Monday, 29 March 2010

MANSAG mentoring Nigerian Doctors

MANSAG is the Medical Association of Nigerians across Great Britain.

Despite the odds, this association has been growing from strength to strength in supporting Nigerian doctors in the UK. Recently their mentoring activities have been  reinvigorated by Nigerian doctors in training, and ably led by Nkem Onyeador - herself a paediatric registrar. Over the last few scientific meetings of MANSAG and during the periods in between, links between mentors and mentees have been established. I have taken up this opportunity myself and supported a few Nigerian colleagues in finding their way when specialising in public health. This has not only benefited the colleagues, but has also brought me significant satisfaction.

But recently, MANSAG has taken this activity one step further by organising a training event for mentors to equip us with the skills to be effective mentors. Going to the event on the day - it was difficult to know what to expect. But getting to the event, it brought immense pride to see close to 40 Nigerian colleagues, mostly senior consultants and general practioners who had converged at the location to avail themselves of this opportunity. They had made the time, and committed the resources to come from Manchester, Newcastle, Liverpool etc to train themselves and each other with the skills to support younger colleagues.

The energy in the room was amazing, as we shared experiences, absorbed each others ideas and challenged ourselves on the different approaches to mentoring; from an informal and formal perspective. We shared the pitfalls, and the triumphs, the benefits and the challenges. In the room were surgeons, physicians, general practioners, public health physicians etc ...all with so much to share, to give and to receive. The session itself was delivered by a professional trainer on mentoring with a long history of working in the health sector. His professionalism was appreciated and acknowledged. No doubt this will be the first in a mutually beneficial collaboration with MANSAG.

Delivered in an excellent location with a view of the Thames - I left with immense pride in my colleagues; pride in the leadership of MANSAG for providing the platform, pride in the mentoring committee for organising an excellent day, pride in colleagues that gave up their time to travel around the country to learn how to support ourselves. I left with pride in the growth and maturing of MANSAG. 

The day ended as usual with a few drinks and we committed ourselves to continue doing the best we can.

View the mentoring pages of the MANSAG website here. Indeed check out the excellent new web pages of MANSAG here.

If you are a doctor working in the UK - we invited you to join MANSAG. Do not stand by the sidelines and hope that things will get better and hope that someone will fight for your interests.

join MANSAG!

Saturday, 27 March 2010

Why is the “giant of Africa” not Nigeria?

March 21 is the day South Africans and the rest of the world  marked the 50th anniversary of the Sharpeville Massacre, a turning point in the nation's history....and events of that day have been on my mind. I wonder how many Nigerian children are taught about Sharpeville in school. Today we bring to you a guest post by Mike Cooke, a true friend of Nigeria and South Africa.

By Mike Cooke

Your mention in Nigeria Health Watch of the South African rescue team being in Haiti with none from Nigeria set me thinking. 

I first went to Nigeria in 1994 to work in Lagos and Abuja. I had previously lived and worked in Swaziland, which almost surrounded by the Republic of South Africa (RSA) which I had to visit regularly. There was an awkward close comparison between Nigeria and RSA.  Both were then “governed” by an elite minority (soldiers or the “Boers”). Rich cliques in both countries had enough money to ignore the inconveniences (incompetences) of 'go slow' and power outages in Nigeria and in South Africa to avoid contact with the majority of the population except domestic servants. These cliques in both countries cared little for the realities of Governance. Both countries had police that would whip their disenfranchised citizens and generally abuse them. Crowd control at Lagos airport  involved public whippings. Crowd control in RSA in general invariably involved brutal and unacceptable police behaviour. The Sjambok or leather whip.
BUT since the 1950's the people of RSA  rebelled. They held strikes not just if the price of petrol went up but when their Government, for example, tried to enforce the teaching of Afrikaans. Matters of principle. They were prepared to show civil disobedience and, like Mandela risk jail and the death penalty. Nigerians will not. My Nigerian friends told me they don't trust the police not to shoot. At Sharpville in 1960 the RSA police did shoot and did kill and did so on many other occasions. The British army in India too, at least once forgot not to shoot. 

South Africans accepted international boycotts that would put many out of work. A lot of us in UK supported embargos of South African coal and wine and fruit while Maggie T imported the coal to defeat UK miners. We knew ANC South Africans welcomed such acts and would see it as painful but necessary support. In the end they could not play any sport except International yacht racing!!! International companies such as Barclays and Coca Cola etc moved out and eventually the apartheid regime crumbled under pressure. 

Happily the days of brutality have gone now there are the problems of criminality and inequality in both countries. In Nigeria there are appalling health standards and still shabby government.
It would be good to see Nigerians united and demanding good government and better health care. There have been the occasional rebels but they never gain the mass support needed for pressure and reform. Perhaps tribalism is the issue. But RSA has tribes as well but maybe they became less dominant through colonialism, but, things being as they are, I think RSA is likely to stay the giant of Africa although it should be Nigeria!!!! 

When in an Abuja Hospital as the GM I tried to get a doctor to accompany a seriously injured man to Kano for Orthopaedic attention. Most declined saying the north was not doable for them.  I cannot imagine a South African doctor refusing to go to the north or south of the country on grounds of religious intolerance. 

I often say to Nigerians that they should pay a more realistic price for petrol. “Why”? They ask, “it comes out of our ground.” Gold comes out of the Joburg ground but the Government does not give it to its people at cheap-rates. It uses the revenue for development. It also does not let it go overseas for refining and processing and then buy it back!! Its refineries and its gold mines work.

As far as I can see the political parties in Nigeria have no particular policies and voters tend to be purchased by the richest candidates. 
But having argued thus I recall myself saying to those who have told me they “knew Africa” from Tanzania or Malawi as a prelude to taking employment in Nigeria that Nigeria was so different it might as well not be connected to the continent. For the time being sadly I’m backing the RSA bid for gianthood!

Thursday, 25 March 2010

Are Egyptian doctors the saviours our health sector ?

We import almost everything in Nigeria. We import our consumables from China and Thailand, we ask Julius Berger to import our infrastructure, we ask Siemens to build our electricity infrastructure, we invite MTN from South African to build our mobile phone network, we even import most of the petrol we use...and we say with pride "WE ARE THE 8TH LARGEST OIL PRODUCER IN THE WORLD"

A few years ago, doctors from Egypt were invited by several states in Northern Nigeria to provide health care in their states. Jobs were advertised in newspapers in Egypt! No details were available about how much this was costing, and why it made more sense than to employ Nigerian doctors, giving them some incentives to work in the rural areas.

Now, it is all falling apart as one of the Egyptian medical practitioners, Dr. Mohsesn AbdelHameed Mohammed El-Asran, has taken the Yobe State government, and 13 compatriots in the state before a Damaturu High Court for an alleged assault on him. These events followed his revelation through a petition, that 10 expatriate doctors were not qualified to practice as medical doctors in the reported in the Independent.

Dr Mohsesn AbdelHameed added that all the 23 doctors including himself had not done any exams since they arrived in Nigeria in 2009, as required for registration as specialists and consultants.

Amazing stuff!

Medical practice in Nigeria is supposed to be regulated by the Medical and Dental Council of Nigeria - what is their stand?

The interests of doctors in Nigeria are supposed to be protected by the Nigerian Medical Association. - where is their voice in this?

This we suggest is the real tragedy of our country - that people who should speak up - who indeed have a responsibility to speak up - just keep quiet.

P/S Find here a series of jobs advertised in Reddington Hospital Lagos.

Monday, 22 March 2010

Professor Grange, History and the Federal Ministry of Health

We forget easily as people. These days, reflecting on the most recent change of guard at the Federal Ministry of Health, it is an opportune time to reflect on if, and what we can learn from history. To do this, I remember a particular saying by the German philosopher, George Wilhelm Hegel that I have always tried to convince myself is not accurate;
What experience and history teach is this -- that people and governments never have learned anything from history, or acted on principles.
Can this be true in the choice of leadership for our Ministry of Health?

When our president came to power in 2007 and appointed his Ministers - one Minister stood out as different from the pack of either typical politicians or quiet "yes men" (and women), chosen by their state governors for every reason other than being competent for the job at hand. For once we had a Minister of Health in Professor Adenike Grange who we were not only convinced was competent but who had also built a career around her integrity. Professor Adenike Grange had served as the President of the International Paediatric Association, and led the Department of Paediatrics of the College of Medicine at the University of Lagos Teaching Hospital in Nigeria, served as a Director at GAVI, formerly the Global Alliance for Vaccines and Immunisation,and had worked as a coordinator of Women's Health Organisation, Nigeria. etc etc. We as others were excited. 

Why does all this matter? Well it does matter - because a few months into the Yar'Adua Government we were told that this woman had lost her seat in government for corruption! Corruption? - It just did not add up! But... the press was all over it and we were left wondering if it could be true. Could she really have given it all up for a few dollars more? How and why in a country of sudden billionaire ex-governors, of lists of people still in public service who had collaborated with Haliburton and Siemens to rip the country of millions etc etc - Why has this lady been picked out as an example for the so called anti-corruption campaign of our government? She was tried in the public space - she lost her job and her reputation was on a knife's edge. She retreated quietly, fought her case in court and re-built her career and her image.

A few weeks ago, I saw hidden in The Lancet, arguably medicines's preminent journal - these few lines;
News from Nigeria. Adenike Grange, the country's former Minister of Health and a paediatrician who was trained in the UK, has been cleared of criminal charges laid against her in 2008. She had been accused of complicity in the loss of money from her ministerial budget. These charges have now been dismissed in a unanimous verdict from Nigeria's Court of Appeal. Prof Grange was a past Lancet -University College London annual lecturer. We are delighted and wish her well. 
We wondered - why had this received so little press in Nigeria ?.

Maybe this article in The Guardian on the present crisis in the Punch will throw some light on how articles are published (or not) in sections of our press.

But this is not universal. In the last few weeks - a few journalists have sought out Professor Grange to find out what she is doing these days. Read here an interesting piece in the Vanguard on how this author of over fifty scientific papers mainly on diarrhoeal and nutritional conditions in children, who rose through the ranks and became a Professor of Paediatrics, the Dean of Clinical Sciences as well as the Director of the Institute of Child Health in the College of Medicine at the University of Lagos in Nigeria and became the first black woman to be president of the International Paediatrics Association (IPA), a position she held until her appointment as Minister of Health in 2007 has being spending her time.

When things fell apart with government, she took up a new challenge to establish and manage an all Children’s hospital, the Otunba Tunwase National Paediatric Centre, Ijebu Remo where she is currently the Provost and Chief Executive.

Find details in the Vanguard.

...and she is still speaking about the issues she is passionate about and competent in - diseases in Childhood as reported by 234Next here.

We have previously written on her new job here.

Even if everyone else forgets - At Nigeria Health Watch we will not forget the hope Professor Grange brought to the Nigerian heath scene, her unfulfilled dreams and continuous work for Nigerian children.

We must learn from history - as yet again the Ministry of Health is in search of new leadership. This search has never been so crucial....

Friday, 19 March 2010

Final activities of our Minister of Health

Our Acting president has dissolved the Federal Executive Council. Conventional wisdom suggests that some of the ministers will be re-appointed while others will loose their positions. It is difficult to predict how things will turn out for our HMOH.

It appears such a short time ago when we were blogging on Professor Grange as Minister of Health, then we were blogging on the famed debate about who would get the health portfolio after Professors Osotimehin and Akunyili were nominated as ministers. Now we seem on the verge of starting a similar discussion for the few months remaining of this government's life span.  

The Ministry of Health could do well with some stability at its helm. This might be the 3rd Minister in 3 years!

It is apt that the last few reports on the Minister's activities related so closely to the major issues that confront the health sector.
Firstly - he was at the 53rd National Council on Health (NCH) meeting yesterday in Asaba, the Delta State capital...presenting his National Strategic Health Development Plan. This plan has been months in writing and has been widely consulted on. Now we are again on the verge of loosing it all. Nigerians pray that this plan will not be discarded...but will be the foundation of the development we seek in the health sector whether Prof stays or goes.

15/03/2009 Champion
Secondly - Prof launced a walk againt Polio. Lately there has been a lot of positive news about progress towards the elimination of Polio in Nigeria. If this turns out to be true - he will take some credit that the crucial decline occured during his tenure.

14/03/2009 PunchThirdly  - is the perverse funding situation where 70% of the Federal Governments spending on health care is spent on tertiary care - an amazing fact. This is a country that claims that primary health care is the bedrock of its health care delivery.

Lets see how events unfold.

Wednesday, 10 March 2010

UNDP report on Nigeria - startling findings

Despite the rhetoric about apparent growth in some sectors of the Nigerian economy ours remains one of the most unequal countries in the world. But what does this have to do with health? 

The effect of inequity and health is one of the most explored questions in public health in the UK. Explored in detail in the "Black Report" it remains the cornerstone of every public health physician's training and a stark reminder that the health of a people is very mostly dependent on determinants outside the sphere of influence of health professionals. One's health depends on access to a means of livelihood, access to education, transport, clean water etc. More recently in a a major new report led by Professor Sir Michael Marmot, for the World Health Organisation (WHO), he cites findings life expectancy at birth for men in Hampstead, north London, is, on average, around 11 years longer than life expectancy for men in St Pancras, just five stops down the Northern line. The research also shows that a girl in Lesotho is, on average, likely to live 42 years less than a girl in Japan. This points to the gradient in health;  the lower you in access to the basic needs to survive, the poorer your health.

The bottomline for our country is that it does not really matter how much money MTN, Shell, or Zenith Bank inject into the Nigeria's GDP, if this is not translated into roads, water, and schools....people will continue to die of causes no one else is dieing from....and most importantly, your chances of suffering or dieing is not equally distributed across the country but linked to one's access to these services. In Nigeria this means that your health depends directly on your wealth - since we have to dig our own boreholes, generate our one electricity and pay-as-you-go for our health care.

Therefore the statement in Nigeria's latest Human Development Report, released in December 2009 and published for the United Nations Development Programme (UNDP), Nigeria is not an abstract academic one!

The poverty problem in the country is partly a feature of high inequality which manifests in highly unequal income distribution and differential access to basic infrastructure, education, training and job opportunities." - UNDP Human Development Report, 2008-2009

It is titled: Nigeria 2008 - 2009; Achieving growth with equity

Find the full report here.


This edition of the Nigerian Human Development Report focuses on achieving growth with equity. In its simplest form, this concept refers to growth which enables the largest number of people, especially those less advantaged and poor, to participate in wealth creation and benefit proportionately more from the increased availability of public and private resources. In other words, growth with equity aims for a society which is fairer in the distribution of opportunities and rewards. This approach contrasts sharply with "orthodox" growth strategies which are focused principally on increasing the quantum of wealth in a country and the average level of income of the population. They are less concerned with whether or not the poor gain relatively more (or less) from this increased wealth and whether the gap between the rich and poor either widens or narrows as a result of the "orthodox" growth path.

Growth with equity, therefore, holds out the promise of a faster reduction in poverty and inequality, enabling more of the poor to gain access to productive and stable jobs, improved health and literacy, higher incomes and increased opportunities to engage actively in the life of their communities. As a result, growth with equity helps a society and country to progress from merely raising incomes to achieving a higher level of human development.

Guided by these perspectives, the Report makes three essential points:

  1. that the development debate in Nigeria over the past few years seems to have focused too narrowly on growth for its own sake rather than as a means to improved human development...
  2. that this narrow focus is likely to reduce the prospects of achieving the 7-Point Agenda and the National Vision 20:2020 because it will fail to tap the potential of countless millions of Nigerians who are poor today but can be highly productive in the future with the right combination of public and private policies and investments; 
  3. that the most effective development strategy for the future is one anchored on growth with equity. The Report marshals the evidence and provides the analysis to make this central case to Nigeria's policy-makers, opinion-leaders and general public

Thanks to Malaria Matters for this link! Excellent blog on all matters malaria.

Tuesday, 9 March 2010

OUR children

Do not look away - these are OUR children - children as old as mine, killed in Jos, in OUR Nigeria, in 2010. All can we live with this pain. How?

Credit - Linda Ekeji

Sunday, 7 March 2010

1948 - A Doctor in Nigeria

Find this video from 1948 Nigeria received via Naijablog. Notice the tight interface between clinical medicne and public health...even in 1948!

Wednesday, 3 March 2010


This is a guest post by Tarry Asoka
First published on the Carenet Website. Here

Nigeria is a federal country of 36 States – federating units, which have considerable economic and political autonomy. It has been noted that on a year by year basis, some of the States in Nigeria have resources well above the annual budgets of many countries in the sub-Saharan Africa (SSA).  Yet, health indicators of Nigeria although with some geographical variation are one of the worst in the sub-region.

Whereas the 1979 Constitution placed Health on the concurrent list of responsibilities with the exception of a few services made exclusive to the federal it also still assigned specific responsibilities to States and Local Government Areas (LGAs). The 1999 Constitution however was virtually silent on this. Each level of government is largely autonomous politically and in terms of financing and managing health services under its responsibility. The Commissioner of Health is only answerable to the State Governor who is the Chief executive Officer of the State.

In principle, State governments are responsible for secondary hospital care and supporting LGAs to provide primary health care - state planning, operational support, coordination, monitoring and training. State hospitals are under-utilised due to so many reasons that are systemic - weak referral mechanisms, the unmotivated and under-qualified staff, the payments required of patients when seeking care, the lack of functioning equipment, medical supplies and drugs. This is due as much to the lack of management systems (e.g. preventive maintenance systems for buildings and equipment, drug supply system) as to lack of resources.

However, despite all these problems many State governments are doing good things but not doing them right; and they are also not doing the right things that can re-vitalise their health systems. States behave in this manner due to a number of reasons. They derive their powers from the constitution, giving them legitimacy to exercise control over resources allocated to them – how to use them and in what ever manner they deem fit. The Federal Ministry of Health (FMoH) has little or no influence over health service delivery in the States because rather than providing oversight the FMoH micro-manages the nation’s health system. The States also have to respond to the needs and demands of their immediate environment. But most profoundly, the States do no have the capacity to absorb the huge resources allocated to them – to plan and implement healthprogrammes for their people.

To reverse these negative trends and improve the health status of Nigerians, three actions are suggested.

  1. Efforts should be concentrated at working at the State level by engaging State governments. 
  2. The role of FMoH should be redefined to become a ‘resource’ for the States rather than executing health programmes. 
  3. Finally, a ‘change movement for better healthcare’ needs to be fired up, possibly through ‘political action’.
For details of what is happening in one state; click here Nasarawa.

Monday, 1 March 2010

Thoughts on the JOB - CMD of our National Hospital

A few days ago we posted a blog on the job for the CEO/CMD for Nigeria's premier public hospital - The National Hospital, Abuja. This hospital is cherished so much as a national treasure that it is not managed by the Ministry of Health but directly under the presidency. We have written in detail in the past on the unfulfilled expectations of our National Hospital. The present CMD; Dr Olusegun Ajuwon got into the position after transitioning from being the personal physician to our erstwhile President, General Olusegun ObasanjoHe has known many a controversy and the hospital has remained  shadow of its beautiful exterior. 

So ...when we saw that there was a public advert for the position - we were indeed glad and put it up on our blog

But since then - we have wondered about several aspects of the Job Description. 

1. Why does the manager have to be a medical doctor? If we need the best manager - then we should allow the best manager for the job! Nothing I learnt in medical school has prepared me for the management responsibilities I have, and I do not see how it will prepare for this job! Indeed this might be the reason our hospitals are so poorly managed! We all loose if our best surgeons, who have never managed more than their clinical teams leave clinical practice where they are desperately needed to "manage" our hospitals. I m also not saying that pharmacists, nurses or any other professional is better suited, nor do I suggest "rotation" in typical Nigerian fashion. If we need a manager - we should seek a manager.

2. Why do the candidates have to send in Fifteen (15) copies of his/her written application with detailed Curriculum Vitae (CV/Resume)??? In 2010 can our presidency not set up a simple online application process?

3. Why do the need to know "Number of Children with Age"

etc etc etc ....

Find below Chief Exec JD for an "ordinary" hospital in the UK. Really its not rocket science! We can do more...

United Lincolnshire Hospitals NHS Trust
11 Feb 2010
Position Type
Job Function
Executive - Chief Executive
Acute Trust
Chief Executive
Substantial package

United Lincolnshire Hospitals NHS Trust is one of the largest acute trusts in the country, providing services to a population of 700,000 across Lincolnshire from four main hospitals and several smaller sites. With a turnover in excess of £350m and over 7,500 staff the Trust has made significant progress over the last three years despite increasing pressure on hospital services. As it moves toward becoming a Foundation Trust in a challenging financial climate, it requires an ambitious individual that can provide exceptional strategic vision whilst prioritising delivery of innovative and high quality patient-centred care.
The Role:
• Develop and build the existing high calibre executive team and work with the Board to ensure the effective delivery of first class healthcare services.
• Develop and maintain public confidence and a positive image for the Trust through effective communications with staff, patients and external partners.
• Lead the strategic development of the Trust, ensuring it is successful in its Foundation Trust application and takes advantage of the opportunities this will bring.
The Candidate:
• Considerable experience of leadership as Chief Executive at Board level within a comparable organisation.
• Strong strategic and business planning skills, combined with the ability to lead and inspire teams to perform at the highest level.
• Innovation and performance focussed with superb interpersonal skills, the ability to inspire, motivate and deliver results through influence.
Please see the 'Apply' button for a candidate brief containing application details, or contact us quoting reference AMM/29655/HSJ. Closing date for applications is 5th March 2010.