Wednesday, 21 October 2009

An interview with the Minister and our comments

Many would have missed this interview with our Minister of Health as it appeared in the SPORTS section of The Guardian.

Healthcare: Our Steps So Far, By Minister

The interview is By Chukwumah Muanya - the Health Correspondent for the Guardian. We offer a few opinions on various parts of the interview to highlight issues we think are inmportant for the Honourable Minister and his constituency:  you and I. Our commments are in bold script.

In recent times, the Federal Ministry of Health has received severe knocks on the sector's performance within the last 49 years. Minister of Health, Prof. Babatunde Osotimehin, who assumed office in January 2009, in this interview with CHUKWUMA MUANYA spoke on efforts to revitalize the country's health system, and what he has been able to achieve in the last nine months. Excerpts:

Strengthening of the national health system

The Federal Ministry of Health's vision is to reduce morbidity and mortality due to communicable diseases with a view to ensuring that this is reduced to the barest minimum, having minimal prevalence of non-communicable diseases, meet global targets on the elimination and eradication of diseases and significantly increase the life expectancy and quality of life of Nigerians.

In order to deliver on the above mandate, the Ministry therefore set out at the beginning of the year to develop and implement policies and programmes as well as undertake other necessary actions that will strengthen the National Health System to be able to deliver effective, efficient, quality and affordable health services, foster improved health status of Nigerians, serve as the engine for pursuit of accelerated economic growth and sustained development.

Achievements, nine months after appointment

Vide the advocacy of the Ministry the National Health Bill was passed by the National Assembly in the course of the year. It is expected to receive Presidential assent very soon. The Bill contains several landmark details with very important implications that will transform the entire national health system of the country. This includes the following: A provision for the allocation of two per cent of the nation's Gross Domestic Product (GDP) to the health of the country; and Establishment of the National Tertiary Hospitals' Commission.  

Sir, Please at every FEC every Tuesday please BEG Mr President to sign this Bill. No systematic progress can be made in the organisation of our health care provision until this bill is signed into law. We will like to believe that Mr President is spending his evenings reading the details of the Bill...but after the years it spent at the House of Representatives and Senate, including associated retreats - all we can say is pls BEG Mr President to sign the Bill Sir.....

The Ministry has delivered on its mandate of coordinating the entire health sector such that the various constituent units are now better placed to carry out their functions and responsibilities to deliver healthcare to the people. In the course of the year, the Ministry has facilitated and achieved better coordination. Among others, a meeting of the National Council on Health was convened and held in Kano bringing together all stakeholders in the national health system most important of which are the 36 States of the Federation and the Federal Capital Territory (FCT) administration. In the course of the meeting, several far reaching decisions and resolutions were taken for the benefit of the health sector.
Sir, kindly share these far reaching decisions and resolutions, with us; the people. Afterall these reaching decisions and resolutions must be in our own best interests...or?
The Ministry also provided leadership for the States when we received Bill Gates in Nigeria. This led to the signing of the Abuja Declaration by the State Governors. The far reaching commitments contained therein along with follow up actions by State Governors have crystallized into tangible achievements for the polio campaign and primary healthcare among others.

Sir, like you, we were proud to see the great man on our soil, but pray sir, what are the tangible achievements this visit has "crystallized" to? Please share.
In line with the premium placed by this administration on primary healthcare, the National Primary HealthCare Development Agency (NPHCDA) has been repositioned to institutionalize and strengthen the primary healthcare system to enable the citizenry take advantage of the benefits that comes with it.
The implementation of the Midwives Service Scheme initiative has commenced most creditably. The scheme is borne out of the paucity and inequitable distribution of health professionals in the country. Thus, the plan is to recruit 5,000 Nurses/Midwives for posting to every local government in the country in order to reduce infant and maternal mortality. Further to advertisements and interviews of the applicants, about 2,580 Midwives are presently being deployed to primary health care facilities in all the 36 States of the Federation and the Federal Capital Territory

On polio eradication efforts

Nigeria's Polio eradication programme has achieved great strides in the last one year, the effect of which indicates that we are on the path towards the eradication of Polio in Nigeria. The Expert Review Committee on Immunization in Nigeria recently concluded a review of Nigeria's Polio Eradication programme. The team noted that there is a decline in the number of Nigerian children being paralyzed by polio and that this is as a result of the progressively increasing number of children being vaccinated countrywide. The experts concluded that if the improvements being achieved are sustained and expanded, Nigeria can stop transmission of all polioviruses by mid 2010.

Sir, here we have to agree with you. After years of inept leadership based on family ties, we finally have an agency on the verge of meeting its mandate to the Nigerian people - Sir - see what leadership does! But Sir if I were you...I would avoid predictions - 2010 is next year oh! But we hope you are right. We are tied of having to defend our position in the world regarding Polio...
Free malaria treatment for all Nigerians

On assumption of duty, I established a Special Task Force under my direct supervision to look after the issues of AIDS, Tuberculosis and Malaria. This is to enable the proper coordination of the national response to the diseases. This is the vehicle with which the Ministry has been moving towards achieving its Roll Back Malaria objectives of 50 per cent reduction in malaria cases and related deaths by the year 2010.

There has been a phenomenal increase in political, religious and technical assistance and commitment towards the control of malaria as a result of high level advocacy by government. For example, the country received the United Nations Special Envoy on Malaria twice in the last one year (Dec 4-5, 2008 and March 20-22 2009).

In April, 2009, the Sultan of Sokoto and the President of the Christian Association of Nigeria led the establishment and launch of the Nigeria Inter-Faith Action Association (NIFAA) in Washington, with the objective of integrating religious institutions to serve as important instrument and advocates for achieving universal access to commodities and treatment. The body brings together the leadership of the two major faiths in Nigeria to partner with RBM on routine and campaign activities.

Going from the advocacy and mobilization described above, Nigeria was able to attract external financial and technical resources to combat the scourge of malaria from the Global Fund, World Bank, British Department for International Development (DFID), United States Agency for International Development (USAID) and the United Nations System among others.

The Year 2009 has witnessed the commencement of a massive deployment of Long Lasting Insecticide treated Nets in the country in a coordinated manner. As at now and in line with plans and schedule, 6.2m Nets have been distributed. An additional 16m Nets will be distributed before the end of the year following a plan to distribute up to 62.5m of the Nets by December 2010.

With the active encouragement and strategic plan of the Government, a local manufacturer has installed in-country, capacity for the production of Long Lasting Insecticide treated Nets is expected to be commissioned in September, 2009. Two more installations are in the pipeline.

Massive roll out of Artemisinin-Based Combination Therapy (ACTs) for effective treatment. 32 million treatment courses have so far been distributed free of charge in public health facilities. Artemisia Annua, is also being cultivated on a large scale in the country and will provide one of the major raw materials needed for the production of ACTs.
As an ordinary Nigeria,  all that matters to me really Sir is an assurance from you Sir that if I walk to the Primary Health Care Centre in  Amaigbo, Nwangele Local Government Area in Imo State with my sick child, that he will be treated with ACTs, and that on discharge, I will be given a  insecticide treated  bed net to prevent future episodes. Sir, can you assure me that that is the case and I no longer have to go to the village chemist to mix my medicines? 

Treatment for Persons Living With HIV/AIDS (PLWHA)

Nigeria's response to HIV/AIDS has continued to improve in all major facets. Awareness continues to increase, prevention messages continues to grow and the personal risk perception of the individual Nigerian is on the rise. Notably, free treatment is now provided for over 60% of those in need of it.

National Strategic Health Development Plan

The Plan is at an advanced stage and it is going on according to plan. It will be completed and finalized by the end of this year 2009.

Circular on the new Medical Service Scale (MSS) salary package for doctors

The Government has approved the new Medical Service Scale in response to agitation by Medical Doctors, which has been on for 11 years. A similar package is being negotiated with other professionals in the health sector to ensure that the welfare of every worker in the entire health sector is adequately taken care of. It is expected that as soon as negotiations are completed, the package will be ready for implementation at the beginning of 2010.
Thank you Sir.  But you know it is not only money we want, although it might sound that way sometimes. We want you to take the management of our centres seriously. We want you to re-think the way our CMDs and Boards are appointed. We admit that many of us asked to manage large teaching hospitals have no clue about management, absolutely no clue. In fact many of us have not managed anything beyond our wives before we were given these huge budgets to manage. How will we manage? Sir, you do not blame us when we fail, when our hospital beds are emty, theatres not used and medicines not available. We need help Sir....

National Ambulance Services Scheme

The Scheme is to ensure that ambulances are available and working for the entire citizenry. The scheme is being operated under the leadership of the Federal Ministry of Health in conjunction with the Federal Road Safety Commission (FRSC), National Emergency Management Agency (NEMA), The Nigeria Police, The National Security and Civil Defence Corps (NSCDC) and the Federal Fire Service among other very important stakeholders. The pilot phase of the Scheme, which is for accident victims in and around the Federal Capital territory was launched in July, 2009.

Sir - out of all the agencies you mention - who is actually providing the actual emergency MEDICAL services? NEMA? Sir, as you well know, an ambulance service is more than the ambulance. It cannot be a stand alone service. It can only work Sir, if integregrated in an emergency medical services programme involving accident and emergency services in specialist centres. There needs to be continuity of care from recieving the patient to recovery.  This service will only work if it is LED by medical services, not by FRSC.....even if they bought the ambulances.

On quality of services provided at Federal Hospitals

Improvement in the quality of the services provided at Federal Hospitals, which has been a source of concern to Nigerians, has received major attention of the government. In response to this concern, the government has invested massively towards providing state of the art equipments in the hospitals. We have thus commissioned various projects in the Federal Tertiary Institutions' Accident and Emergency Unit, National Orthopedic Hospital, Dala, Kano, National Ear Care, Kaduna and the Neuropsychiatric Hospital, Aro, Abeokuta.

Thank you Sir. Pls help us beg your colleagues in the Ministry of Power to help us with the electricity to run these equipment. Sir, also apart from the equipment - the quality we seek are the "small" things. To be attended to quickly, for the doctor to be courteous, not to be asked to pay for gloves. Sir, the small things matter to small people.

National Blood Transfusion Service

The government has established 12 operational national blood transfusion service centers to provide blood transfusion service to the people. Five other centers are at various stages of readiness. Notably also, the Government has gone ahead to provide linkages between the centers and 40 selected hospitals nationwide to provide blood cold storage systems

On emergency preparedness and response for swine flu- A(H1N1) Influenza- Cerebro Spinal Meningitis (CSM), Lassa fever, and cholera

The country recorded a number of epidemics in the course of the last one year notable among which are those of CSM, Lassa Fever, Measles and Cholera. The Federal Government ahead of the outbreak of the epidemics issued alerts to the health authorities of all States of the Federation and provided drugs and laboratory materials in order to minimize mortality resulting from the epidemics. In all 6 million doses of CSM vaccines and 500,000 doses of ceftriaxone and oily chloramphenicol were distributed to the 26 high risk States

In this regard also, the Federal Government carried out an assessment of all public health laboratories in the 36 States and FCT in addition to several advocacy and sensitization visits to endemic places. Specifically for CSM, the Ministry held a training and sensitization workshop on enhanced CSM preparedness and response for all the 26 CSM high risk States officials including Health Commissioners, Directors of Public Health, Epidemiologists, Public Health Lab focal persons, Clinicians and WHO surveillance officers. Follow up actions included the Conduction of cases detection, verification and confirmation of CSM in addition to Supportive supervision for CSM vaccination campaign in the 26 high risk States.

The government inaugurated a Technical Working Group of the Lassa Fever Stakeholders Forum and went on to procure and distribute 300,000 and 100,000 doses of Ribavirin injection and tablets respectively for the treatment of Lassa fever patients.

With the advent of the A(H1N1) Influenza, the Federal Government quickly moved into action to inform the general public about the influenza in such a manner as to prevent the entry of the virus into the country. To do this, advertisements were placed in the electronic and print media to sensitize the public. In addition to this, information booklets, posters, fliers and pamphlets in various languages were also distributed far and wide in the country, including the airports and all the nation's borders. Special sensitization programmes were also embarked upon to bring the issues involved to the attention of relevant government officials at the nation's airports.

To prepare for any eventuality, the National Epidemic Preparedness Committee was inaugurated and sensitization meetings were held for all State Epidemiologists and desk officers to enable them respond appropriately if any case is discovered. 

Thank you Sir, our humble advice on this is well known. As in most other countries we need a center with the expertise to respond to any infectious disease threat. Neither committees, nor task forces can save us if we do get a major epidemic....Sir please advise them at FEC - that infectious disease do not observe protocols. They too are at risk!

We hope that by asking these questions, the Ministry of Health will continue refining its policies. We are not in doubt that  Professor Osotimehin has a massive challenge but also a great opportunity to bring health closer to the Nigerian people. We understand the difficult context in which he works. We wish him well.

Saturday, 17 October 2009

Bitter sweet weekend....

Yesterday evening I celebrated with most other Africans as Ghana won the U21 FIFA world cup. After several attempts this was the first time an African country was winning the cup. It just takes walking around any African country to understand what football means to us. But despite the joy, I went to bed reminiscing at my disappointment that Nigeria was eliminated early in the tournament and had previously been embroiled in the usual controversy around their ages. What an evening it would have been if it was "us"....I celebrate and envy Ghanaians. They have a functioning democracy, their economy is booming, they are respected in international politics..and now they are winning world cups. Bitter / sweet.

This morning I finally get to the piles of the journals I subscribe to for some speed reading. Then staring at me on top of the pile is this cover page..... The whole edition was dedicated to the progress being made in South Africa.

We are told the President Zuma has 5 priorities (unlike our 7-Point agenda). Health is not hidden in a tertiary category but firmly as one of the major 5. One of his campaign promises is not to build more health centres or CT scanners but to close South Africa's health gaps.

His South African Minister of Health acknowledged to Lancet that the new government will have a transparent, confident and science based approach, breaking cleanly from Thabo Mbeki's legacy. South Africa spends more on health both in absolute and relative terms than any other African country - 8.7% of its GDP. In its editorial The Lancet concludes that South Africa is a yound democracy with pride and hope, and above all with high expectations for a fair, equitable and peaceful society. Many of the articles in this special edition of the Lancet on Health in South Africa are available for free on the website of The Lancet. (will require registration).

What do these two stories have in common? Well  to find out - visit the major hotels from Johannesburg through Capetown to Accra over the Christmas period in the next few months. You will find them full of Nigerians that can afford to travel. Seeking new solace in a pan African vision, with the demise of a Nigerian vision. Last weekend I was speaking to a colleague, a surgeon whose group has been collaborating with 2 major Hospitals in Ghana for years....he had tried for years to get something started in Nigeria, but finally gave up.

Yet if we want others to take us seriously, we have to take ourselves and our reality seriously. We all need to re-engage with the political process in the 2011 elections, and ask specifically what this government (at national, state and LGA levels has done with its mandate) in the health sector. If we want to take pride in events in our country and attention paid to it by preeminent journals in the world, and attract attention to a functioning country - we will all have to re-engage.



Wednesday, 14 October 2009

Stories from the ANPA convention in Abuja...

You might have heard that the ASSOCIATION OF NIGERIAN PHYSICIANS IN THE AMERICAS (ANPA) held its annual conference for the first time ever in Abuja Nigeria, this year. This was done in collaboration with the MEDICAL ASSOCIATION OF NIGERIAN SPECIALISTS AND GENERAL PRACTITIONERS (MANSAG) in the UK and the NIGERIAN MEDICAL ASSOCIATION.

The symbolism of this is huge. DESPITE our government's perennial inability to figure out how to tap into one of its biggest resources - the human capital outside the country, Nigerians continue to insist on contributing to the development of their country. As we were not able to attend this conference ourselves - we will bring you a collection of accounts from various aspects and various points of view from this conference. In all these reports - you will find a common theme. You will read from, and about Nigerians that have chosen not to sit back and focus on their private lives, raising their children, playing golf and arguing about football. You will read about Nigerians that continue to give up their spare time and resources seeking ways to contribute...not because of their government's invitation but despite their government's indifference.

This is one account - on an issue we rarely consider in health care - management.

by Enoma Alade

The health care situation in Nigeria is recognized by many as facing challenging times. By many indicators e.g. immunization, mortality rates, it is actually worse today than it was in the 1980s. Several diaspora physicians have recently responded to the call to help improve the health care system by building new hospitals - several of which have been commented on in earlier blogs. However, for every successful diaspora health venture (we applaud Dr Johnson's recent successes on the cardiac front), there are quite a few unsuccessful ventures which have resulted in a waste of resources.  

At the recently held Association of Nigerian Physicians in the Americas (ANPA) Annual convention in Abuja; Anadach Consulting Group organized a workshop that addressed Key Drivers and Challenges to consider in setting up a successful healthcare business in Nigeria and other emerging markets.  The panelists included physician management, legal and business experts from Nigeria and the US. Physicians and other medical professionals tend to focus on the clinical perspective and often underrate the managerial or administrative challenges required in ensuring a sustainable operational service is in place. It is refreshing to see that ANPA decided to address these perspectives at its first convention in Nigeria. 

Further information on the workshop and the presentations are available on here

Friday, 9 October 2009

Stella Obasanjo - Before we rejoice...

The media was agog a few weeks ago with reports that a plastic surgeon in Spain was convicted of negligence in the death of Nigeria's former first lady, and was given a suspended sentence of a year in jail...

Stella Obasanjo, wife of then President Olusegun Obasanjo, died Oct. 23, 2005, two days after undergoing liposuction on her abdomen and other parts of her body at a clinic in the southern Spanish town of Marbella. A court in Malaga convicted plastic surgeon Antonio Mena Molina of negligent homicide. (a criminal charge brought against people who, through criminal negligence, allow others to die.) Mena was also barred from practicing medicine for three years and ordered to pay euro120,000 ($175,000) in damages to the former first ladies son. The judge said Mena Molina had shown "carelessness and neglect."

The medical profession prides itself across the world for self regulation in the first instance. The case described above that has gone through the legal system is an extreme example. Another recent case in the UK that is leading to fundamental changes in how out-of-ours care is provided is the story of  a "German" doctor Dr Daniel Ubani who is reported to have given a patient 10 times too much painkiller while working for a Cambridgeshire health trust, as a locum out-of-hours general practitioner. It might have been a mistake - but he is paying a huge price, has a suspended sentence over his neck and almost irreparable loss of reputation. Many people think he got off lightly.

So what would be the consequences of medical malpractice in Nigeria?

Zilch... nothing. Many colleagues get away with murder.

We acknowledge the valiant work of Dr Shima Gyoh, during his time as Chairman, Medical and Dental Council of Nigeria. Dr Gyoh tried to get the MDCN to make the doctors and dentists self regulate thier profession. We watched sessions on Network news where colleagues were brought to face up to their responibilities of accountability. We saw  the Registrar of MDCN; Dr. C. O. Ezeani, compulsorily retired. The MDCN needs to be supported and strenghthened. Meet the council members here.

But...not anymore.

You must have read about the murder of Bayo Ayanlola Ohu, who until his death was the  Assistant News Editor, Guardian Newspapers. What you might not have read is that Bayo was rushed to the family's hospital located within the Akowonjo area in Lagos but was rejected and no treatment could be administered to him due to the apparent non-provision of a police report. (for non Nigerian readers - this refers to a report to say that the gunshot victim is himself not a robber!!!) The requirement for a police report before treatment is not part of the Nigerian constitution, and ofcourse breaks all our fundamental human rights. Even the Nigerian Police despite its legendary apathy has severally gone public to declare that this does not exist.

BUT THAT HOSPITAL REMAINS OPEN. You will not hear a whisper from the MDCN, nor from the Nigerian Medical Association. We all coil around in silence and pretend we are different. We are not. We are ALL guilty.

Even if there is such a ridiculous directive in place can our profession not stand up and say NO? Can we not inistst that we are bound by the vows we all make on graduation. By not treating a sick man in front of him, is this colleague not  guilty negligent homicide. For the rest of us that have taken similar vows, yet keep quiet in the wake of this incident, are we not all complicit in NEGLIGENT HOMICIDE?....

Well...we live in a country where there are no consequences for the paths of dishonour we chose.....sadly therefore,  no incentive to chose a path of intergrity....

Sunday, 4 October 2009

Nigeria's cancer advocate on CNN

CNN has a new programme; AFRICAN VOICES that highlights the activities of amazing people from our continent. Many great interviews every Saturday with our heroes...the real heroes that we as Africans hear very little about; Trevor Ncube a Zimbabwean is one of southern Africa's most powerful publishers, Leslie Lumeh; the 39-year-old Liberian artist  exiled during the country's civil war, but who returned after the conflict to open a gallery, and the Moroccan Malika Zarra that has taken her mezzo-soprano voice across the world.

I was intrigued when I recieved the email advertising this week's programme....
Nigerian princess Nikky Onyeri has takes the issues of health in Africa After being wrongly diagnosed with breast cancer, she founded the Princess Nikky Breast Cancer Foundation to improve detection and treatment.

...and what a programme it it here on CNN

We were treated to an engaging interview to an "ordinary" Nigerian, telling the story of how she found her calling. She was misdiagnosed with breast cancer and was thrown into the complex world of understanding cancer.

Breast cancer is one of those few cancers for which a significant proportion can be prevented. But this prevention can only happen with a complex of factors relating to the individuals' awareness and proactivity in self examining, the availability of screening programmes (as opposed to screening machines) and the availability of the expert health care provision to provide care including surgery. was even more intruiging to listen to her work being described as;

"Profoundly effective"

"Her tenacity is legendary"

....but most intriguing was the story of how she brought together all African First Ladies to a meeting in Cape Town South Africa to help put breast cancer on the agenda....There were clips of an articulate Mrs Museveni saying...."You cannot say "NO" to her" 

 ....are you thinking what I am thinking?  If CNN could find this lone voice from our country to give a voice to this problem., why has our first Lady and her minders not worked with her in their planning of their  £40M Cancer Centre in Abuja

Breast cancer, like other cancers are complex health challenges. Rather than another multi million dollar centre, we really need to the thinking that will help provide a system.....from prevention to early detection by screening to referral systems to surgical services to radio and chemotherapy to palliative care....across primary, secondary and tertiary care, with equitable access to women from Maiduguri to Yenogoa.

NOT POSSIBLE? - that is the same thing NITEL told us 10 years ago! Remember?

This is Princess Onyeri's message.....hopefully someone will listen.

Thursday, 1 October 2009

Their Nigeria.....

Today is October 1. Our country is 49.

It would be easy for us to do a post about how bad things have become after 49 years. To write about how our collective dreams have remained just that; in even the short lives that my generation of Nigerians have lived, we have seen our country regress so much. It would be easy for us to write yet another blog on the cholera outbreaks reported this week in Adamawa, cholera!!!!. Easy to write about our ongoing challenges with polio.It would be too easy for us to moan about the state of our hospitals and Obasanjo's MRIs in a country dark without electricity, whose leaders jet out for the slightest ailment. We could write about our "teaching" hospitals, the accidents on our roads, the children in our neonatal units.

But let us reflect on the next generation and on the legacy we wish to bequeath to them. What will our answer be when they ask; but Daddy...what did you do? 

...what are You doing?

Happy Independence Day!