Thursday, 26 November 2009

What do we have in common with Zimbabwe?

In common with Zimbabwe, Nigeria has the ability to generate outbreaks of poverty related disease like cholera. The difference with Zimbabwe however is that while they can justtify outbreaks of cholera as consequent on the broader context, we really do not have anything to blame it on in Nigeria! We are a rich country! We are!

We had chosen over the past weeks not to blog on the outbreak of Cholera in Northeastern Nigeria. But when we read statements like this:
Health Commissioner of Borno State Zubairu Maina said.... the government had deployed medical personnel to all the affected areas, and blamed the spread of the disease on poor hygiene and drinking of contaminated water.
...we are obliged to highlight the ineptitude of our colleagues running the affairs in the Ministries of Health in several states in the country.

Pray - why would people drink contaminated water? Because the government elected by the people have failed to provide the simplest of commodities - water.

Cholera is not a disease anyone hould be getting in October 2009..definitely not in Nigeria. To understand the absurdity of this; the last major outbreak of cholera in the United States occurred in 1910-1911! If we want to pursue grand dreams such as becoming one of the 20 largest economies by the year 2020...maybe we should start with some of the apparently small steps such as preventing cholera!


Maybe until we take care of the simplest thiings in life - water, electricity, primary school, malaria treatment NTA will do well to spare us the jingles of 20 2020!

Monday, 23 November 2009

League Table for Health Outcomes - waking up our governors

In case you missed it an important event took place in Abuja early this month.

The Minister of Health, Prof. Babatunde Osotimehin, called a Presidential Summit with all our State Governors around the the theme;

"ACCEPTING COLLECTIVE RESPONSIBILITY FOR IMPROVING OUR HEALTH"

This is not a coincidental title! The general perception is that apart from a few exceptions, most State Governors in Nigeria have abdicated their responsibility for the health of their people. Also with most people worried about electricity, roads and other basic requirements for a decent life, not a lot of political pressure is brought to bear on our state governments around the state of our health. This is the reason why the Governor of Adamawa State is bringing in our friends from Germany to build a state-of-the-art hospital while health workers were on strike for most of the year and the state was ravaged outbreaks of cholera...(yes..really!).


The summit was timely and in a technical meeting that preceded the meeting the Minister made a most critical assessment of the situation when he said:



"....the  state of the health system is  unacceptable, and incapable of delivering general health care services to 140 million Nigerians"


Then our Minister of Health, led a delegation including his Minister of State and the Directors of all the parastatals and key officers in the Ministry  to the National Economic Council meeting. This is a meeting including all the Governors and chaired by our Vice President.


The Vice President chaired the meeting and our governors were shown part of a documentary on the health situation in Nigeria (you will be surprised how little they would know and see riding around in their convoys of bullet proof jeeps). Our governors were shown a presentation on the health situation in Nigeria - and about the planning process underway to address Nigeria 's health situation. Every Governor was given a summary of the proceedings around the new national strategic framework that they have been working on AND most politically powerful, they received  league tables ... ranking states... in their performance on health indicators from the recent DHS...powerful! The data they received is official and culled from the 2008 Demographic Health Survey which the National Population Commission will be disseminating publicly on the 23rd of November here in Abuja.


We gather that there was a discussion between the Governors and the Minister and our Governors all praised the Minister.  They acknowledged his passion and drive, and the way in which states had been brought into the planning process.  But when it came to putting their money where their mouths are - i.e the declaration of commitment was for Governors to sign up to incrementally increase their health budgets toward 15%....they bickered and came up with ingenious excuses.


The responsibility for the provision of health for our people is lies mostly in the hands of our state governors. Whether any of them will see health as a priority remains to be seen.  Building hospitals will not be enough for our health, even if it is enough for the egos of our governors.

But they our our governors! In a federal state like ours...there is no greater power in the polity to affect the lives of our people as in the hands of our governors. This power can be used as is it is being done in Lagos State...or in contrast as in Abia State.



Sunday, 22 November 2009

Bring Back the Dispensaries !!

by ndubuisis edeoga

Growing up in rural Nigeria, I remember one incident vividly, because I still have the scars. My parents were away, and I was home with my two older brothers and one or two relatives that lived with us. During a scuffle very early one morning, apparently my two brothers wanted to skip their chores and go to school and the older relative would not take that, she said "no chore no food", well my parents were away and my two older brothers wanted to assert some authority. The struggle was over a flask of hot water for the tea, I was the happy onlooker, well the flask broke and guess who had the hot water all over his abdomen; me of course.

That was in days before we all had cell phone (sometimes I sit and wonder how we had survived without cell phone). To cut a long story short my eldest brother put me on his bicycle, and was sprinting away as fast as he could go, with my other brother running after us, I guess the trip to the dispensary which was about 3-5miles away, took forever, I was screaming in pain all the way to the dispensary.

The dispenser was so kind he took very good care of me, I guess I has second degree burns, no fees were charged, no forms were obtained, I JUST GOT GOOD HEALTH CARE ! when I grew up I realized the dispenser was not even a doctor, but who cares when he was the best doctor I ever had.

Repeat the scenario today and you would end up in one of the several private hospitals abound in rural areas, where you would have to get a form, pay some money upfront before you get any care, that is if you do get any care before you die. What would my brothers have done, they had no money.

In the newspapers yesterday I saw a very sad story Again; "CHOLERA CLAIMS 73 IN BORNO, TARABA", the story goes on to tell give us some reasons for these deaths "He alleged that medical officers posted to the camp had refused to attend to patients, because their allowances were not paid. He said, besides that, the camp lacks drugs, beds. LACKS BEDS and DRUGS!! .

ON the next page of the same newspaper I saw this other story "FG MOVES TO END OVERSEAS MEDICAL TREATMENT" The story went ahead to tell us about the efforts to "provide one of the best facilities in dialysis, radiology, dental laboratory, theaters, mortuary and such other her facilities that will make the a difference". The MORTUARY part I completely agree with for very obvious reasons.

We are putting the horse before the cart, we need the basics while we attempt to get the greatest and biggest,

I too would like to have a hospital as good as the Havard medical center or the Cleveland Hospital in my village, who wouldn't. But what we need most are the small things.... the dispensaries and the dispensers.

More Nigerians die from diarrhea, malaria, and pneumonia than from ALL the diseases needing an MRI to diagnose put together....i.e.

IF WE HAD FUNCTIONAL CT SCANNER AND MRI IN EVERY VILLAGE IN NIGERIA....WITH A GENERATOR TO GO.....WE WOULD STILL HAVE THE SAME NUMBER OF NIGERIANS DIEING ...go figure!

Friday, 20 November 2009

The Ibadan Medical Specialists Group

A few weekends ago...we attended the biannual Fund Raising dinner of the Ibadan Medical Specialists Group in London. I must admit - I have heard a lot about this aumni group of Nigeria's oldest medical school. IMSG is a group of medical graduates from the University of Ibadan, based in England but with members from across the world.

I first met Lanre Ogunyemi a few years ago and he proudly told me about how the group had engaged with the Ibadan for years, donating a laptop, projector and photocopier to college every year, providing theatre outfits for medical students, subscriptions for medical journals for the Latunde Odekwu Library, travel fellowships for registrars and consultants and endowments for medical students....I really thought to myself that he was bluffing. We (Nigerians) love coming together to celebrate our alma Mata but to engage to this extent in its development was really unique.

Then a couple of years ago...I met another colleague; Jimi Coker. I invited Jimi to a private function but he gave his apologies saying that he was going for the most important trip of the several training missions he undertook every year. He was going "home" to Ibadan with a group of other Alumni for their annual symposium for medical students at the University of Ibadan! Kai...I thought...these guys are serious oh!

So when they invited me to their annual fund raising dinner this year...I jumped at it.


The dinner was great, full of inspiration and commitment. Well attended by colleagues, all full of energy and nostalgia about their "Ibadan".

But these guys were not done. I was handed a copy of a book publised by the group for the school. They re planning more. I got back home and sat down and imagined the enegy it takes to do all this and wondered what keeps these guys going? Why do they do it? How do they find the time? How do they find the energy?

Since then, I have also been in touch with colleagues from the University of Ife. I found that they also have a group of medical graduates in the UK who started meeting formally in 2004 and has been growing...find out more here http://www.ifemedalumni.co.uk/

So what of the rest of us..."Lions" as we tend to call ourselves, graduates of the University of Nigeria or all of the over 20 medical schools in Nigeria.

What of the over 3000 Nigerian Doctors with full registration to practise in the UK? How are you engaging with your alma Mata. And colleagues in the US...and colleagues in Nigeria.

I have learnt a lot from Lanre and Jimi....that it does not take a lot really. It only takes a small group of thoughtful, committed citizens to change the world. Indeed, it is the only thing that ever has....aluta!





Friday, 13 November 2009

Nigerians - walking the walk


Its the beginning of a weekend so lets clebrate some of our own...

Chima Onoka has recently been appointed as the Country Representative in Nigeria for the IHP+Results team. IHP+Results provides an annual independent monitoring and evaluation review of the International Health Partnership (IHP+). This process of monitoring and evaluation was mandated by the IHP+ Global Compact and the subsequent high-level Ministerial Review in February 2009.  Chima says that this is an exciting time in Nigeria and the work could not have come at a better time as there is currently significant progress underway here to develop state and federal health plans, which together will be compiled to form a National Strategic Health Development Plan. This is all in line with Nigeria’s overall Development Plan (known here as 20 by 2020). This week bilateral and multilateral partners, including the IHP+ Global Compact signatories, are working on this together. In fact, a substantial IHP+ Harmonisation for Health (HHA) international team are here in Nigeria to support this whole process, including costing and a framework for monitoring and evaluation.
Find details here...


This year's John D. and Catherine T. MacArthur Foundation's genius grants awards included two well-known names in oncology: One of them is our own Olufunmilayo Funmi Olopade, MD, Professor of Medicine and Human Genetics and Director of the Center For Clinical Cancer Genetics at the University of Chicago Medical Center-whose research on individual and population cancer susceptibility has been translated into effective clinical practice for treating breast cancer among African and African-American women. Olopade is working to close the knowledge gap in several ways, including teaching pathologists and residents at Nigeria’s University of Ibadan, where she received her bachelor’s and medical degrees, how to properly screen for breast cancer. She’s also working with government and drug companies to get treatments to Africans. Finally, she’s sharing the results from the study, funded by the Breast Cancer Research Foundation and the National Women’s Cancer Research Alliance, with her peers worldwide, including at the Fifth International Conference on Cancer in Africa this November in Sénégal. Find details here...





Afam Onyema went to Stanford Law School intending to go the Big Law route. He summered at Kirkland & Ellis and got an offer from the firm. But by the time he entered his third year in 2006, Onyema's plans had changed. He turned down the K&E offer and one from Paul, Hastings, Janofsky & Walker. Instead, he decided to open a hospital in Nigeria. In doing so, he was fulfilling his father's dream. Onyema's parents had moved from Nigeria to Chicago in 1974 so that his father, an obstetrician and gynecologist, could complete his residency at Cook County Hospital. His mother, a nurse, also finished her training in the United States.  Find details here...



......the most we can do in "re-branding" our country is to highlight the great work of its people. One day we hope to also be celebrating the success of Nigerian institutions....




Wednesday, 11 November 2009

Are waiting times over at our public hospitals?


There are many problems that one can solve with money. There are many that money cannot solve. One example is the time it takes to be seen by a doctor in any of our public hospitals. We have mentioned this in several blog posts in the past. In any public hospital in our country - the first patient for the day is normally seen by a doctor from 11 am. In all my time as a houseman and registrar in Nigeria - I cannot remember a consultant that started his clinic before 10am. ....as my colleagues would say "na so we deh do am for Naija"

...so I was quite excited to read a recent article in The Guardian of a new policy whose goal is that in the next one year.Have you heard about SERVICOM? If not read on.....
... the Federal Ministry of Health in partnership with Servicom office gathered all the chief medical directors of university teaching hospitals, specialist hospitals and the medical directors of Federal Medical Centres in Abuja to brainstorm on how to roll out a pilot programme aimed at reducing patients' waiting time at the General Out Patient Department (GOPD) of hospitals in the country developed by the Servicom office. The pilot implemented at the Federal Medical Centre, Keffi by the Servicom office reduced waiting time at the GOPD from seven hours to 30 minutes.

Read a full account here.

Wow...so we can do these things? ....We will congratulate our Honourable Minister of Health on this and we will watch the progress of the policy. We hope that it will be extended beyond the General Out Patient Departments to the specialist clinics where the consultants reign...What a difference this would make! What a difference....

The fact is that in the context of the options for quality health care, the best specialists are still found in our teaching hospitals. The primary reason people choose not to go to these places is because they are managed like everything else in our public sector...nobody cares about the "client" or "patient" in our case. You are made to wait for hours....walk around from laboratory, that can only do half of the required tests, to pharmacists that can only provide a third of the required drugs. To be admitted you have to buy your bedsheets, kerosene lamp, mosquito net, food, drinks, gloves for doctor, syringes for nurse etc etc (please I am not exaggerating!)....If you really want to know how bad things are try taking the body of a loved one to the mortuary of any of our teaching hospitals......

These things have nothing to do with the actual delivery of health care.  Nothing. They are the reason NITEL failed, the reason NEP plc is the way it is, the reason why Nigeria Airways is extinct, the reason why Sam Mbakwe "airport" in Owerri is the way it is, the reason why it takes 4 hours to get past Ore, the reason why public our Univerities were closed for 4 months, the reason why to renew our passports at Nothunberland avenue in London takes a full day plus....it is not rocket science - its our public sector!

How do we fix it? Servicom is a good idea....

Servicom a social contract between the Federal government of Nigeria and its people. Servicom gives Nigerians the right to demand good service. Details of these rights are contained in Servicom charters which are now available in all government agencies where services are provided to the public. The charters tell the public what to expect and what to do if the service fails or falls short of their expectation.


Let us support the strengthening of Servicom. It will only work if we work with them. Its a challenge for us! Let us start with our hospitals. If they do not provide the service we expect ...do not accept it. Write about it. Send to everyone you know. Send it to Servicom through the contacts below..its your problem too! Its your public sector.

No 3, Usman Dan Fodio Crescent, Zone A4, opposite Banquet Hall, Presidential Villa

Asokoro, Abuja, P.M.B 622, Garki, Abuja
FCT, Nigeria

info@servenigeria.com

09-3140372, 08036591090, +234-9-3140373



....no patient would wait for more than an hour before seeing a doctor in any Federal Government owned hospitals across the country.

Sunday, 8 November 2009

The race to build our to good health continues...

Thisday reports that ...The Adamawa State Government, at the weekend signed an agreement with a German medical consortium for the construction of a N4 billion specialist hospital. The Governor of Adamawa State, said that when he was signing the contract with Munchner Medizin Mechanik (MMM German) group of companies for the delivery of a functional unit for diagnostic, operation and general medical purposes at the new Specialist Hospital, Yola, that he was committed to the hospital project as part of his administration’s determination towards the improvement of health care delivery in the state (Kai...I wished I was the one that brought in these guys!).

Anyways....we will be visiting Yola soon to bring you update you on progress.

But here on Nigeria Health Watch we continue to insist that the problems will not be solved by importing German firms to build our way out of our health problems. We have good hospitals already - if only we will manage them well. If only we can get the systems to work for the people...to manage the "smallest" of problems...

The article below requires no further commentary. It basically says that mosqitoes have run over the University of Port Harcourt Teaching Hospitals....

Mosquitoes! Maybe we need some German companies to put up nets and insecticides! We rest our case...



Friday, 6 November 2009

Physiotherapists ask - what about us?


One issue we find with ourselves; Nigerians; is our huge sense of entitlement. It is all pervasive. We always want to be recognised. This is the same in our percieved national identity as the so-called "Giant of Africa" and in our individual love for titles ....Chief, Professor, Doctor, Architect, esq, JP, mni, etc etc etc ...we just cannot help ourselves.

This article in 234Next caught my eyes recently....

Physiotherapists ask government for better treatment

I naively thought that our physiotherapists were advocating for better treatment for their patients, for all the accident victims on our roads, for our stroke patients, and all the other challenges they face with the system...but no! That was really really naive of me....read what I found....


Nigerian physiotherapists have called on the government to give proper recognition to the practice in order to enhance the morale and output of practitioners. Speaking at the 50th anniversary of the Nigeria Society of Physiotherapy, on Thursday, in Lagos, its president, Adeoluwa Jaiyesimi, said physiotherapists in the country suffer discrimination.

Mr. Jaiyesimi faulted how senior officials in the health sector are appointed. "There are eight directors in the Federal Ministry of Health, and they are all headed by a medical doctor, except one," he said. "That's unfair. They are supposed to distribute the rest on a plurality basis."
I could not believe what I read...of all the health problems relevant for physiotherapists in Nigeria, the president of their organisation found the apparent lack of representation of the profession among the 8 directors in the Ministry of Health as the one thing to complain about! The most important thing...the "Single over- riding Communications Objective" of his speech.

Maybe I am really naive, but maybe we all have a problem. Where do we get this sense of entitlement from? On what is it based? On the concidence of our population size based on the arbitrary delineation of our borders by our colonial masters in Berlin, or based on the coincidental finding of oil in 1956 in Oloibiri in the Niger DeltaWhat ever it may be.....it is a problem....a big one.

The earlier we can loose this sense of entitlement for a sense of responsibility for the people....the sooner we will find the change we so desperately seek....Our personal and collective interests are important, and that is what unions are there to fight for, but there must be more for a professional society to advocate for durings its annual meeting.

Honestly...there must be more!

Thursday, 5 November 2009

Health in Vision 20: 2020 and the National Health Bill

We have blogged severally on the National Health Bill, on the strange process it has gone through, the intrigues in both houses of parliament in the past few years including retreats in Ghana. Our understanding is that the Bill has now been ratified by both houses and is with Mr President awaiting signing.

Over the past few months, the Federal Government, led by the office of the Vice President has brought together eminent Nigerians to draft a document to guide the implementation of its Vision for Nigeria to be one of the world's 20 leading economies by the year 2020. We reached out to the eminent colleague that led on working group on health for the Vision 20:2020 Document (which you can read in full here). We asked him on how his work was tied up with the new National Health Bill awaiting signing. We got a most amazing reply. Most amazing!. Reading his email correspondence reproduced below with his kind permission. He agrees like we suggested that Nigerians have a right to know how their demoracy works!
Dr Shima Gyoh, the chair of the committee on health for Vision 20:2020 did not see a copy of the National Health Bill until their last day of sitting.






Dear Chikwe,



Attached is my submission to the FMOH on the National Health Bill (NHB). As you noted in the report of the Health Schematic Group of Vision 20, 2020, our persistent efforts landed us a copy of the National Health Bill at the end of our work. I read it overnight and presented the attached “Problems with the NHB” to the group, but they correctly said our time was up, and the members did not have the privilege to go through the document and then discuss it as a group. Since there was not going to be an extension of the time, they did not want to be involved in doing emergency work on such an important document.


None of the “distinguished” members of the Health Schematic Group had previously seen, not to talk of participating in producing the document; the only member that was familiar with it was the representative of the Federal Ministry of Health. I was alarmed by the omissions and commissions in the documents, and the indications that it might have been produced without wide consultation within the health sector. Following a dispute as to whether the copy of the NHB which I reviewed was authentic, the Minister sent us a copy from his office, and it was identical to the one reviewed.


I was informed that it was too late to recall the Bill. My opinion was that rules and regulation are made by human beings, and nothing should be beyond change if it is to serve the public but contains serious deficiencies. I therefore sought to cause a re-think by submitting this document to the Minister, urging him that if this was really the final and authentic copy of the document we were hearing has been passed by both houses and was awaiting Presidential signature, it should be quickly recalled for urgent reconsideration.


Since I have not yet received a reply, I can only pray about it, meaning I have given up, and simply hope that the much taunted NHB is something much better than what I had seen and reviewed. Copies of it should have been widely available to the public at the stage of public hearing, long before the final debate on it. Yet even at our Group, getting a copy was no easy task. Our democracy is quite peculiar!


Kind regards from


Shima K Gyoh



Chairman, Health Thematic Area,


National Technical Working Group



The analysis presented below are personal, and I alone should be blamed for its shortcomings. The Health Thematic Group did not have time to go through it, but they unanimously felt that the Bill could do with more consultation. My own work on it was rushed, and not as comprehensive as I would have liked it to be. It is my strong belief that if the Bill goes through in its present form—granting that the version I have reviewed is the final form, it would create more problems and a demand for its amendment would come sooner than later. Shima K Gyoh


Primary Health Care Development Agency.


The Bill does not create a Primary Health Care Development Agency (PHCDA). Section 11 establishes a Primary Health Care Development Fund (PHCDF) which cannot be confused with an Agency because

1. The sources of the fund are spelt out in Sections 11 (1) and (2).

2. However, clause (4) of Section 11 suddenly begins to talk of the PHCD Agency, which is nowhere established in the Bill.

Can the PHDCF be converted to PHCDA? Not really for the following reasons:

1. The Established PHCDF does not have membership because it is only a fund, and cannot be both an agency and a fund, and there is no list of membership or of functions that can be proper for an Agency.

2. Conversion of the PHCDA into a fund-disbursing body would be disastrous for the health care in Nigeria. The Government, like the WHO, is emphasising that PHC must be greatly strengthened to constitute a good foundation for our health services. The function of PHC in the health care development in Nigeria is very crucial, and the Health Committee of Vision 20, 2020 is making strong recommendation to that effect. The Agency should be involved in full-time PHC activities.

Under the leadership of Professor Olikoye Ransome-Kuti, the FMOH embarked on setting up PHC units (posts, clinics, health centres and CHC) in the States as templates which each State could replicate to cover its entire territory. The FMOH naturally gave more attention to States that were slow in implementing their PHC services, thus achieving a more uniform performance all over the Federation. Because of the importance attached to PHC, the Ministry, which had several other functions, decided remove PHC out of its multiple commitments and delegate it to a new body it created, the PHCDA, which would devote its full time to the task without other distracting duties as was the case in the Ministry. This principle for creating the PHCDA might perhaps have been modified with time, but the parastatal should never be turned into a money disbursing body. The confusion of its name with Fund in the Bill is a serious mistake that should be immediately corrected before it becomes law, especially as the proposed legislation will benefit from wider consultation.



Federal Capital Territory PHC Board

Section 12 establishes the Federal Capital Territory PHC Board with membership and functions. Problems are:

1. There was no need to multiply the cost and lengthen the process of administration by establishing a whole Board just for PHC in the capital territory. A Committee of professionals would have done.

2. Nowhere in the membership of the Board is qualification and experience in PHC demanded. It consists of just technocrats with experience in accounting. Yet the Board is to “ensure coordination, of planning, budgetary provision and monitoring of all PHC services in the FCT.

The National Council on Health

Section 5 creates the National Council on Health (NCH). The following aspects need reconsideration:

1. Each meeting of the Council requires enormous work: gathering memoranda from the States, debating them at the Top Management Committee of the Ministry to determine the correct policy to adopt, and again at the meeting of the Technical Committee of the NCH when it is presented by the originating State. There are many challenges in trying to do this properly, as any person with responsibility of organising the NCH meetings should know.

2. Section 5 (3) provides that the NCH meets at least twice in a year. The NCH is a large and expensive meeting. The Ministerial Committee has about 58 members and the Technical Committee about 150. When one adds up the secretarial and other staff, one gets a minimum of 300 delegates. There are serious problems doing the job properly even when the meetings are held annually. If they are to be held every six months, both the States and the FMOH would abandon everything else and concentrate on NCH affairs. Policy matters do not require such frequent meeting. The meetings should remain annually, and the law should only provide for extra-ordinary meetings to satisfy the occasional need.

3. The private sector which is reputed to provide from 40% to 70% of services depending on the part of the country, is severely under-represented at the Technical Committee. Even if one includes the religious health organisations, their total representation would be only 3 out of 150, about 2%. If we are serious about the public private partnership, the private sector should be allowed fuller participation at the stage of policy formulation.



National Tertiary Hospitals Commission

Section 9 creates the National Tertiary Hospitals Commission which not only takes over some of the functions of the Federal Ministry of Health; it also subsumes nearly all those of the Hospital Management Boards. Is this commission really essential? What value does it confer on the system?

i. It is another administrative body that would need offices, office equipments, secretaries, vehicles and highly paid staff that would greatly absorb the scarce resources and multiply the expense of administration without significant added value.

ii. It is a serious delay “middleman” stage that would convolute bureaucracy and delay issues because the hospitals would no longer be able to get direct and quick access to the Minister on grounds that the commission should be consulted first.

iii. The Hospital Management Boards are also Bodies Corporate that can sue and be sued. Why this additional exposure to litigation? Why create a powerful body that is not directly in charge of the hospitals, and open up another avenue of likely conflict with the Management Boards?

Research or Experimentation with Human Subject

On health matters, only a person’s doctor can give reliable, professionally competent and acceptable advice. Therefore, if any human being is going to give informed consent to participate as a subject on research or trial of any sort, he or she should do so only after his or her doctor has studied the protocol and can advise on the possibility of adverse sequelae both in the short and long term. The advice, though not perfect, would be expected to be better than that of any other person, especially those involved with the proposed research.

Yet Section 33 of the draft bill nowhere provides for this. Section 33 (1) (b) says “... with the written consent of the person after he shall have been informed of the objects of the research or experimentation and any possible effect on his health.” This does specify anyone to do the explaining, and the research team would fill this vacuum.

The draft should be amended to require the family doctor of the propositus to not only explain things, but to be an obligatory witness to the written consent.

Unfortunate Legal Requirements

Legal Blood Donation: Section 50 (a) states “A person may not remove tissue, blood or blood product from the body of another living person for any purpose unless it is done (a) with the informed and written consent of the person from whom the tissue, blood or a blood product are removed granted in the prescribed manner and (b) in accordance with the prescribed conditions by the appropriate authority.” This provision is going to kill any attempt to set up blood transfusion services in the country. If you ask blood donors to first sign a legally binding agreement, they are going to be suspicious that you are about to do something that might harm them, and you are seeking a legal escape from the consequences. Suppose they ask the doctor, why must I sign this, what would be the answer? This provision should be deleted.

Section 53 (b) (i) Provides that the written permission of the medical practitioner i/c of clinical services in the hospital is required before an organ is transplanted from a living donor to a living recipient. This introduces unnecessary complication to a relatively simple process. The consent for the operation signed by the donor, the recipient and the operating doctors provides sufficient legal requirements to do the operation without convoluting the bureaucracy.

Section 56 (3) provides that “an organ shall not be transplanted into a person who is not a Nigerian citizen or a permanent resident of the Federal Republic without authorisation of the appropriate authority in writing.” This again is unnecessary convolution of bureaucracy already noted in Section 50 (a), and 56 (3). Once the health services of Nigeria become good, there will be an influx of many patients from other countries, just like it is happening with India. Consent documents signed by the people involved will not be improved upon by introducing third parties that might complicate matters and cause unnecessary delay and controversy.

Section 7 (2) (k) The FMOH decided in the 90s to abandon the phrase “Specialist Hospital” because it was used to mean many different things; the majority of people understood it to mean “a hospital where there are specialists.” The more accurate phrase “Specialty Hospital” meaning a hospital that deals with only one specialty should be used to describe such institutions, e.g. orthopaedic, psychiatric or eye hospital.

The National Health Bill 2008: More Consultation Needed

Finally, the Health Thematic Group of the National Technical Committee of Vision 20, 2020, consisting of experienced top players in the health sector from various specialties was surprised that, while their members had all heard of the National Health Bill 2008, none had had the opportunity to read it, and none knew for sure what its provisions were.