Wednesday, 29 June 2011

The Nigeria Field Epidemiology and Laboratory Training Program

Those that read our blog regularly will remember the early days when we called for a Field Epidemiology Training Programme in Nigeria to train health professionals in Nigeria on the response to outbreaks of infectious diseases in Nigeria. We were delighted to meet a team at the Emerging Infectious Disease Conference in Atlanta last year that introduced themselves as Fellows of the Nigeria Field Epidemiology Laboratory and Training Program (NFELTP).

NFELTP is a service-oriented training program in applied epidemiology, public health laboratory practice, and veterinary epidemiology.

Created in 2008, NFELTP is managed from within the Nigeria Federal Ministry of Health (FMOH). Most of the funding has come from grants from the US Centre for Disease Control. The programme is run in collaboration with the University of Ibadan and the Ahmadu Bello University, Zaria.  It trains field epidemiology, public health laboratory, and veterinary epidemiology residents for leadership positions both in the Ministry of Health (MOH) and the Ministry of Agriculture (MOA). During their training, the residents provide service to the ministries through long-term field placements. They learn by doing, investigating outbreaks on infectious disease under the supervision of a senior colleague. 

The NFELTP is based on similar programs that have been established in more than 30 other countries since 1980. The first field epidemiology track is the U.S. Centers for Disease Control and Prevention’s (CDC) 2-year Epidemic Intelligence Service (EIS) training program. In Africa, there are maturing programmes in Uganda, Kenya, Zimbabwe and South Africa among others. The African programmes cooperate with each other

In addition, NFELTP is the first applied epidemiology program of its kind to offer a veterinary track. This enables veterinary epidemiologists to be trained alongside public health professionals to address the ever-growing threats of zoonotic and epizootic diseases to improve public health. The programme is growing and has doubled its intake this year. There is a lot to be proud of here and the challenge for us in Nigeria is to be able to sustain the funding beyond the grant from CDC, and own it, hopefully as an integral part of a Nigerian Center for Disease Control.

A programme to be proud of in Nigeria!

Monday, 20 June 2011

A revival of Continuous Professional Development for Nigerian Doctors and Dentists

Until recently in Nigeria, on completion of your 6 years of medical training, one year housemanship and one year youth service, you could begin to work as a medical doctor anywhere in the country and continue to work for the rest of your life without having to do a single hour of further training. The decision to develope one's expertise further was left completely at the discretion of the doctor. While some colleagues pursue further training, many go into the world of private practice, sometimes very early in their careers. In most cases there is no incentive or compulsion for further training. Medical knowledge and practice is continuously changing. If the medical profession is to meet its responsibility to provide effective patient care, then all doctors must continuously update their knowledge and skills throughout their working years.

The Medical and Dental Council of Nigeria (MDCN) regulates medical practice in Nigeria (the present website is horrendous, but we have it in good stead that a new one is on the way). For years, the need to update knowledge and skills on a continuous basis has received inadequate attention. MDCN has on various occasions in the past tried to address this deficit in our medical education. It is trying again to do this through the Council’s recent directive for mandatory Continuous Professional Development (CPD) for all doctors in practice in Nigeria. As from January 2011, Continuous Professional Development/ Continuous Medical Education (CPD/CME) has become mandatory in Nigeria. From January 2012, every doctor in practice in Nigeria will be required to show evidence of at least 20 CPD credit units collected in the preceding year before renewal of their annual practicing licenses.

MDCN itself has had a chequered history recently. It was dissolved in 1994 and not reconstituted for another 6 years. It was reconstituted in the year 2000 and again in 2004, but could not appoint a new Registrar because its erstwhile Registrar invoked court injunctions that immobilised it in a legal duel to resist his removal. A new Registrar was appointed in 2006, but within a year the Council removed him. The regulations of the MDCN were revised in 2007 to make renewal of the annual practising licences conditional on showing evidence of having participated in a minimum quantity of measurable training in the form of continuing professional development. Under the leadership of Professor Shima Gyoh, the Council organised a workshop in July 2007 in attempt to inspire the establishment of a network of providers of continuing training for doctors nationwide, facilitating the participation of every doctor especially those in rural areas. Before this could be implemented, our Federal Government in its infinite wisdom again dissolved the Council and it remained dissolved until late 2010. Now we have a new Council ably led by Professor Roger Makanjuola resurrecting the issue of continuous professional development. We hope that the good professor and his team have the determination to see this through and our government gives them the space to implement.

However, mandating this is one thing, facilitating the availability of appropriate CPD courses is another. If one opens the later pages of any edition of the British Medical Journal, the primary journal on the health system we have tried to adapt in our country, one finds a plethora of courses in areas ranging from clinical expertise to ethics, from management and leadership to safety. We challenge the Nigerian medical scene to rise to the challenge and develop the courses to meet this need in Nigeria.

The MDCN will then need a simple system to accredit courses for CPD courses and points, which will then need to be assessed every year before approving a doctor's licence to enable him to continue to practise. We understand that MDCN is indeed developing an e-platform through which all business with doctors and dentists will be conducted and that their website is being upgraded alongside this (a new website is desperately needed!). MDCN says that it has agreed with an initial number of CPD providers, including the two Postgraduate colleges (NPMCN and WACP), Colleges of Medicine and other bodies engaged in medical education to develope CPD content and is also currently developing a system of certification. 

This will not improve the competence of our doctors over-night. But it will hopefully consolidate a culture of continuous learning among our doctors and empower our patients to demand to know from doctors when last they went on a training course to improve their skills. The MDCN will then have to embark on a massive public education campaign to enlighten patients to request and insist on it. It will also have to brace its enforcement and legal teams to make the consequences for defaulting doctors serious and detrimental.

Maybe, just maybe we might be able to bring some

We will point to a few resources already available:

The 11th annual edition of the popular BMJ West Africa Writing Workshop  will feature its first Open Access seminar. Professor Richard Smith, Director of Chronic Disease Initiative of UnitedHealth, former Editor BMJ until 2004, has  agreed to moderate the event in the4-cities in Nigeria in 11-22nd July.

Africa Health was relaunched as a CPD stand alone journal, and provides an open access opportunity for readers to access the content, as well as to develop a forum for other resources. It als manages peer-reviewed Diabetes (AJDM) and Respiratory (AJRM) journals which are also made available on an open access basis.

Wednesday, 15 June 2011

Goodluck Jonathan's 105 commitments on HIV/AIDS

You would have all heard about our President's recent  trip to New York for the UN high level meeting on HIV/AIDS. Apart from a few pictures with President Obama, the Nigerian press has been largely silent on the crux of the matter, the reason for the trip, and the commitments our president made on our behalf. Addressing the press at United Nations (UN) headquarters following his speech at the General Assembly, Jonathan reminded us that three million Nigerians are currently infected with HIV (after South Africa, Nigeria has the most cases in Africa) adding that his Government is “totally committed to reducing this number.” Contributing to the open debate on the impact of the disease, the President stressed that the "time is ripe for a final solution" to the 30-year-old pandemic.
On our behalf, President Goodluck Ebele Azikiwe Jonathan signed up to 105 Commitments on HIV/AIDS to be delivered by 2015 - coincidentally the year his current term comes to an end. 
We urge you to download these from here and keep them. In 2015, and every year between now and then, we will read them and ask our president how he is doing. As the President himself has said....this era cannot be business as usual. So, it is up to us to hold him accountable for the promises he makes.

A few of the commitments are summarised here - some tough ones!

Reaffirm the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS and the urgent need to scale up significantly our efforts towards the goal of universal access to comprehensive prevention programmes, treatment, care and support;

Commit to seize this turning point in the HIV epidemic and through decisive, inclusive and accountable leadership to revitalize and intensify the comprehensive global HIV and AIDS response;

Commit to redouble efforts to achieve, by 2015, universal access to HIV prevention, treatment, care and support as a critical step towards ending the global HIV epidemic;

Commit to increase national ownership of HIV and AIDS responses ensuring that they are nationally driven, credible, costed, evidence-based, inclusive and comprehensive.

Commit to ensure that national prevention strategies comprehensively target populations at higher risk; ensure that systems of data collection and analysis about these populations are strengthened;

Commit to working towards the elimination of mother-to-child transmission of HIV by 2015 and substantially reducing AIDS-related maternal deaths;

Commit to encouraging and supporting the active involvement and leadership of young people, including those living with HIV, in the fight against the epidemic at local, national and global levels; 

Commit to continue engaging people living with and affected by HIV in decision making, planning, implementing and evaluating the response;

Commit to redouble HIV prevention efforts by taking all measures to implement
comprehensive, evidence-based prevention approaches;

Commit to ensure that financial resources for prevention are targeted to evidence-based prevention measures that reflect the specific nature of each country’s epidemic;

Commit to accelerate efforts to achieve the goal of universal access to antiretroviral treatment for those eligible based on WHO HIV treatment guidelines by 2015;

Commit by 2015 to address factors that limit treatment uptake and contribute to treatment stock-outs, drug production and delivery delays; inadequate storage of medicines, patient dropout;

Commit to review, as appropriate, laws and policies which adversely impact on the successful, effective and equitable delivery of HIV prevention, treatment, care and support programmes to people living with and affected by HIV;

Commit to redouble efforts to strengthen health systems, including primary health care, through measures such as allocating national and international resources; appropriate decentralization of HIV and AIDS programmes...

All the commitments available here.

Friday, 10 June 2011

Nigerian banks throwing money at medical practices

We are not quite sure whether we should be celebrating a new trend we have noticed emerging in Nigeria or not. In many Nigerian newspapers there are financial products targeted at medical institutions. At the typical interest rates of over 20%  per annum for borrowing in Nigeria , we wonder how the operations of a typical medical institution will lend itself to these products. Also with the reputation of our banking sector, it is impossible to say if this innovation in our banking sector is a good thing for our health sector or the beginning of the monster that has consumed many others.

What do you think?

Monday, 6 June 2011

Thoughts of Nigeria at the Africa Health exhibition in Johannesburg

Between the 14th and 16th of May, we attended the first Africa Health exhibition that took place in Johannesburg. It attracted over 290 international exhibitors from countries as diverse as China, Germany, Taiwan, France, Italy, USA, UK, India and many more, as well as representation from Africa’s best local suppliers, all looking for space in the emerging health sectors in African countries. In addition to the exhibition, there were a series of conferences on diverse topics such as; imaging and radiology, quality and accreditation in healthcare, obstetrics and gynecology, leadership, complementary medicine, otolaryngology, ethics, human rights and medical law.

Going round the exhibitors at this exhibition one could not help but reflect on the uncharted territory of health and health care in Nigeria. from diagnostics to medical imaging, from hospital construction to medical training. We seem to be stuck in time as we still rely mostly on our clinical acumen, and its inherent limitations for practice in most settings in Nigeria. But there is some hope! We ran into a representative of the Lagos State Government (no surprise there), the newly appointed Chief Medical Director of the University of Nigeria Teaching Hospital and a number of other colleagues working in the private sector. At dinner after one of the sessions, there was consensus that while we still had a long way to go, the time is now to start challenging conventional wisdom on the realms of possibilities for the health sector in Nigeria. The exhibition was definitely an eye opener, and showed where we were not in Nigeria, and the opportunities in several medical disciplines such as diagnostics and therapy in healthcare. These are things not easily accessible to the wider Nigerian populace.

One product that absolutely blew my mind was this mobile clinic. The flexibility of the clinical suite that can be converted from a delivery suite, to a dental clinic or even a vaccination and HIV testing unit. The possibilities are simply amazing. We gathered that there has been been one order already from Nigeria; from the Bayelsa State Government. The challenge with a piece of beautiful equipment is that it is only as good as good as the system in which it operates. Like every other piece of technology, on its own, it is not going to save a single life.

Unfortunately, we know that many other planned visitors of the exhibition were frustrated by hurdles placed by the South African High Commission in Nigeria, but next year we will expect a few more Nigerians at the Expo. We need to see and experience what is happening in the rest of the world. We also need colleagues to experience how demand is driven by well planned and executed conferences and exhibitions. The feeling after this event is summed up in this view by one of the attendees....
This event has been powerful, especially because many of the topics are relevant in Africa. It has been an informative experience and we have seen the great way in which science has helped the healthcare system.
Can this event be brought to Nigeria...I hear you asking. Not yet I would say. We are just not there yet to offer the market that will enable the success of an exhibition of this magnitude. But .....if you are interested in this we will suggest you attend MEDICA holding in Lagos from the 18th to 20th of October

Friday, 3 June 2011

The outbreaks continue...

We have blogged a lot about outbreaks in Nigeria, and the apathy of our government in responding to them. We have stated our worries about the impact of these on the people, and the ineptitude of the various "taskforces" often set up by government in response. We have on several occasions called for the identification, and collection of the requisite expertise into a National Centre for Disease Control. We know that the promise to do this has been made by several previous Ministers of Health. The last such promise was made in November last year when the Vice President, Namadi Sambo "directed" the Federal Ministry of Health to collaborate with the office of the special assistant to the president on Millennium Development Goal MDGs to establish a Center for Disease Control (CDC), in Nigeria. Nigerians have grown used to taking these public proclamations made during the hundreds of public appearances by our leaders with a pinch of salt, we hope that this will be different this time.

Recently, Médecins Sans Frontières (MSF) recieved an international award for its response to the lead poisoning incident that began in northern Nigeria in March 2010, and is still ongoing. MSF is reported to be treating more than 1,000 children for lead poisoning in several villages in Zamfara state. It is one of the most serious cases of acute heavy metal poisoning ever recorded. Why does MSF have to treat Nigerian children for lead poisoning since March 2010? Where are the instruments of the Nigerian State, that should be doing this?

Even here at Nigeria Health Watch, we have fallen prey to the apathy we complain about. Reading the newspapers during the election period in Nigeria, we were so engrossed in the intrigues of our emerging democracy and the violence that came with it that we hardly noticed these headlines until it was drawn to our attention by some of our readers.

I would often argue vehemently for our government to make progress with our power sector. The reason for this is two-fold. Firstly, due to the inherent benefits of an efficient power supply to the country, but secondly so we can find some time for the other challenges facing our country. It is our opinion that our democratic governments in the past 12 years have simply not prioritised the health sector, and neither have the population put pressure on our government in this regard.

The time has come for this to change, and maybe a more proactivce and strategic response to these outbreaks would be a good place to start. We simply cannot accept a situation where Nigerians are dying of such diseases as Cholera and Measles in 2011. These are disease that are technically easy to prevent and easy to control with basic tools. But it will take political will, and an appreciation of the complexity of the issues at stake to make progress in this regard. Several partners have offered their assistance in this regard, but we must now show the courage it takes to set up a disease control center to bring the expertise, equipment and resources needed together into a National Centre for Disease Control in Nigeria.