised global child health. It is just sad to reflect that such landmark developments which were completely 'made in Nigeria' were adopted internationally, but largely ignored in the country of their birth.

The process commenced when the then senior doctors at Wesley Guild, Drs Andrew Pearson and John Wright were discussing the huge caseload of acute paediatric cases and resolved that surely much of this could be prevented if appropriate measures were instituted in the community. To a degree they had brought the problem on themselves having negotiated a deal with their new regional Governor, Chief Awolowo to provide free health services for under 18's. Awo's administration agreed to pay three shillings per patient. Not surprisingly, attendance surged.
 Undeterred, Dr Pearson approached the West African College of Medical Research (WACMR) in Yaba and obtained funding for an expatriate to come out and spend half their time on community-based child health research, and half their time on clinical duties. Dr David Morley was recruited.
 Quickly he made his mark. A survey of the population of Imesi-Ile village was undertaken, which revealed that 450 children out of every 1000 was dying before the age of five years. A full longitudinal study was initiated and over the next 18 months all children born into the community were registered... and then followed with monthly checks for a full five years. Growth charts were introduced (now utilised universally) and a special 'Under Fives Clinic' was initiated back at WGH. High protein weaning food was introduced. Mothers kept the children's records (less loss than for hospital based records); Grade II midwives were taught to deal with 90% of clinical need and to refer the other 10%. By 1960 outpatient attendance had reached 200 000 at WGH, 80% of whom were under 18 year olds. The first measles vaccine was trialled at Ilesa and Imesi-Ile in 1960...
 And thus the community-based health revolution was born. Quickly the Imesi-Ile population started growing at more than 9% per annum, and the first family planning programme (as it was known then) had to be initiated.

It is no accident that Prof Olikoye Ransome-Kuti was closely involved and inspired by David Morley. Just a shame, that despite all Olikoye's efforts, so little of what was learned from this landmark work of community-based prevention was adopted throughout the Federation. Many other countries did take heed, and probably millions of children have benefitted.


Every year our country gives its national awards to all sorts of characters. People that really affect the lives of people are hardly eve honoured. But what greater honour can we do for David than if we did finally saved our children from measles ...nearly 50 years after his seminal work! Well...thats our country..its up to us!

Thursday, 24 September 2009

Have you heard about "Vision 2020"?

If not please listen to our friends at NTA Network news every night!

This is one of the illusions (some say delusions) of grandeur that our government occasional emerges with. We "the people" ask no questions, as we are ourselves carried away with the hype. We start believing that we are actually the "giants" of Africa, and that by some waving of a magic wand we can actually emerge as one of the leading 20 economies in the world by the year 2020.

So the office of the Vice President puts together groups of eminent Nigerians, organises them in thematic groups and asks them to come up with a blue print to achieve this vision more than half way into the tenure of the government of the day. They set up a website, make long speeches, and bring our colleagues to Abuja to draw up the vision.

The website of OUR vision says "The Vision 2020 is a grand agenda, which the federal government has adopted as the main thrust of what it is out to accomplish between now and the year 2020. It is a 13-year plan of dramatic socio-economic transformation of the country. The goal of the vision is to transform the Nigerian economy to be in the league of the 20 most industrialized countries of the world,"

The thematic group on health was led by eminent colleagues; Dr Shima Gyoh and Dr Mike Mbanefo Ogbalu.

The forward of their report illuminates the seriousness this governments places on policy development.

"The Health Thematic Groups did not get all the documents it needed, and many came rather late. The version of the National Health Bill described as authentic, and which we understood had gone through all the stages of legislation was obviously very important for our work, but it arrived only after we had completed our report....

....The group would have probably worked more efficiently if it had a secretariat with computers, printers and photocopying capabilities. Members were however, very resilient, using their own machines, flash drives and individual internet access to fill the gaps."


Their report makes extremely interesting reading. The eminent colleagues that worked on this for weeks obviously took this task on with energy, passion and obvious competence. I recommend it unreservedly to fellow Nigerians. We hope that this government that chooses to ignore two consecutive UN assemblies, does not ignore the work it has commisioned itself.....but I am sadly not optimistic. I hope to eat my words in the year 2020.

The year 2020 might seem very far away....but it is not really. By the year 2020, it is the Vision of the Thematic group on health that every household in each town in Nigeria should havea running pipe borne water supply!

Wow....maybe thats why its called a "Vision"!

2020 we come!

Read the full report here....afterall its OUR government  therefore OUR vision ...

Report of the Vision 2020 Technical working group on Health.

Monday, 21 September 2009

Where is your NAFDAC number?

You might not have heard a lot about him, but NAFDAC actually does have a "new" Director General, Dr Paul Orhii. A Russian trained doctor, he holds a PhD in medicine, and has a Juris Doctor degree from the Thurgood Marshall School of Law at the Texas Southern University. After initial debate about his suitability for the job, and links with our most reverred Attorney General. Now he seems ready to make his mark....

He recently called "a world press conference" in Abuja where he proposed a new law, advocating for the death penalty or life-jail term for manufacturers and distributors of fake drugs, especially in situations where it is determined that such medicines caused death or injury.

Wow ...the death penalty!

This has led us to have a think at the Nigerian pharmaceatical "market".

This article in 234Next describes the Idumota open drug market, the Sabongeri market of Kano and the Onitsha Head Bridge Market, which was reopened in 2008 after it was closed by NAFDAC in 2007 for drug counterfeiting. All three are still fledging OPEN markets where anyone can walk in and buy the most potent medicines....anyone!

Do not ask me if these medicines are kept at the temperatures many of them have to be kept in to preserve their efficacy. In fact, the the same article outlines a report by the University of Lagos College of Medicine, showing that most of these medicines failed a sensitivity test.

Are all the traders in Idumota open drug market, the Sabongeri market of Kano and the Onitsha Head Bridge Market facing the death penalty if the medicines they sell, lead to a therapeutic failure and death? Wow...

Yes, of course we advocate for a sanitisation of the medicine, industry in Nigeria and yes we do hope that one day we will find the leadership to provide this, but we suggest that we need to move beyond world press conferences! This is just one step ahead of calling the press together to burn medicines in public, then proclaiming across several newspaper pages that they had successfully burnt drugs worth millions of naira. This is still being done by NAFDAC in 2009!

What are our governments and NAFDAC doing to provide institutional alternatives to these markets? We celebrated the innovative idea of a modern drug store to be handled by professionals such as  the one built by the Segun Oni-led government of Ekiti state opened by the NAFDAC boss himself!. How many have been built since then? Why is the only one in the country in Ado Ekiti...and not in Onitsha, Kano or Idumota?

A lot is made of Professor Dora Akunyili's successes at NAFDAC rightly so!

Very few Nigerians had heard about this agency before Professor Akunyili's tenure. It was at the same level as several other parastatals of the Ministry of Health in the late nineties such as NPHCDA, NPI, that were barely doing more than paying salaries.

In one area where NAFDAC can claim significant progress is in the enlightment of Nigerians. We are all aware of the existence of fake medicines and we make a conscious effort to check if the product has a NAFDAC number. Now even the Kellogs Cornflakes sold in all the supermarkets in th UK carry a NAFDAC registration number. Recently NAFDAC appointed one of Nigeria's most popular contemporary musician 2Face Idibia as an Ambassador! Note that Alhaja Turai, is also its Grand Matron! (Naija! :)

During every advertising break while the Network news is being broadcast, we watch NAFDAC public announcements warning citizens not to buy fake drugs, and to report those that do.

Nigerians are doing their best. But the era of celebrating individuals and awards has passed. We desire strong institutions. We do not want to see NAFDAC officials gathering a few mobile police men in drug burning orgies...

We want to see institutional changes. In the past 10 years what has actuallly changed with the medicine trade?. Anyone can walk into any open market, anywhere in Nigeria and buy any medicine they want from people who have not finished primary school. The best the average Nigerian can do is ask if it has a NAFDAC number. From the "My Pikin" know what that means.

NAFDAC is one Nigeria's instiitutions with a good reputation. World press conferences are not going to solve our problems. Let them roll up their sleeves and go to work.

Monday, 14 September 2009

The Obama speech on health care reform and our country

Last week was particularly interesting. My facebook updates were on-fire again with ooops and aaahhs for another great Obama speech.

...yes it was a great speech. A friend of mine asked me to change my status to an Obama quote "No one should die because they can't afford health care, and no one should go broke because they get sick. If you agree, please post this as your status for the rest of the day."

This has got me really thinking. Before the financial crisis, healthcare was probably the single largest domestic issue in American politics. The biggest issue? It can't be!

But then I thought of sense of loss I felt at the death of Senator Ted Kennedy. I am still not sure why I (and many in my generation) feel such an intense affinity to the Kennedys. I have been following the politics of Senator Kennedy for quite a while, especially the pride he took in public service. I have listened to him speak and wondered when we will ever get a senator in our Senate with the passion, knowledge and ability to articulate as Senator Kenney.....I digress. I remember one of his favorite quotes: This is the cause of my life. For four decades I have carried this cause—from the floor of the United States Senate to every part of this country. It has never been merely a question of policy; it goes to the heart of my belief in a just society.

Can healthcare really be that important in the politics of the USA?

I remember my early lectures on health systems and the evolution of the NHS. I remember reading with intrigue about the attempt at creating an "internal market" in the UK's NHS in 1990s. Its big idea was the creation of a market so that some parts of the organisation would become providers selling their services to the others, the purchasers. I remember the lecturer enthusiastically pointing out the peoples' opposition to Margaret Thatcher’s plans for the NHS contributed significantly to her fall from power. Again I wondered...

Can healthcare really be that important in the politics of the UK?

Many of you might know that we in Nigeria have had  National Health Bill stuck with in our houses of parliament for over 5 years. Our Senators have been to Ghana and back to discuss the Bill and finally passed it in 2008. In February 2009, without a wimper the the bill was passed by the House of Representatives in 2009. I gather both houses have now passed the bills and it is now waiting for Mr President to sign it into an ACT. Do you hear any speeches? The irony of our situation is that our president is widely believed to have significant health challenges of his own!

Why is there such a lack of any popular momentum around the National Health Bill? How can we be so indifferent to how our health system is managed.

Why is HEALTH not on the agenda in Nigerian politics?

Wednesday, 9 September 2009

………..WHO AFRO 59th session and a few more resolutions

by ndubuisi edeoga

Four resolutions aimed at scaling up action in areas deemed key to improving the health situation on the African continent were proposed at the 59th Session of the World Health Organization (WHO) Regional Committee for Africa which just ended Kigali, Rwanda, in attendance were African health ministers, with their official and unofficial retinue as usual. (if you have not been to should! If only to understand hpw far way we are in Nigeria to a decent standard of living)

Nigeria and many other African countries seem to have given up on the MDG goals, you can read more here:

In some Nigerian states the MDG is a source of contention as exemplified by this statement from one of our dailies (quote)

“The Governor of Niger State, Dr. Muazu Babangida Aliyu, visibly worried by the grim reality evident in his state, ordered the probe of all the contracts awarded under the MDGs in the state since 2006. According to him, inspite of the huge sum totaling N3.7bn “claimed to have been spent” by the Federal Government on MDGs- related projects in Niger state, “there was nothing on ground to show that such amount was committed to development projects in the state”.

Some of the new resolution sound and look good on paper…….. as always:

1.Tackling drug resistance related to AIDS, tuberculosis (TB) and malaria;

The resolution on drug resistance related to AIDS, TB and malaria urged countries to establish drug resistance and drug efficacy monitoring systems; strengthen procurement and management of HIV/AIDS, TB and malaria supplies; and develop and implement policies and strategies to improve diagnosis and effective early treatment.

2.Strengthening outbreak preparedness and response in the context of the current influenza pandemic.

Regarding the current influenza A (H1N1) pandemic, the meeting urged countries to: ensure the highest level of government support in addressing the threat; strengthen national capacity for influenza diagnosis, and of health services to reduce transmission; periodically update preparedness and response plans; implement communication strategies that regularly provide updated information; and contribute regularly to the African Health Emergency Fund.

3.Policy orientation on the establishment of centers of excellence for disease surveillance, public health laboratories, food and medicines regulation.

To boost national capacities for effective and comprehensive disease surveillance and response, laboratory investigation and food and medicines regulation, the meeting urged countries to conduct an assessment of existing infrastructure and human capacity to determine their state of preparedness to set up centers of excellence; develop a national policy frame-work on centers of excellence; sensitize relevant national departments and ministries to the need to create centers of excellence and secure multiple funding for centers of excellence to guarantee their sustained performance.

4.Accelerating progress towards malaria elimination in the African region.

On prospects for malaria elimination in the region, the meeting adopted a resolution calling on member-states to integrate malaria control in their national development plans and poverty reduction strategies; support ongoing research and development initiatives; strengthen national health information systems, and invest more in health promotion, community education and participation.

To these I say yes we can especially the part about community education and participation.

My prescription:

Let the 60th session next year be spent on evaluating which of the resolutions in 2009 are implemented in our countries. Let the Ministers go back home and tell the peopel what they have resolved to do and ask that the people hold them accountable if they do no deliver on their words.

Nigerians...note the resoolutions. Hold your Government accountable for their delivery!

Enough of meetings and resolutions…enough…..Lets start implementing!!

Monday, 7 September 2009

Doping, MRI and our sports

(apologies for typos in previous post...pressed send too early!)

I love sports...even if I am not great at any myself. I love sports in the Nigerian context because it is the closest to a meritocracy most of us will get to experience living in Nigeria. I woke up on Sunday morning to the Nigerian papers and as usual our leaders never fail to disappoint you...The Guardian reported that "The President, Alhaji Umaru Musa Yar' Adua has handed a 'presidential order' to players and officials of the Super Eagles to go all out and secure victory against Tunisia in today's 2010 World Cup qualifier in Abuja." To the President, victory in today's game is non-negotiable.

I though about the scandals in our sport in the last few weeks. How we were learning to cut corners to win despite the scrutiny to athletes these days. When last has our country of 150 million won a medal at a major sporting event? It has been a while. You see…you can bring Julius Berger to build you the best stadium in West Africa...but just like hospital buildings don’t treat patients...stadia do not produce good athletes.
I though about the scandals in our sport in the last few weeks. How we were learning to cut corners to win despite the scrutiny to athletes these days. When last has our country of 150 million won a medal at a major sporting event? It  has been a while. You see…you can bring Julius Berger to build you the best stadium in West Africa...but just like hospital buildings don’t treat patients...stadia do not produce good athletes.
Just a few weeks ago too, our youth team was exposed. Medical tests showed that they could not be anywhere close to the ages they were claiming. Well...this was not really news to any Nigerian. We have long known what the truth as many of us went to the same primary and secondary schools as our Under 17 "heroes"....but who would stick out his neck?  Doing so would be seen as terrible. We have come to accept the unacceptable. So yes I do love sports. Despite the doping and the is still the closes to a meritocracy we will experience in our country.

And what happened to the president’s order to the "Super" Eagles....well what do you think? The chances are that the World Cup in South Africa may well happen with out us. But maybe we should make the point to FIFA. If one of every fifth African is really Nigerian....maybe we should have an automatic place?

A few years ago, we could no detect who was doping their way to success or cheating their ways to under aged championships...but now that we have found a way, meritocracy rules again!

Friday, 4 September 2009

Contradictions of Abuja III

In 2008 ...the erstwhile Minister of our Federal Capital announced with great fanfare that smoking was banned in Abuja! Thisday declared that the is a master stroke that signifies a new dawn for the city's public health. Just before that...there was fanfare in the press as it was reported that the Nigerian government was suing three international tobacco firms for $44bn (£22bn) - the first such case in the developing thought...our government is waking up to taking its public health responsibilities seriously! The billboards still stand tall in strategic locations.

So the other day ...when PHCN had dome the usual, we had run out of diesel and the inverter was not charged as we had not had power for days...I left the house to search for a bar to watch the midweek chamions league game between Arsenal and Celtic.

Was I surprised that not in a single bar did anyone pay attention to the so called smoking ban...of course not!

Was I surprised that Arsenal cruised to an other conmfortable win.......of course not!

Most inportant is that we have a billboard a large billboard, quite impressive for our visitiors when the come down "Bill Clinton" from the is reassuring to note that smoking is still least on-paper.


Wednesday, 2 September 2009

The contradictions of Abuja II

Its interesting driving around Abuja....our beloved capital city. You see refuse disposal trucks with smartly dressed young men emptying the bins....impressive.

Then you drive around in Fashola's Lagos...and you see the street sweepers...making sure no piece of rubbish is left on any road. this lady on the middle of Third Mainland Bridge...yes really!

What you will not see are these scenes in Onitsha, Aba, Kano, etc....the other face of our country. In states without the attention Abuja gets and without inspirational leaders as Fashola.

Photo credit WIEF

But maybe ...just Lagos was turned around...maybe one day Aba will ...and Onitsha will see the opportunities at their doorsteps and become the model clean cities they can so easily become.