Friday, 29 January 2010

Book Launch - "Turning the world upside down"

Many that work in the UK will remember Lord Nigel Crisp as the Chief Executive of the NHS between 2000 and 2006. Since 2006 he  has been a passionate and tireless advocate for health workforce issues. He has been acknowledged as "A Champion advocate for Global Health Workforce Alliance" by the Alliance Board. 

In 2007, in response to an invitation from the Prime Minister and the Secretaries of State for Health and International Development to look at how UK experience and expertise in health could be used to best effect to help improve health in developing countries, he published what is now known as the "Crisp Report". This report among other things recommended that NHS should assist in and coordinate the release of staff in response to humanitarian emergencies. (pertinent today as ever).

So recently we received an invitation to the lunch of his new book titled "Turning the world upside down" Ike and I attempted to attend but unfortunately I was declined entry for being inappropriately dressed for the high profile London venue "The Reform Club".

Ike made it in and contributes this report...

Turning the world upside down launch

Emerging from the underground into the freezing hustle and bustle of Piccadilly Circus, I make my way to the Reform Club at Pall Mall. I am there at the invitation of Lord Crisp, former Chief Executive of the NHS and current global health advocate. He has recently written a book, Turning the World Upside Down, published by the Royal Society of Medicine Press. I am not quite sure how or why I have been invited but imagine that it is either through having met Lord Crisp at a BAPIO conference some years ago and exchanging some emails about international health or through his eullient parliamentary researcher, Susannah edjang who has been greatly supportive of many of our initiatives.

Arriving at the imposing building with pillars in front of it, there is no sign indicating that this is the Reform Club so I resort to checking the building number. Having confirmed it, I join the stream of guests- I am directed by a uniformed gentleman to leave my bag on a shelf and then make my way upstairs to a cloakroom where I can leave my coat. "By the way" he asks, "are you wearing a tie?". I am not, and so he invites me to pick one from a box overflowing with ties sitting on a table behind reception. I select the least garish, and move into a corner to knot it, ruing the fact that my top shirt buttons cannot come together

Having achieved some semblance of presentability, I make my way up dimly lit stairs to a cloakroom where I leave my coat and then to the open library like room where the drinks reception for the launch is holding

I meet Susannah and after exchanging greetings begin chatting to a number of other guests including public health doctors, presidents of the medical Royal Colleges, people who work in health, international development, the civil service and some politicians. I also meet a gentleman who works in scenario planning, who is grateful that he does not need to explain what that is to me.

I receive a telephone call from my friend and colleague Chikwe who is livid that he has been refused entry to the event as he is apparently innappropriately dressed. Since there wasn't any dress code on the invitation, it is certainly annoying. I later learn that another gentleman actually had to go and buy a shirt and tie in a nearby shop before returning. We later learn that to have the priviledge of entering this venue, gentlemen are required to wear closed collar, jacket and tie. Ladies are required to dress with similar formality....well...if only we knew.

There are 3 brief speeches, one from the author Lord Crisp who thanks all who have supported him especially the firm which sponsored the reception, his family and colleagues. He explains that the book started out from his being asked by the Prime Minister to look at how the NHS could help improve global health, and his observing that learning was not a one way street; that there were many lessons that health in the West could learn from developing countries, citing the examples of the numerous Caesarean sections carried out by nurses in some African countries; Geoff Mulgan Director of the Young Foundation reviewed the book, saying that it contained any useful examples and challenges for rethinking how global health challenges can be met, stressing the importance of the 2 way learning flow The final speaker was Ransford Smith, the Deputy Secretary General of the Commonwealth and a former Jamaican permanent secrtary and diplomat who highlighted that a great part of the burden of global disease sits in the Commonwealth. He highlighteed the important contributions that Lord Crisp had made to global health and the commonwealth, particularly in his role at the Global Health Workforce Alliance and recommended the book to all readers....

We look forward to reading it.

Wednesday, 27 January 2010


CARE - NET is managed by Dr. Tarry Asoka in Nigeria. The organisation provides leadership in a broad range of strategic and technical areas related to Nigeria's Health Sector Reform Programme enabling the country make  progress towards the MDGs. They advise and support Nigeria's efforts to improve health service provision through improved policies, more efficiently managed sector resources, and improved quality of health services.

Of particular interest to this blog is a journal they publish on health: HEALTH INSURANCE AFFAIRS  in Nigeria focusing on health management, policy and health insurance.


  • Massive push for Community-Based Health Insurance in South Saharan Africa: Are we taking on board lessons learnt?
  • Doing Well by Doing Good: The private sector's potential as a force for social good yet to be fully tapped
  • Nigeria's 202020 Vision and Investment in the Health care industry 
Find all the archives HERE.

Monday, 25 January 2010

GUINEA WORM eliminated in Nigeria?

I still remember my assignment in my MPH class. We were asked to do a presentation to the class on a common public health problem in our countries. I did one on Guinea worm. Having lived in Enugu for several years, a few kilometres from the epicenter in Nigeria in Ebonyi State, the images were very present in my mind. Yet I could not believe that half of the class had NEVER heard of the disease. I had never really thought of it as one of the classical examples of a disease of poverty....

 Early this month I was sent a document from the WHO Collaborating Center for Research, Training and Eradication of Dracunculiasis at the CDC stating that....

"At the end of December 2009, Nigeria completed thirteen consecutive months with ZERO indigenous cases of dracunculiasis (guinea worm disease), thus having stopped transmission of the terrible disease after centuries and generations of untold suffering. Once home to more cases of dracunculiasis than any other country in the world, having enumerated 653,620 cases in 5,879 villages in 1988/89."

Since its inception, Nigerian Guinea Worm Eradication Program benefited from early technical assistance by the Centers for Disease Control and Prevention (CDC) and early financial assistance by the UNICEF mission to Nigeria; sustained technical and financial assistance by The Carter Center; major in-kind donations by American Cyanamid/American Home Products/BASF (ABATE@Larvicide), DuPont Corporation and Precision Fabrics Group (nylon filter material), and the Government of Japan (vehicles, motorbikes) through the Carter Center; and major water supply project assistance by UNICEF and the Government of Japan; with substantial funding in later years by the Bill & Melinda Gates Foundation through The Carter Center.

"The Government of Nigeria itself provided early leadership in its Federal Minister of Health, the late Prof. Olikoye Ransome-Kuti, and by donating two million dollars to The Carter Center for the Nigerian Guinea Worm Eradication Program."

So since Kuti OUR Government has done nothing???? 

Find the full report here.

Friday, 22 January 2010

Nigeria's disappointing response to swine flu

It has been frustrating following the response to swine flu in Nigeria. We live in hope of the day our country will to put its act together and act with competence and confidence.

lets start from the beginning....with all the  reports from the Ministry of Health assuring Nigerians that there was "no swine flu in Nigeria". Our Minister of Health in June 2009...assured the country that everything that needed to be done was being done.

Hear the Minister himself speaking in June...

Then on the 29th of October, a private laboratory in Lagos announced to Nigerians its "first" case of swine flu and then a few days ago the special assistant (media and communication) announced to Nigerians the"first" death. He is quoted as saying
"Nigeria has recorded 11 laboratory confirmed cases of Influenza A/H1N1 and one death from the Influenza A/H1N1"
The simple question is how do they know? What exactly is the surveillance system for influenza in Nigeria?

When most countries were confronting this new disease  months ago, they followed up their numbers with a description of the surveillance systems used to collect this data. Guidelines such as these were developed for people and health care professionals and disseminated. people were told not only what to do but also were and how. Information was updated daily on a website. In record time a new vaccine was developed and distributed....the response was managed, coordinated and effective, preventing a third wave.

Now we are told that in Nigeria, 4 months after most countries in the world had secured vaccine stock for their populations, at a time where many other countries are trying to get rid of excess stock of vaccines, that OUR  Commisioner of Health for Lagos state admits that they have NO VACCINES, not just in Lagos but in Nigeria and the state has only now placed an order that will be delivered in 4 weeks. Thisday reports that the Minister of Health says that negotiations with the UN to supply vaccines to Nigeria has reached an "advanced stage". The Minister's Special Assistant on Communication is quoted further as saying  deaths recorded so far were not as a result of absence of a "curative drug" but as a result of "late diagnosis" and urged Nigerians to adopt "precautionary measures",  notably frequent hand washing, use of clean water and soap, keeping hands away from the face while sneezing or coughing as the disease gains access to the body through the eyes and nose, seeking medical attention on noticing cough, catarrh and high fever, among others. He went on to assure us that the "National Epidemic Preparedness and Response Committee was already on top of the situation" On top of the situation?!?

Then our commissioner of health went on to display an unprecedented ignorance of the transmission dynamics of influenza when he stated that "38-year-old victim of Influenza A/H1N1 (swine flu) travelled to the United States about three months ago and developed a respiratory tract infection about six weeks after the victim returned to the country"...implying that the infection was imported from the USA. Influenza has an incubation period (from time of getting the bug to becoming ill) of 1-4 days (averageof 2) and patients remain infectious for up to five days (seven days in children). Do the math! This person was infected in Nigeria! Indeed with the traffic between Nigeria and the rest of the world it is most likely that H1N1 has been circulating in Nigeria for months!

We cannot blame the commissioner. In no other country in the world is the response to infectious disease left to state and local governments. Infectious diseases, you will not be surprised to note do not respect our geopolitical boundaries! As most other countries in the world, Nigeria needs a central, well resourced centre for infectious disease prevention and control or one day we will pay the price the hard way.

Generally, while aspects of  service provision for clinical care have improved over the years (many will argue with this) our public health arrangements have not moved since independence. Our grand arsenal of responding to public health treats is a derelict Public Health Laboratory in Yaba, bureaucrats at the  Department of Public Health in the Ministry of Health,  a series of outbreak-specific task forces and a disparate group of epidemiologists in state ministries of health across the country. The lack of expertise is so glaring that it falls of the Minister's own special assistant on media to interact with the Nigerian people on the threat of infectious diseases.

Countries that take this threat seriously consider the threat from infectious disease a matter of national security and give it deserved attention with specialised institutions. We have to believe that they are not stupid!

 In the USA its the Centres of Disease Control, in the UK the Health Protection Agency, In Germany the Robert Koch Institute, in France the l'Institut de veille sanitaire (InVS) ...and South Africa National Institute of Communicable Disease (please Nigerians go at these websites to learn what you need to know). They all one thing in common - bringing together the expertise for the prevention and response to infectious diseases.

There was a collective sigh of relief around the world that the novel  2009 H1N1 influenza turned out not to be as virulent as initially feared....if it was, we would have been lost like a fish out of water. Now please go to the website of OUR Federal Ministry of Health for instructions on what to do if you are a health care professional or a patient regarding H1N1. Well, I bet you will not be surprised at what you find...

If we do not invest in protecting the Nigerian people from the threat of infectious diseases we will pay the price...its only a matter of time...and not even the high walls of the 3 Arms Zone or bullet proof 4X4s will save our politicians.... those little things have no respect!

But watch this space  - next epidemic - next task force - next media briefing. This is exactly how NOT to rebrand out country...Aluta

Friday, 15 January 2010

Think of how many of these cost of one CT scanner could buy

Freeplay Fetal Heart Monitor, a device can be powered by winding the handle. Each minute of winding the device results in 10 minutes of monitoring time. When grid power is available, the batteries can be charged and will provide continuous power for several hours.

Ebook Reader - The major inhibitor to making books many people all over Nigeria is ofen not the cost of the book but the cost of transporting them to Nigeria Imagine having all the text books you could ever need on this reader ....and it works without cosntant electiricity!

From the AsokaTechBlog: As the Healthcare Reform Debate rages on here in the US, in other countries healthcare is being transformed by a new crop of social entrepreneurs popping up around the globe. This trend, micro health clinics, boast high-quality, affordable and accessible healthcare in rural areas of countries where income and health disparities can have devastating effects on the population.

Wednesday, 13 January 2010

Nigerian Doctors in the UK meet in Plymouth

Until recently, like 90% of Nigerian Doctors living in the UK, I chose not to engage with the Medical Association of Nigerian Specialists and GPs (MANSAG). I claimed that I had too little time....and that the British Medical Association would suffice for my trade union engagements. Events led me to change my  mind a couple of years ago as I came to realise the futility of my own ignorance. Since then I have grown to immensely respect and admire colleagues that give up their time, resources and energy to represent us.

This is a report from the last Annual Conference in Plymouth, October our guest blogger Oge Ilozue...Thanks Oge! We apologise that we are posting this so late

MANSAG held another successful annual scientific meeting hosted by Plymouth, which was apparently the location for the Nigerian Independence negotiations! The theme was Health Service delivery in Nigeria - Role of Nigerians in Diaspora.

The conference kicked off on Friday evening for those of us able to manoeuvre ourselves down to Devon on time. Three informative workshops were held with topics including Mentoring skills, Career change and diversification and the Status of HIV and Malaria control in Nigeria.

Saturday started the main proceedings with the opening session including a short welcome by the Lord Major of Plymouth who stayed for the duration of the morning. Followed was an address by our hard working outgoing president Mr Stanley Okolo. Another important guest was the President of our fellow organisation in America - ANPA who gave a talk on the strategy for health in Nigeria. He outlined the recent conference organised by ANPA held in Abuja earlier this year with contributions from MANSAG and the NMA. He discussed the lack of presence at the conference of the Nigerian health ministry except for a brief appearance by the Minister of Health, and the importance of continued collaboration between our organisations.

The next session included a very inspirational talk given by Dr I Wada who is the MD of Garki Hospital in Abuja and he gave details of his experiences in leading the first public-private partnership (PPP) hospital with all the trials and triumphs. Next was an informative and apt talk by Mr Dayo Ogundayo about how the finance industry sees these PPP initiatives. Then a talk delivered on behalf of the director of Primary health care Nigeria about our role as Nigerians in the Diaspora in helping deliver healthcare, tackling the basics in healthcare delivery and targets such as the MDGs.

During the lunchtime break an exciting impromptu meeting was held with the president elect the secretary elect and all the trainees plus medical students present at the conference of which there were good numbers. This meeting briefly discussed our role as the future of the organisation and our responsibility to spread the message to our peers increasing knowledge of MANSAG to our Nigerian colleagues. We will endeavor to maintain good links with the students and ensure the organisation remains relevant to trainees also with focus on mentoring and professional skills development.

The afternoon session started with a talk by Dr Peter Ozua about his experiences in taking equipment to Nigeria and even providing mortuary facilities. Followed was a talk by Mr J Akoh - Renal transplant surgeon - about the need to also ensure specialist services - all much needed - are not forgotten in the drive to improve healthcare delivery. During this session our keynote speaker and his entourage who had flown in from India that morning arrived - Professor Babatunde Osotimehin - Minister for Health. The Minister gave an eloquent address on the state of healthcare delivery in Nigeria currently, gave some of his thoughts on the reasons for the failures and his plans for the future. This was followed by a lively question and answer session.

The annual AGM for paid members of MANSAG followed which discussed several constitutional changes and swore in the new executive council.
Find all the official pictures here.

Find the conference report here.

Find an upcoming MANSAG subsidised mentoring training day here on the 20th of March 2010.

Find future MANSAG events here.

Monday, 11 January 2010

Quiet optimism around Polio Elimination in Nigeria.

There is a sense of quiet optimism around those working on the Polio Elimination in Nigeria.

By the end of the year the number of new cases detected was down from 782 in 2008 to 388 polio in 2009 and from 30% zero dose (to vaccine) to 17% zero dose for the same period in 2009.

A lot of work...a lot of work is being done by the NPHCDA, MOH, WHO on Polio around the country and we hope that 2010 will bring even more success. We need to get this elephant in the room - OUT - so we can focus on other public health priorities. Until then...the struggle continues.

Details of the state of play end of 2009 are....

A total of 388 WPV cases have been confirmed in Nigeria in 27 states as at 18 December 2009.

A national mOPV3 round was conducted from 31 Jan – 3 Feb, 2009.

A sub-national mOPV1 round was conducted from 28 Feb – 3 Mar 2009.

A national mOPV1 round was conducted from 28 – 31 March 2009.

A national tOPV round was conducted from 30 May – 2 June 2009.

A sub-national mOPV1 round was conducted from 4 – 7 July 2009.

A sub-national tOPV round was conducted from 1 – 4 August 2009.

A sub-national mOPV3 round was conducted from 10 – 13 October 2009; mOPV1 was used in concurrent outbreak response activities in 4 southern states.

A sub-national mOPV1 round was conducted from 21 – 24 November 2009.

The stuggle continues

Friday, 8 January 2010

Rejoinder: NHIS in Nigeria

A few days ago we posted an interesting article by Chukwuma Muanya describing the evolution of the NHIS in Nigeria. This is a rejoinder sent in by an avid reader of this blog. Dr Joseph Ana is a colleague we hold in extremely high regard. In every generation of Governors in Nigeria, one always stands outs and catches the imagination of the people by his vision and action. In this dispensation, beyond doubt that person is Raji Fashola in Lagos State. In the 8 years of the Obasanjo administration, the one Governor that stood well ahead of the pack was Donald Duke in Cross River state. Many  will have heard of the several projects that are in the limelight but few would have followed the quiet but visionary changes in the health sector - led by Dr Ana. We think he has earned the right to be heard - Enjoy his contribution!

Thank you for highlighting the National Health Insurance Scheme (NHIS). I believe that in 50 years time when the scheme will be 60 years, historians will look back and celebrate its implementation as the golden hour of former President Olusegun Obasanjo. Few people know that Dr Majekodunmi, Nigeria's first Minister of Health at Independence presented the first Bill for a Health Insurance Scheme in 1962! It took Obasanjo's second coming as President 43-years after to see to its implementation in July 2005.

On going through the Guardian Newspaper article, what is missing is the fact that a major obstacle to the NHIS is the antagonism and cynicism of the labour unions to the scheme. Indeed the progress that has been made has been at least as far as the formal sector in the face of very stiff and continuing opposition by surprisingly from the Labour Unions (NLC and TUC).

This is an important point for people to be aware of as there seems to be a complete lack of understanding of the benefits of health insurance among the trade unions. In 1948 when NHS-UK was established it was a Labour Government – and the principle of free healthcare at the point of care – from the cradle to the grave – has been more or less maintained ever since. It is the one institution in the UK that is held sacrosanct. As is seen in the politics of the present election cycle in the UK, both parties are trying to do out do each other in who will protect the NHS more from impending economical challenges. This has only strengthened my disappointment that organised Labour in Nigeria is a major stumbling block on the way to full enrolment for the NHIS in Nigeria. I had a first hand experience of this unfortunate absurdity in 2006 when under former Governor Donald Duke, I signed Cross River State into the NHIS-Nigeria (the first state to do so). Again in 2008 as vice chairman of the Health Advisory Commiittee to Bauchi State Government of Malam Isa Yuguda, I encouraged Bauchi State to join the scheme (the second state to do so).

In Cross River State, the Labour Unions continue to oppose the scheme even in the face of glaring benefits and advantages to their members who have enrolled from the State’s civil service and Local Government Service. Both Unions cite the failed Housing scheme and failed National Provident Fund as their reason for opposing the NHIS. Indeed some Union Leaders not only preached against their members enrolling for the scheme but physically destroyed registration forms until the police was invited in!. The most astonishing part of the Unions’ action was the fact that State Government had not even started deducting the 5% of basic salary from each enrollee. The State Government was paying the full 15% of basic salary for each enrollee and yet the Unions were up in arms. I wonder what will happen when the State Government begins deductions. Therefore, the NHIS- Nigeria has some major work to do on 'educating' the Unions because they are a major BLOCK to the scheme.

All the other points listed in the article are true in my experience but as I have said at many fora the NHIS cannot achieve its laudable overdue objectives until the INFORMAL sector is covered!. The majority of Nigerians who stand to benefit the most from the NHIS because they fall under the poverty bracket are in the INFORMAL sector.

Joseph Ana

Wednesday, 6 January 2010

What hope for the National Health Insurance Scheme in 2010

Many have described the National Health Insurance Scheme ( ... website is "down") as the longest it has taken any project to reach matuaration...even in the Nigerian context (find the law establising it from 1999 here). At the same time....some progress has been made with the emergence of large Health Maintenance Organisations as Hygeia and Total Health. among others. This detailed review of the sector by Chukwumah Muanya in the Guardian  provides a good review of the state of play. Its an interesting read on what will be an extremely important issue in 2010.

Credit to The Guardian for an excellent piece...reproduced in full here.

Not yet assurance for your health

By Chukwuma Muanya
THE National Health Insurance Scheme set up by the government to ameliorate the health burdens of Nigerians is everything but national after several years of implementation. It's chief executive broods over the kinetic forces hindering the quick spread.

A GLOOMIER picture of the global economic meltdown as it affects the health sector is just emerging.

It is so bad that many Nigerians cannot afford going to hospitals. They rather patronise quacks and roadside drug vendors. Even in states where healthcare is free for the elderly, pregnant women and children under-five, many complain not having enough money for transport and other logistics.

To address this, the Federal Government introduced the National Health Insurance Scheme (NHIS). Health insurance is a social security system that guarantees the provision of needed health services to persons on the payment of token contributions at regular intervals.

The NHIS is a body corporate set up under Act 35 of 1999 by the Federal Government to improve the health of all Nigerians at an affordable cost through various prepayment systems.

But 10 years on, only 5.3 million Nigerians (3.73 per cent of the population) are benefiting from the scheme. The beneficiaries are civil servants in Federal employment, and in Bauchi and Cross River states, and 300,000 pregnant women and children under the Maternal and Child Health Project (MCHP).

There are also private health insurance firms offering services to Nigerians in the organised private sector. Unverified reports put beneficiaries under this platform at about seven million.

Under the MCHP, the NHIS with funds from the Millennium Development Goals (MDGs) office plans to put 600,000 pregnant women and children under five in six states on health insurance by the end of this year as well as start in six other states with funds from the Debt Relief Gain (DRG).

The pilot project, which has enlisted over 300,000 vulnerable women and children, is ongoing in Gombe for the North East, Sokoto for North West, Niger (North Central), Oyo (South West), Bayelsa (South South), and Imo (South East).

However, the NHIS plans to make the scheme mandatory and has set December 2015 deadline to get all Nigerians to be enlisted into the scheme.

But why are many Nigerians not benefiting from the NHIS?

The Executive Secretary, NHIS, Dr. Dogo Mohammed, explains: "The first challenge is the Act, which has a lot of inadequacies and until the right amendments are done, we will not be able to have a very strong legal document to operate."

The NHIS Governing Council is in the process of amending the Act to transform it into an agency with regulatory powers to make the scheme compulsory.

Mohammed said: "The Act establishing the NHIS makes social insurance optional. From experience, quite a number of potential participants are not participating. Because it is not mandatory you find out that despite our advocacy to states and local government areas (LGAs), they are not doing anything about joining the scheme. And the only way we can make it mandatory is to amend the Act.

"Since 2006, attempts have been made to get this Act changed. The name of NHIS will change because we have realized that the Act gave the scheme a very difficult name to operate.

"The Act as it is does not cover private insurance, the vulnerable group (women and children) but only the formal sector, public servants.

"If we want the NHIS to regulate all the various fields either in the social health insurance, or the private or vulnerable groups, it cannot just be a scheme, it has to be an agency that is going to look like an authority that can monitor various schemes in the country that are to be established".

He said that the NHIS Council will look at the new draft and made input during its meeting holding from November 24 to 25, before a final draft goes to the Minister of Health who will in turn take it to the Federal Executive Council and from there to the National Assembly.

The NHIS boss said the second major challenge towards making the scheme universal is the three tiers of governance in the country.

"The three-tier system of government is another problem because what obtains at the federal level is not necessarily accepted in the states. Now, you are talking about the Federal Government as one entity, and the 36 state governments and the Federal Capital Territory (FCT) as another. It is a problem before you get them to listen to you. By extension, when you go, not all states will say their LGAs are coming along. In the states that we have been, it is only the state employees that are on but not the LGAs employees.

"The third problem is the economic status of the country where over 70 per cent live below $1 a day.

"We have found that if we were to offer the scheme 100 per cent free to people, they will not value it. They will say it is second-best, it does not have quality. In fact, they will say 'it is for the poor, why should I join this.'

"Another problem is the provision and distribution of medical facilities. The way the facilities are distributed is questionable. Over 90 per cent of our disease-burdens are in the rural areas, but less than 10 per cent of the facilities are in the rural areas. So where you have the disease burden, you do not have the facilities. And where you have the facilities and the human resources comes in as another problem. Many of the qualified human resources are not ready to move to the rural areas because of lack of infrastructure such as schools for the children, potable water, electricity and others.

"Another one is lack of public awareness. No matter what you do, there are some people that do not want to know. They are dogmatic, their mindset is that they do not want to know. Being contributory, some will say it is wrong to pay for it. There is this lack of awareness. And to create awareness is a very expensive thing, not in terms of money but even in human time."

Mohammed said contrary to widely held belief the NHIS has gone a long way in meeting its objectives of bringing down the cost of healthcare in the country.

He said: "There are 10 objectives of setting up the NHIS - that people should have easy access to quality healthcare. I have already talked about rising cost of medical care in the world and Nigeria is not an island. So the NHIS is supposed to collapse that rising cost so that you maintain it at an acceptable limit. And that is the basis for the payment mechanism where you say you tag a capitation."

Capitation is a quotation of money which the NHIS sends every month on behalf of any registered person to the Health Care Provider, whether that person visits a facility of choice or not. Though there have been calls from some quarters for an upward review of the capitation to reflect the present economic realities in the country, it has been N550 since 2005 for the primary level of care.

Mohammed added: "Reducing the rising cost to health is another objective, which people do not realise we have been able to achieve. The second one is to get a fair distribution of contributions for health in order to attack this out of pocket thing. And that is why the contribution is a capitation. That is why somebody on Grade Level 1 contributing just N170 will receive the same care with another on consolidated salary scale and contributing over N10,000. That is, when the fellow paying N170 gets sick with malaria, the treatment is the same as he pays according to his ability. So you find out there is fair distribution, the more you get the more you pay.

"Not only that, another objective is to make sure that this social economic grouping does not give a barrier to somebody to access care where he wants. I can give you an example. Before, it was very difficult for an ordinary fellow on Grade Level 2 to go to Abuja clinic. Today, he can say: 'I want to go to Abuja clinic', and he will be treated".

The NHIS Executive Secretary said the scheme has restored confidence in primary and secondary level of care, unlike what was obtainable in the past where 90 per cent of patients visit the tertiary health centres.

Primary health care is obtained at the Primary Health Centres (PHCs), secondary care at General Hospitals and Medical Centres, while tertiary healthcare is offered at Teaching Hospitals and Specialist Medical Centres.

He said: "We are going to make sure that this lack of confidence for primary and secondary level of care is restored. Everybody rushes to the tertiary level. Having to go to a primary provider is bringing back the former referral system. Because this is your gatekeeper you can only choose your primary provider. When you have a complaint, you go to your primary provider of choice. From there, you may go to the next level. It is the primary provider that will refer you and there is a protocol for that. So you can see that you are getting the proportionate number of patients visiting the appropriate levels of care. That is another objective. We are gradually re-installing some sanity in the system."

Mohammed said although the mandate is clear, "by 2015, we are supposed to cover every Nigerian." He said the reality is that one tree does not make a forest, and even if all the money that is supposed to give Nigerians cover to put into the scheme, there will still be issues of capacity, willingness to even participate, the health seeking behaviours of Nigerians, the difficult terrains, the problems of infrastructure, the problem of human resources for heath, and so on.
He said the NHIS cannot deliver on many issues as regards health of Nigerians because the system is weak.
"And there are many non-health related issues that are adding more burden. Today, if you take the environment, we should not just be treating malaria, we should be attacking the vector, we should have a clean environment. That is something that is beyond NHIS. If you come to distribution of facilities, there are also problems with standards. So it is something one cannot say, 'this is where I want to be'. You see there are so many problems."

Monday, 4 January 2010



invites you to




Professor Babatunde Osotimehin, Federal Minister of Health, Nigeria

Professor Idris Mohammed, jt. Editor-in-Chief, BMJ West Africa Edition-Nigeria
Professor Kwawukume jt. Editor-in-Chief, BMJ West Africa Edition- Ghana

Professor Richard Smith, former Editor BMJ London.


consultants, general/private medical practitioners, dentists, pharmacists, nurses, medical laboratory scientists, community health practitioners, tutors and lecturers, trainers, residents, postgraduate and undergraduate students in health professions


- What editors look for and peer reviewers
- How to read, write and publish papers in health
- Critical appraisal of published health information
- Applying published results in health practice
- ICT and Health Improvement
- Practical Work


N 5,000 per participant per day payable to BMJ West Africa (covers lecture notes, hand-outs, tea and lunch breaks, certificate of full participation)

CONTACTS - BMJ West Africa Group

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NIGERIA- CALABAR: 55 Atu St.; 20 Eta Agbor Rd.; Big Qua Shopping Mall.

LAGOS: LASUTH Premises, Ikeja. ABUJA: 7 Third Avenue, Gwarimpa.

GHANA - Dr Ado-Aryee, Dept of Surgery, Korle Bu Hospital, Accra.

UK - 65 Warden Hill Road, Luton. Bedfordshire.

Saturday, 2 January 2010

The choices we make

by ndubuisi edeoga

'Tis the season of new year resolutions, when we make and un-make even more promises to ourselves and to our friends.

We have passed through a season of changes the world financial melt downs, sick presidents, possible terrorists from our land, ASUU strikes, NASU strikes, and all other related strikes that has affected our lives in no small ways.

We would keep all of that in perspective as we dwell on the most important aspects of our lives or what is left of it " our HEALTH"

One of the most important books that I read in 2009 is "Nudge: Improving Decisions About Health, Wealth, and Happiness written by Richard Thaler and Cass Sunstein, see more here

Two days ago I was chatting with a friend in Abuja who gave himself the best Christmas present ever. He finally got delivery of the car that he spent about $47, 000 getting for himself, he enthused about the rear view camera which came at an extra cost of $680. I was very happy for him.

At the tail end of our jist I asked him about his family and all the culturally required question we are supposed to ask as Africans. Then I asked him about his health.

Me: when did you last get your blood pressure checked
Friend: About a year ago, and my doctor said it was borderline
Me: what was the value,
Friend: I cannot remember, the last time I went to the doctors office the "machine" was broken.

The machine he was talking about is the blood pressure machine also called a sphygmomanometer, it is the most basic of all hospital equipments, well we all know that Nigerian hospitals have gone beyond these basic machines we now talk about MRI, machines, CT scans, and machines in their league.

To make a long story short, I gave my friend a "NUDGE".
My friend is an UK trained attorney, who bought his car from Nigeria over the internet, after an extensive research on the web. But he would not go on the same internet and read about " borderline" blood pressures.

The choices we make.

We and our friends should not leave our health care in the hands of our doctors and some broken machines. I made my friend understand that for the extra money he paid for the rear view camera in his car, about $680, he could buy 10 portable blood pressure machines each for $68, and give one to his father who just happens to be hypertensive and to 9 other family members.

Guess what I bought him for guessed right!

According to Thaler and Sunstein in their book, some people might need more than a NUDGE, they would do better with a SHOVE or even a PUSH. We all know that doctors are crucial social architects but friends and family are even greater social architects.

Call all your friends and family and ask them for their "VITAL STATISTICS" as I call them.
1. Blood Pressure: systolic/diastolic or the upper number / lower number.
2. Fasting Blood glucose: FBS or HBA1C for people that are already Diabetic
3. Cholesterol, + LDL and HDL

NUDGE...SHOVE...PUSH in 2010!

Friday, 1 January 2010

Why we will continue blogging in 2010

At the end of 2009, one of our good friends intrigued by a blog we wrote, called to ask a simple question - why do you do it?

So, we reflected on this question this Christmas, always a good time for reflection. Some activities are dropped and others are picked up, In 2010 we will  continue blogging on the Nigerian Health Scene! But we have had to think about this question and try to provide an answer ....

Just two or three years ago, we viewed blogging as a harmless activity for people with too much time on their hands.....Since then we have seen how citizen journalism nearly brought down the Government in Iran, and the struggle continues. In Zimbabwe we saw how mobile phones were used to take pictures of election results at the periphery making falsification at the the centre difficult.

We have  realised the opportunity, indeed the responsibility we have in holding our leaders in the health sector accountable for their actions and inactions regarding our health. But more importantly - we feel that you have a right to know and we will draw to your attention the key issues.

We now see blogging as an important means of creating a more democratic and open and just society.

Fareed Zakaria eminent editor of Newsweek says in his piece in December..
This diffusion of knowledge may actually be the most important reason for the stability. The majority of the world's nations have learned some basic lessons about political well-being and wealth creation.
So we have challenged our Government for working without a Minister of Health for 9 months (but now we are learning how the country can exist without a President) , we challenged our elected representatives for abdicating on their responsibilities for 4 years but at least finally passing a watered-down version of a National Health Bill (we gather it is awaiting the president's signature). We wondered how a Vision 2020 committee on health can work in parallel and not together with the MOH.....yet we have reason to be optimistic.

We have a Minister of Health who is articulate in elucidating his vision and persuasive in forging dialogue among partners in the health sector...but in the final analyis he will only be judged by what he has done...In 2010...the job continues.

We end with this excellent Photo Story of 2009 by the World Health Organisation

Have an excellent new year!