Thursday, 24 December 2009

Round the media on health

It was interesting listening to Dele Olojede - Founder of 234Next speak on Inside Africa on CNN. He spoke about the apathy in our society about the big issues, such as  ex Governors that have become king makers despite 234Next showing Nigerians evidence of convictions that should make us very angry. So why are we not?

How can we read stories like those below on the state of affairs on our health system and shrug her shoulders..and move on.

...waiting on good news on primary health care

ThisDay Editorial - We urge the Ministry of Health and other public health agencies to brace up with the challenge of reviving the comatose Primary health care institutions in such a way that they will, once again, restore the hope of the people not only on the healthcare delivery system but on the government as a whole.

...and we learn from China what happens to people that poison others for a profit....(remember "My Pikin"?...its been long forgotten by after all the initial gra - gra)

Punch  China has portrayed itself as a nation that is serious about ridding its landscape of adulterated products, while exposing Nigeria as a country that is unserious about issues relating to the welfare and security of lives of its citizens. Zhang Yujun and Geng Jinping were executed recently after being sentenced to death in January 2009 by a court for their role in the impure milk scandal that sent six children to early graves and got over 300,000 hospitalised in September 2008.

Ebonyi State gives up on proving healthcare itself and gives money to private sector

Champion - Determined to ensure the availability of adequate healthcare facilities to the people and at affordable rate, the Ebonyi State government has disbursed N.6 billion to six rural private health institutions in the State.

Anambra buys ambulances but no idea where the emergency care will come from!

Thisday Governor Peter Obi of Anambra State. has vowed to take affordable healthcare delivery to all parts of the State. He said the launching of 36 ambulances comprising 32 conventional ambulances and 4 water ambulances for the local Government areas in the State.

A member of our House of Representatives calls Makurdi Federal Medical Centre a death zone

Vanguard  ' The House of Representatives Committee on Health has declared the Federal Medical Centre, FMC, in Makurdi, Benue State, a death zone, with some of the worst facilities in the world.

...and finally the Public Relations Officer of the Kaduna Ministry of Health says that with the resources in our health sector, there is no need for Nigerians to seek medical attention abroad if our doctors were giving their best - now we know why our President is in Saudi - Doctors not giving their best!

234Next  The Kaduna State Government yesterday charged medical doctors in the country to be more patriotic and committed while performing their duties...saying “No amount of investment in medical equipment, facilities and recruitment could significantly improve our health care delivery system without a positive attitudinal change by doctors, nurses, midwives and other health personnel,” he said.

Tuesday, 22 December 2009

5th National Conference on HIV/AIDS announced

It was great to see the announcement of the 5th National Conference on HIV/AIDS by the Conference Chair, Dr Oni Idigbe, President, Network For HIV/AIDS Research In Nigeria (NARN) and former DG Nigerian Institute of Medical Research, Yaba, Lagos.

I remember the last conference vividly between the 2 and 5 of May 2005 and we should remind ourselves of this. It was a year before the ICASA (The African conference held in Abuja). These are my notes...

Nigerians had  gathered at the International Conference Centre in Abuja to share knowledge on HIV/AIDS. Since we won the hosting rights for the next International Conference on AIDS and STIs in Africa (ICASA) in 2005, this conference was not only crucial in its scientific content but also in testing our organisational capacities and the challenges of hosting the week long ICASA next year.

An estimated 5000 participants registered for the conference. I have no knowledge of the funding mechanisms for participation but the crowds were huge. It was obvious at the time that the establishment of ARV treatment centres across the country had reinvigorated the medical community back to the forefront of the battle against the virus after they had initially abandoned the fates of their patients to frivolous cure claimants both from within and outside the profession.

Scientific Content:
This is obviously the most crucial indicator by which a scientific conference is judged. There were many very interesting presentations on results from behavioural surveys, knowledge and attitude surveys as well as reports on the implementation of advocacy campaigns. There were also very interesting presentations from civil society and faith based organizations and it was obvious that these two groups have increasingly mobilized in their response. One aspect that was obviously missing was useful operational research results from the several new ARV treatment centres all over the country. Despite implementation for about 2 years, I found no new results showing what aspects of treatment options work in Nigeria, and what the challenges are. We are loosing out on a major window of opportunity if we fail to describe the local challenges, as well as peculiarities in implementing treatment on the scale being done in Nigeria. The need for national operational, monitoring and evaluation data on programmes cannot be over-emphasized. The absence of a rapporteur sessions at the end of the conference cost participants the opportunity of a summary of key issues from the conference.

The role of PLWHAS
For the first time in my recollection, people living with HIV/AIDS stood up, confidently and courageously made themselves heard and seen on the scale seen at the conference. Women infected and affected took to the podium in the middle of the second plenary session and asked Nigerians to come to their aid. They stood there not as beggars but as active stakeholders in our country, mothers of our children and our future. PLWHAs, by their active involvement in the preparation for the conference as well as the conference itself, and this 

The Venue

The International Conference Centre is one of the edifices adorning the FCT. I found it in a relatively good state of affairs. The grounds around it were well kept, the air-conditioning was working and the lighting was good.

The magic of PowerPoint!!!
It was refreshing to see how much colleagues had familiarised themselves with presentation software programmes most notably Microsoft’s PowerPoint. However there is still a long way to go in developing skills in it’s appropriate use to enhance communication with the audience and not to impair this. While some presentation formats were good many were very poor and with the full use or misuse of  PowerPoint!
Logistics and Organisation

This was indeed a massive conference with up to six parallel sessions running after the plenary sessions daily. One full parallel session was cancelled on the first day….but all subsequent sessions held albeit often late. Registration was a pain on the first day, and the ushering and directions for participants to sessions were a disaster. There was obviously a lot to learn for the conference organisers, but also we as Nigerians also have a long way to go in comporting ourselves in public venues.

This conference had shown the extent of the challenge we face especially in terms of the managerial and logistic effort involved. The magnitude of the  numbers of participants almost became unmanageable and robbed the conference of some of the academic serenity needed to take in the vast amounts of information available for exchange at the conference.

The entry of the wife of the Governor and the deputy governor of Ekiti State with a team of mobile police men and an entourage of aides through the middle aisle disrupted the plenary on the first day. This should never be allowed at during the ICASA. Any important dignitary who needs their aides should be advised to drop their entourage at the entrance. A chief of protocol should be assigned for the conference halls as well as a small team, especially for the opening and closing ceremonies. There should also be seats reserved and contingency plans for late arrivals of dignitaries.

Please pass these on to the Chair.....unlike with our elections, we have to make progress on the last one.

Sunday, 20 December 2009

No Water No MDG !

by ndubuisi edoga

We know Nigeria and many other African nations cannot achieve the Millennium Development Goals (MDG's).

Goal 1: Eradicate extreme poverty and hunger
Goal 2: Achieve universal primary education
Goal 3: Promote gender equality and empower women
Goal 4: Reduce child mortality
Goal 5: Improve maternal health
Goal 6: Combat HIV/AIDS, malaria, and other diseases
Goal 7: Ensure environmental sustainability
Goal 8: Develop a global partnership for development

That is common knowledge.

But after watching a documentary: Water First: Reaching the Millennium Development Goals by Mr Charles Banda, founder of Malawi Freshwater Project. see more here "Freshwater Project Malawi"
Mr Banda through his revolutionary work with low cost water well/pumps and , low cost Latrines both providing employment and teaching our children the essence of hygiene in health and disease prevention also successfully conveys the critical importance of clean water and sanitation in achieving all of the United Nations’ Millennium Development Goals (MDGs) and relieving global poverty.

Mr Banda through his works and his commitment in implementing a ‘social work’ approach to solving water problems, and prioritizes community engagement and ownership in all projects. This approach can be used in supplying medical equipments to our Universities and Hospital.

Since 1995 the organization has provided more than 2,000 wells and more than 5,000 pit latrines in Malawi. Mr Banda uses locally made materials or simple equipments for all his projects for easy of maintenance.

Compare this to the CT scan supplied by Vamed to one of our Universities that has not been used because the new CT scan could not fit into the old CT scan room and there was no contract for building a new room or expanding the old room. The government of Malawi and UNICEF has bought into the project and is actively behind this project.

Recently in a public appearance the American Secretary of State, Hillary Rodham Clinton, has listed the Federal Government of Nigeria among governments that are "able but unwilling to make the changes their citizens deserve," and such governments, she promised, will come under vigorous U.S. pressure.

Need I say more, it is very obvious that our government has failed us.

That is common knowledge.

Mr Banda has shown us that " there are many ways to reach the MDG's aside from building the biggest and best hospitals that we hear everyday in our media, buying the latest MRI equipments without any inputs from the beneficiary institutions as per needs and scale of use.

Let us celebrate the Mr. Banda's in our societies and in our lives, and let us hope that our leaders can learn from the Banda's of the world.

Friday, 18 December 2009

Thisday - ‘Nigeria Needs Hospital for Presidential Treatment’

Sometimes it is difficult to decide on whether to get angry at the impunity of our so called leaders or sad at their ignorance. It is even more astonishing when this impunity or ignorance is displayed with so much arrogance. But that is our country.

Thisday reports that OUR House of Representatives yesterday took a swipe at the deplorable state of hospitals in Nigeria and declared that Nigeria deserved a health institution that should provide presidential treatment.

Thisday further reports that OUR House of Representatives said it was appalling that at 49 we lacked a health facility that should provide adequate health care for the office of the President.

In a moment of revelation - OUR House of Representatives came up with a magical analysis and proposed solution:
"The National Hospital is a strategic health institution and deserves more in terms of funding"
Just this week the Leadership reported on a N253.7 Million Contract Scam at OUR National hospital...this same week! it is not a new problem. Below is an article reminding us of 2002 (it feels like so long ago) ...first OUR National Hospital was given out to the International Hospital Group to "manage" and after they basically ran it to ground...our President in his infinite wisdom appointed an Interim Board for the Hospital  in April 2003 headed by a lawyer and his Special Assistant, Hon Musa Elayo to turn around the Hospital within three months. Interestingly, Obasanjo charged Elayo to

"fix the hospital to a standard where I, the Vice President, the secretary to the Government of the Federation, the ministers and top government officials will receive treatment instead of going abroad."
Subsequently ....a new management was appointed led by the President Obasanjo's personal physician Dr. Olusegun Ajuwon OON. He remains the medical director.....

Now we can see how our National Hospital is managed....How do we really expect it to deliver....

One day the people will reclaim their country from their "Representatives" ....until such a time our National Hospital will remain what it is - a most public example of the failure of our country to provide its most basic needs even to its most privileged people.

Tuesday, 15 December 2009

The Minister in Ottawa

The Minister of Health speaking to Ottawa Canada courtesy of our High Commissioner to Canada, Amb Iyorwuese Hagher who endeavors to give Nigerians in Canada the opportunity to meet with their Ministers and other Government officials whenever they are in town, whether on official or private business.

Monday, 14 December 2009

MTN - leading the coorporate sector in engaging our health sector

When I read that MTN was donating heamodialysis equipment to a series of tertiary healthcare centres across the country - initially I was sceptical.

When Obasanjo's own VAMED has not gotten any of the equipment to actually serve the people how as MTN going to do this....the detail is really interesting:

1. The decided on what to do and earmarked the funds

2. The asked health centres across the country to put in  Expressions of Interest (EOI) - 57 responded.

3. After short-listing some of the applicants, their project team embarked on inspection visits to their premises to verify claims made and ascertain that they will indeed be able to host and competently and judiciously utilize the facilities we propose to install on their premises.

4. They chose 12 public medical institutions drawn from the six geo-political zones of the country.

5. They are not just supplying the core equipment but the consumables, the beds, airconditioners and even generators for electricity!

6. MTN Foundation will bear the cost of the civil works and non-clinical training of the facility staff.

Not only this....MTN Foundation is also unveiled the beneficiary hospitals of the MTN Foundation Mammography Centres - a project  currently equipping six public medical institutions in the six geopolitical zones of the country with mammography centres in order to strengthen breast cancer screening capacity in the health sector.

Yes MTN Nigeria made a profit after tax of N78 billion, Yes the quality of their service still leaves a lot to be desired BUT in doing the above the way they have - maybe there is something for our Ministry of Health to learn from MTN on HOW to execute projects...Just maybe!

MTN - Everywhere you go :)!

Saturday, 12 December 2009

2009/9 National Human Development Report for Nigeria by UNDP launched

Lots of highly skilled people are payed lots of money to produce lots of important information in reports, presentations etc that should drive our national development.

In the past these reports have not been accessible to you. That is about to change. Nigeria Health Watch is working on a portal to make all the UNAIDS, DFID, WHO, UNDP etc etc reports relevant to the health of Nigerians available to you via an internet portal, searchable and accessible to anyone with internet access. When possible we will commission a short summary. Its your country! You have a right to know!

Thanks to Felix Obi - find below  summary of the REPORT OF LAUNCH OF THE UNDP NATIONAL HUMAN DEVELOPMENT REPORT (NHDR) FOR NIGERIA 2008-2009.

Date: Monday, 7th December 2009

Venue: Transcorp Hilton Hotel, Abuja

The NHDR is one of UNDP’s contributions to Nigeria’s developmental efforts as the report provides empirical and evidence based data on the state of socioeconomic issues in Nigeria, which would assist policy makers and other stakeholders in designing and implementing policies that impact on the population. A few years back, UNDP developed the Niger Delta Human Development Report; a region-specific document that discussed the complex nature of the Niger Delta conflict and proffered solutions on how to tackle the crisis in the area.

The 2008-2009 edition of the NHDR is aimed at providing the Government of Nigeria, a useful document that will help in the development and implementation of the Vision 20:2020 and the 7-Point Agenda. This NHDR tries to evaluate Nigeria’s economic development since the government-led reforms which has improved Nigeria’s economic ranking from a Low to a Medium Income Country especially with the growth in the financial and telecommunications industry.

The data set used for the report includes the following;

- National Living Standard Survey (2004)
- General Household Survey (2007)
- Core Welfare Indicator Questionnaire Survey (2006)
- MDGs Midpoint Assessment Report (2008)
- Life Expectancy Ratio Measurement (2008/9)
- Multiple Indicator Cluster Survey (2008)

The 2008-2009 NHDR has as its theme “achieving growth with equity” ; a concept which refers to economic growth that enables the largest number of people, especially the less advantaged and poor, to participate in wealth creation activities so they can benefit proportionately from the increased availability of public and private resources. Essentially growth with equity enshrines the principle of fairness in the distribution of economic opportunities and rewards within a society. Through growth with equity, the reduction in poverty and inequality is expected to happen through the availability of more productive and stable jobs, improved health and literacy, higher income levels among the population through which a higher level of human development can be attained.

Highlights of the Findings

1. Nigeria’s macroeconomic performance has improved markedly since the early 2000s as the gross domestic product (GDP) has averaged about 6% in the last 7yrs based on the expansion of the non-oil sectors like the banking, insurance, telecoms, IT and other service-oriented sectors. However, the output of the manufacturing and real sector has declined progressively over the past decade.

2. Between 1990 and 2007, Nigeria’s score on the human development index (HDI) improved rising from 0.452 to 0.511, helping the country move up from low to middle human development category. However, Nigeria’s HDI is lower among its peers (Brazil, Ghana, Kenya, Malaysia and Indonesia) and the rate of improvement in HDI is much slower in Nigeria than among its peers.

3. The proportion of Nigerians categorized as poor rose from 27.2% in 1980 to 65.6% in 1996 but declined to 54.4% in 2004. This implies that though there was an improvement between 1996 and 2004, the proportion of Nigerians who are poor today is twice the proportion in 1980.

4. Nigeria has the highest levels of income inequality in the world, with a score of 0.43 (out of 1) for the period of 1985 to 2004 as measured by the Gini coefficient.

5. And within Nigeria, there are wide variations in poverty, inequality and human development across the states and geopolitical zones. Inequality is highest in the FCT (0.64) followed by a group of 10 states with a score of 0.5 or above, with 3 states (Abia, Adamawa, and Akwa Ibom) with the lowest inequality score. As for HDI, among the top 10 states, 8 are in the south, and among the lowest 10 states, 9 are in the north.

6. The rate of growth in employment is not keeping pace with the economic growth and expansion of a young labor force from 2000 -2007. The manufacturing sector has the lowest, and the major expansion in jobs has been the services sector.

7. There is absence of real structural transformation in the economy since Nigeria’s production has remained focused on agriculture and oil and gas which account for over 70% of the GDP, whereas the manufacturing sector contributes less than 6% of the GDP.

8. The social indicators have remained poor despite improvements over the last decade which has impacted significantly on the productivity and quality of life of the citizens, especially the majority poor. There has been low coverage of basic health services, basic education, weakness of vocational training, and exceptionally high rates of maternal, infant and child mortality in the country generally.

Recommendations of the NHDR

To achieve the Vision 20:2020, the NHDR emphasizes the need for discipline, consistency and continuity in the setting of priorities and policies over a sufficiently long period of time if Nigeria is to become a strong economy in the coming years. Three key recommendations have been proposed for the Government of Nigeria.

1. Create an environment for high levels of investment and growth through the following strategies:

• Improve access to and the quality of physical infrastructure, most notably power, roads, ports and railway. In addition, put a specific emphasis on improvements in rural areas and in linking rural and urban markets

• Pursue spending efficiency and effectiveness. While Nigeria’s resources are limited, they are still considerable compared to other low income countries (LICs) and least developed countries (LDCs) with similar large populations. A key task is to reduce corruption through fiscal responsibility and other reforms aimed at improving physical infrastructure, agriculture and social services.

• Maintain macroeconomic stability to avoid return to boom and burst conditions

• Deal with key institutional issues which are at the heart of any effort to make government more effective and accountable such as building capacity of public sector workers, improve coordination at all tiers and sectors of government, and provision of information to the citizens and civil society.

• Strengthen financial sector intermediation to provide better support for real sector including the access to credit, technology and useful information to the poor.

2. Make growth pro-poor and inclusive through:

• The promotion of human capital development by focusing and spending more public resources on essential social services (basic education, primary health care and nutrition, safe water and sanitation), and boosting vocational education in response to the felt needs of the labour market.

• Provision of safety nets for the extreme poor and the vulnerable against economic shock/crises arising from government policies through such schemes like targeted cash transfers, fee waivers, school lunch programmes, low cost housing, nutritional programmes fir pregnant and nursing mothers etc.

• Scaling up investments in the rural areas to make them economically viable through rural infrastructural development etc and fostering linkages between agricultural and non-agricultural activities, and building skills for off-farm employment.

3. Achieve effective multi-tier cooperation in government; and it is only the active commitment and engagement of the three tiers of government through coherence, transparency and effectiveness in spending of public resources.

What has this got to with health? - Well...WHAT are the determinants of health? What are they?

Tuesday, 1 December 2009

Problems medicine cannot solve

This evening I attended UCL's Annual Lancet Lecture. This year's theme was; Climate Change - The biggest global health threat of the 21st century? ....But no, climate change is not my topic for today. In making a point this years lecturer and one of Britain’s most senior scientists; Lord May, a former President of the Royal Society and Government chief scientist mad an astonishing empirical fact - that on average, girls that have had a primary education - have 1.5 children less than those that do not. Girls that have a secondary education have on average 3 children less!

Now...what does this have to do with anything?

Vesico vaginal fistulas (VVF) is one of those things very few of us talk about, even in the profession. I have hardly thought of this since leaving university. It is just not on the health agenda......What are VVFs some might wonder, especially if you have not worked in our neigbourhood. In simplest terms these are abnormal anatomical passages between the bladder and the vagina most often cause by obstructed labour in young (often very young) mothers. Another reason obviously is more access to appropriate antenatal care. It is a devastating condition as women become incontinent of urine.

Recently the Minister of Health announced during the foundation laying ceremony of National Vagina Fistula (VVF) Centre in Kwali area council, Abuja that Nigeria had the higest number of VVF cases in the world. Its is hardy a surprising statistic - although the source of any health data in Nigeria is always a worry.

To mark this, Thisday published an excellent piece analysing the VVF situation in the country. To start of ..they quote the number of 800,000 women affected. Its not quite clear where they get this number from or what time period it covers...but we can all agree that there are lot women affected.

Apparently there are five major centers in the northern part of the country where those with the condition are looked after. These include Katsina as the headquarters, Kano, Zaria, Sokoto and Kebbi. The National VVF Project  in these five centers in the north are managed by Dutch surgeon known as Dr Kees, who is the head of the whole project. He added that Krees trained all of them in these centers.

With population growth without a parallel increase in access to education and antenatal care by women, especially young women we will be needing the expertise of Dr Keets for a while to come.

Another thing that struck me was the very little space and prominence given to this launch. Okay the Miniter was there and so were  few others....Compare this to the launch of Madam First lady's cancer centre in Abuja a few months ago!!! this surprising? Which of our elite will like to be associated with VVFs? This is one problem modern medicine cannot solve! We need a societal shift from the acceptance of this as a norm and then societal synergy to do something about it.

This is one problem medicine cannot solve! Not for us....