Friday, 28 May 2010

Instant electronic medical records for hospitals in Katsina State

We are always seeking innovative approaches to the myriad of challenges in the Nigerian health sector. If you follow this blog, you will also be interested in this website - eHealth and Information Systems Nigeria. 


On this website, we found an interesting story about a project which is focused on improving maternal and child health in Northern Nigeria, by creating effective ways to implement reliable health information management systems.


The plan is to equip seven general hospitals and five primary health-care centers with eHealth Nigeria's "Instant EMR." Instant EMR is an electronic medical records system that can be rapidly deployed to manage patient information, streamline clinical procedures, and provide data and analysis of health program outcomes.


An American Student, Evelyn Castle, had received a $10,000 public service scholarship from the Donald A. Strauss Public Service Scholarship Foundation  which awarded the scholarship to fund her engagement with this project. Her Q&A is quite interesting and is published on her school's website here.


Excerpts;
Q: How would you describe the health care system in Nigeria? 
A. Countrywide, it is one of the worst in the world.... 


Q: What was the state of the records system when you first spent time in Nigeria? 
A: The funny thing is, Nigerians record everything on paper.Everything is written down, but once it is written down it is not used.... 


Q: What is the biggest challenge you will face while implementing an updated system? 
A: There is very limited power there. There is very little Wi-Fi reception. The Internet and cell phone calls are very expensive....


OK, we know Nigeria is tough and the challenges for this project are obvious. They are heading back to Nigeria to implement an estimated 12 “Instant EMR” implementations and to strengthen relations with partner organizations, like Pathfinder International


Technology is always a winner in demonstrating innovative solutions to solve problems in countries like Nigeria. While electricity and bandwidth will no doubt pose significant challenges - the biggest challenge will be for systems to work, for health professionals to find real value in them, and for Nigerians in Katsina to acquire the expertise to maintain it.


But yes - there is a lot of space in the health sector for innovative technological solutions!  We need more takers!



Saturday, 22 May 2010

An excellent book by Dr Ana

There are extremely few books on aspects of the health sector in Nigeria. Why is this important? The critical thinking that needs to happen to transform the health sector is started again with every new administration. This is unfortunate.

So when we were recently invited to a book launch for this book titled "Whole System Change of Failing Health Systems", we were obliged to attend.

Not only did we find this book fascinating, but the author himself has a fascinating story. But first let us consider the context. As Governor Fashola is today considered the most progressive Governor of a state in Nigeria, between 1999 and 2007 that honour belonged to the Governor of Cross River State - Mr Donald Duke. Donald Duke recruited Dr Ana  to become Commissioner of Health. Unlike most of our politicians who immediately start either a building programme or a medical equipment buying spree, Dr Ana took a different approach. Following a tour of health facilities in Cross River State he decided that the problems were  not solvable by buildings or MRI scanners. He set up the first Centre of Clinical Governance in Nigeria. This idea was later adopted by the National Council of Health in 2006.

Read some of his initial findings.....
There was virtually no emergency care provision, no hospital had an emergency preparedness plan functioning resuscitation equipment, not in theatres, not in the emergency rooms, not in the labour wards....
There was no ambulance service....there were a few vehicles called "ambulances" but they were de factor hearses....
No running water - not even in the General Hospital in Calabar....
Poor patient attendance, turn over, follow up.....  
It is a page turner - as this is not one of us that is accused of sitting on our arm chairs and writing. This is from a man that was invited to serve. So what did Dr Ana do about the situation he found?

To find out - you'll have to buy the book - through bmjwa@yahoo.com

Thursday, 20 May 2010

The 5th National Conference on HIV/AIDS in Abuja

We will not be surprised if you did not hear that the 5th National Conference on HIV/AIDS held in Abuja on the 2 - 5th of May. There were just a handful of articles in the print media and almost nothing on radio and TV. Yes - there is growing apathy in the country - but with an estimated 3 million Nigerian adults infected, the pandemic has hardly receded. So when Nkem Chineme told me she was travelling with her group of colleagues from the University of Ibadan for the conference in Abuja - we inevitable jumped on ask her to write a personal account of the conference. Faithful readers of this blog will remember her excellent report from the ICASA in Senegal. 


This is her story.... enjoy and reflect....


I recently attended the 5th National Conference on HIV/AIDS in Abuja, Nigeria, May 2-5. It was my first national conference in Nigeria, so I had nothing else to really compare it to except take it for what it was or other international conferences, especially the most recent ICASA conference in Dakar, Senegal.

All in all, I was impressed on my first day of attendance at how many people attended the 9am plenary session. Although we had to wait in long security lines to get into the conference center, causing a one hour delay of all sessions, the crowd was very engaged and in full attendance.

Unfortunately, there were several events on the Saturday before the official start of the conference, and early Sunday (May 1 and 2), although the conference officially begun May 2. And since the conference program was only put on the website a few days before May 1, most people I spoke to did not know about these earlier skills building sessions that took place all day Saturday and Sunday.

The theme of the conference, “Ownership and Sustainability” was resonated in the plenary sessions of May 3 and 4. On May 3, it primarily focused on the role of the government in sustaining HIV/AIDS programs in Nigeria, while on May 4, the session was largely clinical, with most of the panel made up of PEPFAR staff/affiliates.

I have to say, for a national conference, the presence of non-international affiliated Nigerian researchers and the publicity within Nigeria were minimal. I am not sure if there is a rule against having banners at the conference center, but there was none anywhere outside the conference premises that would alert people about conference – although there was on site registration. Also, there was nothing on the television advertising the conference, except for a few seconds of mentioning it during the 9 o’clock news regarding what one government official might have said. The new Minister for Health was only appointed/confirmed a few days before the start of the conference, so probably was engaged in other things, because he was not present at the conference any of the days I attended.

Personally, I would say the conference was well organized with regards to having things close together and having shuttle buses that took people to the Chelsea hotel, Abuja, which was a second venue for the conference. There was constant electric power supply (PHCN or generator) and a large number of people attended.

However, from some of the questions raised during Q&A sessions, and the response from audience members in support of some questions, such as when there was applause to a question about doing away with ARVs and focusing on “our” traditional herbs. Apparently someone (who I didn’t catch his name) had proven years ago that these herbs work, but they have been ignored by the medical world. The ignorance of the question – especially since he begun by saying “prevention is better than cure” so the herbs should be used rather than ARVs – was disturbing. And from my studies, which we presented the findings of at the conference, several people believe that bathing with or rubbing several herbs after intercourse will prevent infection from the AIDS virus. But what was also more disturbing was the loud applause from the audience in support of what the man said.

One issue that I would have liked as a focus of the conference is Stigma. There is a serious problem with stigma and stigma in man ways in driving the epidemic more than anything else. It was also somewhat evident at the conference – in my opinion. For instance, when I visited the exhibition area, I went around looking at who was there, and also looking for those providing HIV testing services. At ICASA, 2 or 3 exhibitions stands had testing services at their stands and I have seen that at other conferences, but there was none here. I roamed the conference grounds and far off in one corner of the conference center grounds, there were four or so obscure tents. Without going close to them and actually asking what happens here, you would never know they were testing areas. A tent for an event planner advertising at the conference was much closer and more visible than the HIV testing tents at an HIV/AIDS conference.

Overall, from questions that were asked, there is still widespread anger towards the Nigerian government with regards to their response to HIV and AIDS. Some directly addressed the former Minister for Health during one of the plenary sessions asking him to account for what exactly he had done to address the AIDS epidemic in Nigeria while he was NACA DG and most recently Minister for Health. In addition, we had all received a free newspaper at the conference and the headline on one of the days was “Senators demand N43bn annual allowance.” This is outside of furniture allowance and housing and all what not. It comes out to something like N100million each quarterly or something like that. But at the same time, there we were proudly being told how the 2010 budget included N5bn for the Ministry of Health and NACA together, with majority going to HIV/AIDS, with an expectation for an applause. One woman couldn’t help herself but to say “Shame on the government!” According to her, we keep talking about what external donors are contributing to addressing the AIDS problem in Nigeria, but what has Nigeria ever given any other country to address AIDS, when some people in government are collecting large sums for allowances?



In my personal opinion, the conference was relatively well organized, but for future conferences, it would be nice to see a larger presence of Nigerian researchers (outside of those related to PEPFAR or other international institutions). There was very little of that, especially none from the University of Nigeria, Enugu, where I used to work. I hope for the next conference, the focus will include addressing stigma, all SACAs across the country will be required to give presentations on what they are doing within their states to address HIV and AIDS. But all in all  - a good conference.

To the right is Professor Idoko, DG of NACA. A few more pictures from the conference below.






Tuesday, 18 May 2010

Our new Minister of Health

Its not been easy finding out much about the new Minister of Health in Nigeria Prof.Onyebuchi Christian Chukwu ( ...a powerful name invoking the Almighty in all three names!). He was born April 22, 1962, hails from Afikpo in Afikpo LGA of Ebonyi State. He graduated from the University of Lagos in 1986 and was Chief Medical Director, Ebonyi State University Teaching Hospital from 2003-2008. Later, he became Deputy Provost of the College of Medicine of the Ebonyi State University, Abakaliki, from where he was appointed the Minister of Health.

He is reported by Vanguard to have stated his vision around these vague parameters;
"ensure that Nigerians begin to enjoy good health indices as well as entrenchment of the tenets of team work and unity amongst staff of the Ministry of Health"
Then one of his first activities was reported as a visit to Lagos University Teaching Hospital (LUTH) on a fact-finding mission. Why is this worrying?  We have real challenges in understanding the difference between a "Minister of Health" and an "Administrator of Tertiary Health Care Centres"...and this visit is indicative of this. Why LUTH? Will Professor Chukwu now go on fact finding to all the teaching hospitals in the country? Will he go to the secondary and primary care centres. Will he go to pharmacies and medical laboratories?  When then will he have time to deliver....in a 1 year term? Professor Chukwu has come fresh out of a tertiary care centre, I would argue that if there is one aspect of the entire health sector that he does not need to visit - it would be a teaching hospital!

It is difficult to run a Ministry of Health. It is even more difficult to run it in 1 year cycles. Professor Osotimehin in his first year was implementing a budget and agenda that he inherited, at the beginning of the life cycle of the implementation phase of his first budget - he is removed. Professor Chukwu will now implement this and draw up the next budget - which someone else will deliver.

Not easy!

But because so much is at stake.... because there is an opportunity for a fresh start with a virtually new team of directors at the Federal Ministry of Health. With the opportunity of competent and visionary directors in charge of parastatals in the Ministry such as Dr. Pate at NPHCDA and Professor Idoko at NACA (don't ask me about NHIS)...maybe Professor Chukwu will build on Professor Osostimehin's trajectory...if for nothing else for the sake of long suffering Nigerians.

If we were to suggest one single priority....

Get the new Health Bill signed by Mr President.

Sunday, 16 May 2010

Innovation in Ghana

Until recently we had our way of hunting down fake medicines in Nigeria. The DG of NAFDAC would team up with a squad of "mobile" police men and go to the nearest market, round up a group of dealers, sieze their apparently fake medicines, go to a large open space, invite all the gentlemen of the press and burn them in a large burn fire. Until today all sorts of medicines are available in any mixture you want throughout the major markets in eastern Nigeria - fact! (I know this statement will not be popular).


The World Health Organization believes that 25% of the medicines sold around the developing world are inauthentic copies containing little or no active ingredients.

Now to Ghana...

Ghana has become not only the choice destination of businesses leaving Nigeria and the choice holiday destination of an emerging middle class, but now they seem to be at the centre cutting edge of innovative solutions for the continent. One has caught our eyes....

Can you imagine a lady walking to a patent medicine dealer and then sending of a quick SMS/text-message via her cellphone to confirm that the prescription drug she intends to purchase is safe for her child and not a fake?

mPedigree, a Ghanaian start-up, is working to make this a reality throughout Africa. It is led by Bright Simons, a dynamic, young social entrepreneur from Ghana, who is on a mission to find partners and investors and spread the word about mPedigree. If mPedigree is able to forge the public-private partnerships necessary between governments, the pharmaceutical industries, and telecom giants, this technology may well become a revolutionary force in bringing access to safe drugs to people across the developing world.
How it works

Pharmaceutical companies emboss special codes on drug packaging that are recorded in mPedigree's database. When consumers purchase a drug, they can scratch off a panel to reveal the unique code and send it via text message to a universal four-digit number. The request is routed to mPedigree's servers, located in New Hampshire. After sending the code, consumers get a response by text, usually within five seconds, indicating whether the product is genuine.


To read more.....

- in Business week
- in the Economist
...etc etc....

...and Bright is now a TED Fellow.


Pls NAFDAC save us any more pictures of burning drugs in our newspapers. This is after all 2010...

Friday, 14 May 2010

Twist of fate - new Ministers of Health in Nigeria and the UK

Nigeria and the UK have an important historical relationship that is not lost on us. In October this year we celebrate 50 years of independence. By some twist of fate both countries have in the last few weeks appointed new Ministers of Health. After the self-serving debate on whether the MOH should be a medical doctor or not in Nigeria, we await some indication of a policy direction from our new Minister. Meanwhile within 24 hours of being appointed, read below a press briefing by the newly appoointed Health Secretary (equivalent of a Minister of Health) in the UK. Interprete as you wish ...(coincidentally he was a career civil servant, working at the Department of Trade & Industry)



Andrew Lansley CBE was appointed yesterday as Secretary of State for Health. Mr Lansley is the MP for South Cambridgeshire and previously served as the Shadow Health Secretary – a position he held from 2003.


Mr Lansley said:

“It is an immense privilege to be appointed Secretary of State for Health in the new Government.

“Just as Britain needs strong and stable Government, so we intend to bring to the NHS the consistent, stable reform, which enables it to deliver improving quality of care to patients.

“I have met many people working in the NHS and social care; I know they want to focus on patients and to be accountable for the results they achieve.

“I am determined that we will have an NHS in which the patient shares in making decisions; where quality standards are evidence-based and form the basis of the design of services and their management; and where the objective is consistent improvement in the outcomes we achieve, so that they are amongst the best in the world.

“To achieve this in the current financial crisis requires leadership and highly effective management. The NHS will be backed with increased real resources but with this comes a real responsibility. We will need progressively to be more efficient, to cut the costs of what we do now, to innovate and re-design, in order to enable us to meet increased demands and to improve quality and outcomes.

“This will not happen in a top-down, bureaucratic system. Decisions must be taken with patients, close to patients and with clinical leadership at the fore.

“If we are to succeed in improving the health service, we must also improve the public health of the nation. We must promote good health, stronger locally-owned public health strategies and effective screening and prevention of disease.

“We will create a more integrated public health service at the heart of healthcare policy. To improve health and well-being, we must offer support, security and services to those in need of personal and social care.

“There is much to do. If I have learnt one thing over six-and-a-half years as Shadow Health Secretary, it is that in the NHS we have an immense number of talented, committed and capable people, who want to be trusted to get on with the job. It will be my task to enable the NHS to do this; with our shared ambition to achieve the best healthcare service anywhere in the world.”

....maybe there are somethings in this for us to learn from ...just maybe.

Thursday, 13 May 2010

Wishing this was happening in Nigeria

It takes courage and leadership to confront some of the huge health challenges confronting us. But health is complex. Its a bit like our electricity problem in Nigeria. It cannot be solved by throwing money at it. It cannot be solved by grand statements of intent. It requires in depth knowledge of the issues at stake, and not just clinical issues but expertise in management and financing mechanisms. It requires careful negotiation with stakeholders as the last leadership of our Ministry of Health attempted to do. But now Nigerians seek the innovation and courage to be translated into opportunities of real health gain.

Find below two examples of what we refer. Its no surprise the countries they come from.


Rwanda

Almost exactly one year ago today, Rwandan Minister of Health Richard Sezibera vaccinated the first child in Rwanda against pneumococcal disease. In so doing, he made Rwanda the first 'GAVI-eligible' (low-income) country to begin protecting its children against this devastating disease. Dr. Orin Levine joined GAVI Alliance CEO Julian Lob-Levyt, the World Health Organization's Dr. Thomas Cherian, and others at this event in rural Rwanda, and to then meet with Rwandan President Paul Kagame who reiterated his country's commitment to improving health for all its citizens. Since that time, The Gambia has also joined the ranks of GAVI countries using pneumococcal conjugate vaccines. Last year's program launch was based on a donation of 7-valent vaccine from Wyeth (now Pfizer). The company agreed to provide enough vaccine for these countries to vaccinate all their children for at least two years. This year they're launching 10-valent and 13-valent vaccines through the Advance Market Commitment (AMC). This innovative approach to vaccine financing means that the world's poorest countries will have long-term access to these vaccines at affordable prices. Basically, each dose can be purchased for about the same price as a Starbucks latte! What makes this most remarkable is that the launch of these vaccines at these prices is occurring within the same year as the launch of these vaccines in rich countries at prices of close to $100 per dose.

Details here in the Huffington Post. 


South Africa

In what the United Nations calls the largest and fastest scaling-up of AIDS services ever endeavored by a country, South Africa plans to test 15 million people for HIV by 2011, a six-fold increase in just two years, and provide antiretroviral treatment to 1.5 million people by June 2011, up from 1 million the past year. To achieve this target, the South African government will help its 4,333 public clinics to dole out AIDS medicines. The Joint United Nations Program on HIV/AIDS lauded the new campaign, and expressed hope that it will set off a new dialogue on HIV prevention and safer sex. UNAIDS also welcomed the South African government’s move to reduce the cost of antiretroviral treatment.

Details here in the UN



....if only we could hear more of these from our country, rather than the next plan to buy MRI and CT scanners for teaching hospitals!

Sunday, 9 May 2010

The Paediatric ward at LUTH: A simple story of our collective failure

We have often been critical of some of the health reporting in our mainstream newspapers in Nigeria but this morning I have found a well researched piece, simply and explicit that brings to life the horrific conditions in our tertiary care centres in 2010 Nigeria. We have always wondered why Nigerians are not angry enough at the state of their health care system, why our colleagues in the profession seem to be in denial about the prioritisation of their demands of government and why the the government itself chooses to focus on everything but the quality of care. I invite you to read this piece by TOYOSI OGUNSEYE in the Punch of Sunday May 9. I then invite you to send it to every Nigerian you know. It s the story of how OUR children are cared for in the Lagos University teaching Hospital Lagos, one of the country's premier public tertiary health care facilities.

Below are some excerpts...read each one slowly. None of these will require millions of dollars to solve. None of these should be insurmountable in 2010 Nigeria, as we approach 50 years of independence. But be strong as you read, as if you do have children yourself it will be hard to hold back the tears. Each of these excerpts has one simple element that is solvable with a bit of will and leadership. 


Common Nigerians.... don't let this keep happening to YOUR children.


"While weary looking mothers sit on the wooden chairs in the reception area, the frequent shrieks from babies in the clinic unsettle everyone in the environment, which is a far cry from being clean. There are a few men around in this section of the hospital, which has only two dirty toilets, already flooded by water. There is no bathroom..."

"After a few minutes, his mother comes out of the hospital and screams profanities at the medical personnel on duty. She feels that they did not do enough to save her five-day-old baby. The doctors and nurses ignore her and continue attending to other babies who are in critical condition..." 
 
"Each bed in the emergency ward, which was opened by former Health Minister, Prof. Olikoye Ransome-Kuti, in Aug. 22, 2001, has a minimum of two babies that are between a day and one-month-old occupying it..."

"It is important that their mothers hold their babies all the time because the beds in the hospital do not have side bars that can prevent the babies from falling off. Even when the drip is removed, I can‘t sleep because my baby may fall down..."

Since I gave birth to my child, I have not slept. Even if they allowed us to sleep in the ward, I doubt if I will do that because the mosquitoes there are too many. We use mosquito nets at night to protect our children. I have also not had my bath because there is no bathroom here..."

”When they admitted my child, I was asked to pay some fees and buy some drugs. Where I paid for the drugs was different from where I collected them; which was also different from where I was given a receipt.

”The pharmacy is a 10-minute walk from the bank where I paid the money and the office issuing the receipt is another 10-minute walk back to the hospital. I have had to make this journey several times because my baby needs new medication almost every day. I realised that if I did not device a means of sleeping, I will collapse.”

That scenario was what the mothers in the room needed to express their reservations about the doctor on duty. ”I don‘t know what is wrong with him. He behaves as if he is doing us a favour, but he is not. We are all paying; nobody is treated free of charge here and that is how the doctor gets paid. He acts as if he doesn‘t care about our babies, doesn‘t he have children?” one of the women says.

Last week, a baby died because the nurse did not remove the drip in its hand early enough. Its mother called the attention of the nurses on duty to the drip, which had finished. She kept calling the nurses when she noticed that her baby‘s blood was flowing back into the drip. By the time the nurses attended to the baby and removed the needle, it was already very weak. The baby died.”

So, why do people stick to the hospital despite its shortcomings? Some of the mothers explain that they do not have a choice. They say, ”This is a federal hospital that has specialist doctors. Most of the private hospitals don‘t have specialists or equipment so we have to come here when our babies are in danger.

The hospital's response: 
”We have to keep three babies in one bed because we don‘t have enough beds. Is that not better than turning them back and allowing them to die? They say that babies die here but this happens because the mothers will watch the health of their babies deteriorate before bringing them to us. But we are not magicians. No one talks about the lives that we save.
Read the full story here.

We have a long way but we can start somewhere. We can....

Wednesday, 5 May 2010

Social networks and health....are we missing a trick?.

by ndubuisi edeoga


Despite all the best efforts of modern medicine, the cost of medical care keeps rising, for those who can afford it, and the quality of care keeps falling for those who cannot. What a paradox.


One simple fix to this rising cost is to improve our efforts at preventive care....Or NOT so simple!

The Internet today offers us the opportunity to get a good chunk of our medical information at minimal costs.  Several sites exist that try to fill this niche...www.ccjm.org, www.aafp.com, www.webMD.com, www.BMJ.org, www.up-to-date.com to name a few. Most people will argue about the content, veracity, and usefulness of internet sites, all very valid arguments. Sometimes the information is not organised in a way that makes it easily accessible or usable. Some of it is of unknown validity...but at the very basic level ...there is a lot out there.

The rise of social networks like Facebook, Myspace, and twitter, adds another dimension to information access. These sites literally come to you with information (no need to go to...), via regular updates. Every day I get a new invitation to be a "friend" from people I have known from all over Nigeria. Old and young, Real friends and ex foes. School mates, soul mates...and "kporapos"...

Maybe ...we could all do more in using this medium to remind our loved ones on the things that matter so much ..the things we always push off to the next day.

Imagine... instead of sending a poke, or a pillow, or another message of who won the weekend's soccer game...you send a friend a reminder to go get their blood pressure, fasting blood glucose of cholesterol checked....


The viral use and wide spread acceptance of social media affords the medical community an opportunity to tap into this resource. This is even more important in developing countries like Nigeria. I did a recent count of all my friends and it seems to me that "Every Nigerian" (emphasis all mine) is on Facebook. Well not quite, but you get what I mean. While we wait for the hospitals to be built, while we wait for the new health minister to settle in, lets help ourselves and be our brothers/sisters keepers.

The next time you get a birthday reminder, or a poke, poke them back with a reminder about getting their blood pressure checked, fasting blood glucose, cholesterol, annual eye exam, colonoscopy for people above 50 years, and all the good stuff recommended by the preventive health agencies.


That way you are helping ensure that they stay around for their next birthdays.