Thursday, 24 February 2011

How did it get to this full blown crisis in our health sector?

The simmering crisis in our public health care sector has now become a disaster as staff working in hospitals managed directly by the Federal Government have closed shop. If you have been following us on twitter you would have seen as more states joined strikes, all most on a daily basis. The Guardian reports that medical personnel are not only striking, but actually gathering at the gates of teaching hospitals and federal medical centers and turning back patients. They are turning back sick Nigerians! What does it take to act like this? How did it get to this in our country? The answer - money. The reason given - "withdrawal of teaching allowance and discrepancies in the Consolidated Health Workers Salary Structure (CONHESS)"....Apparently all staff from Grade 7 were previously paid a "teaching allowance" whether they taught or not. Now this has been withdrawn and being paid only to those who show that their job description actually includes teaching! Makes sense I hear you say, but who approved the global payment in the first place? This is how our country is run.

For daring to to do this, the workers, under the umbrella of Joint Health Sector Unions (JOHESU), have made a call to the presidency to relieve the Minister of Health, Professor Chukwu Onyebuchi Chukwu, of his appointment. Our Minister who was reported to be in Lagos early this week trying to negotiate with the workers had earlier issued a ‘No work no pay’ circular to the striking workers.

Meanwhile in the various states, the industrial actions by doctors has continued unabated as they insist on the N800,000.00 being paid their colleagues at the Federal level under the new "CONMESS" scheme. Colleagues in Enugu state announced a "total and indefinite withdrawal of services with effect from Monday, February 21, 2011 adding that "all doctors working in the federal institutions in Enugu State will join the total withdrawal of services with effect from Monday, February 28, 2011.”

Our government has not got its priorities right! It cannot expect professionals to compromise on the appropriateness of  their earning when it is extremely wasteful in its own spending with our Presidency employing a total of 133 aides including six physicians (two senior special assistants and four special assistants) who attend to the health needs of the president, the vice president and the first lady. They include two chief physicians to the president and vice president, two personal physicians to the President and the vice president, an assistant personal physician to the president, and a personal physician to the first lady as reported in 234Next.

Most of our states are not any better as they embark on white elephant projects. Having not thought strategically about their health workforce they are being caught out. As reported in 234Next, below is the picture of a hospital, apparently built by Nkoyo Ibori, wife of our beloved former governor of Delta State, James Ibori. Mrs. Ibori was recently jailed by a British court for defrauding the people of Delta State while her husband is  in Dubai fighting extradition to the United Kingdom to face corruption charges. Where she got the money to build this "hospital", which she in all humility named after herself is less of a scandal than the state it finds itself now, overgrown with weeds, and infested with rats.

Just when you would hope for a robust response from the Minister of Health to the crises, making a strong case to the Nigerian people articulating the scenarios to our president, communicating his vision to the country, the Nigerian Compass reports that the Minister is "begging" health workers to return to work. I am guessing that this time begging will not be enough.

We need to turn this argument around. It cannot only be about salaries, but also has to include the services delivered. Our government will do well to communicate to the Nigerian people what exactly our doctors are employed to do. How many surgeries are our surgeons expected to do in a week? How many patients should they see on a working day? When does work actually start in a teaching hospital in Nigeria? How is their performance managed, what performance indicators can we use to measure this.

We absolutely need to change the argument to win it for the patients. If the argument remains one only of renumeration, the answer will always be "more!", but even if we do change the argument and our government remains as profligate as it is....then arguing will not matter!

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Thursday, 17 February 2011

Nigerians on the average die 13 years sooner than Ghanaians

So very often in discussing the state of affairs in our country, we tend to compare ourselves to countries in the West, to the "Asian Tigers" or the BRIC nations. Lately we have adopted a more rationale path of comparing ourselves to our neighbors. The most obvious of these being Ghana. We share a colonial heritage with our brothers to the west, and have shared a lot of the post colonial challenges of military rule, coups and corrupt, inept leaders. But somehow Ghana has managed to dig itself out of the quandary, and start on a strong trajectory of self development. It has become one of the most travelled tourist destinations forNigerians, to the extent that the famous meeting of the Iyabo Obasanjo led Senate Committee on Health which was financed with N10 million from the illegally disbursed N300 million that the Ministry of Health took place in Ghana.

I recently found this interesting website that enables one to compare Nigeria to other countries on publicly available data. So, naturally I compared our great country to Ghana in terms of our health outcomes and the answers were sobering.

Nigerians on the average die 13.31 years sooner than Ghanaians; the life expectancy at birth in Nigeria is 47.24 while in Ghana it is 60.55.

Nigerians have 86.39% more chance of dying in infancy than Ghanaians; the number of deaths of infants under one year old in a given year per 1,000 live births in Nigeria is 92.99 while in Ghana it is 49.89.

For more visit the website yourself. 

To find out more about what our neighbours are doing in the health sector - visit some of these websites

Ghana Ministry of Health

Ghana Health Service

To get our health sector in order to deliver on the expectations of the Nigerian people and empower us to stand firm again will require re- prioritisation of health on the political agenda as we go into election season. In addition it will also require the Nigerian government to recognise that delivering on health will require sustained competence and commitment. As we have done for other priority sectors we must search the country for the individuals with the competence and courage to deal with the immediate challenges of strikes and the long term challenges of improving our life expectancy! By comparing ourselves to our neighbours maybe our politicians will see the political capital waiting for them if they prioritise the health of Nigerians.

The map below shows countries sized in proportion to the absolute number of people who died from childhood disease in one year, from the great comparator website Gapminder. It does help up put into perspective where we are!
Source -
Maybe if we communicate to people better, they will begin to demand more of their government. Maybe these tools will help our politicians see what everyone else does.

That to live in Nigeria is a greater health risk compared to almost any other country in Africa. 

Friday, 4 February 2011

Resign, Minister Resign!

While we stay glued to our television sets watching events unfold in Tunisia and Egypt, we ignore atrocities in our own governance. The image below is the home page of our Federal Ministry of Health. At the bottom right of the page, it has a picture titled "Honourable" Minister of State - Alhaji Suleiman Bello. Alhaji Bello is a serving Minister of our Federal Republic; the Minister of State for Health. The Minister, was recently served  notice of a trial to face an eight-count charge for the alleged corrupt self-enrichment of about N11.2million.

He is still serving as our Minister of State for details here.

Alhaji Suleiman Bello, is alleged to have conferred a corrupt advantage upon himself when he unlawfully solicited from Governor Murtala Nyako of Adamawa State for about N11,245,000 as ’hardship allowance.’ Hardship allowance (Nigerians would shudder at this) He is alleged to have done this while he was Resident Electoral Commissioner of Adamawa State. He is not being accused by the opposition political party or any motley crowd but by the Independent Corrupt Practices and Other Related Offences Commission (ICPC). As the story broke, and we awaited the trial to learn how hard things were for this senior government official, while working in Yola, the story took an interesting turn.

Saharareporters published a letter from the office of the Attorney General of the Federation and Minister of Justice, Mohammed Adoke stopping the trial of our Minister of State for Health. Stopping the trial! The letter said to be signed by one Akin Akintewe, Assistant Director, Department of Public Prosecution, is as below:
“I am directed to draw your attention to the above case which was instituted by your office and slated for hearing on the 31st January, 2011 at Federal High Court, Yola”, the Ministry of Justice wrote on behalf of the AGF in the letter addressed to the Acting Chairman of ICPC.
“ I am further directed to request that the original case file be forwarded to the office of the Honourable Attorney General of the Federation and Minister of Justice immediately, to enable the office take over the prosecution of the case in exercise of the power of the HAGF under S,174(1)(b) of the Constitution of the Federal Republic of Nigeria”,.
This is all very confusing. Why does Alhaji Suleiman Bello not do the honourable thing, resign his post while he clears his name? Shortly after the story broke, The Nation reported that President Goodlluck Jonathan might ask Bello to leave the cabinet this week to clear his name. But no....Alhaji  Bello remains in office serving us as our Honourable Minister of State for Health. 

Our country cannot change for the better if our public officials perceive themselves to be above the law.  As we see from North Africa, the consequences of political leadership being less accountable to the people can have devastating consequences. It is not a future we wish for our country. 

We call on the Alhaji Suleiman Bello, our Honourable Minister of State for Health to resign.

He should choose a path of honour and spare the health sector the ignomity of managing the health sector while facing these charges.

If the Honourable Minister of State for Health chooses not to resign and hides behind the cloak of a letter from his fellow Minister to the "Independent" Corrupt Practices Commision, then there are no options but for the Executive Chairman of the Agency, Justice Emmanuel Ayoola, to resign himself. How else will he have the credibility to do his job?

"Democracies survive when citizens believe that the state can give them justice. Justice is not the assurance that you must win in your cause, but the assurance that the rules will be applied fairly, - Ken Nnamani