Wednesday, 21 September 2011

No ordinary webinar with Dr Ali-Pate Minister of State for Health

On the 7th of September 2011, there was an extraordinary meeting with the Minister of State for Health in Nigeria; Dr Ali-Pate and his team, were seated in the offices of the Federal Ministry of Health in Abuja Nigeria, with hundreds of Nigerian health care professionals around the world. No, they had not all flown into Abuja, but met via a  webinar (web based seminar), that was hosted by the Anadach group. Technology is bringing those Nigerian leaders that choose to use it closer to the people, and hopefully they can begin to reduce the perceived distance between the 'leaders' and the 'led'.

NHW asked Dr Pate the first question of the webinar – “What objectives he had set for the health sector”. Previous Ministers of Health have answered this question in dubious ways, listing the number of primary care centers to be built or CT scanners to be bought. So, we were quite excited when Dr Pate, probably for the first time since we started writing on health issues in Nigeria said explicitly that he will set health oriented outcome measures and process indicators to measure these. He went on to list the 4 strategic objectives that the Ministers of Health had set themselves during this tenure as

  1. Improve basic service delivery at the front-lines focusing on consolidating the work begun in maternal and child health
  2. Focus on the prevention agenda - immunisation, health education, tackling the growing non-communicable disease burden etc
  3. Focus on clinical governance and improve quality of care in the Nigerian health sector from the chemist to the specialist hospital
  4. Unlock potential of market forces to support and drive innovation and improvements in the health sector
To achieve this, the Minister called on the help and support of Nigerian health professionals in the Diaspora, especially in these 3 areas;

  1. To hold the health sector and its leaders accountable with constructive criticism.
  2. To be advocates for the Nigerian health sector
  3. To leverage their expertise, resources, skills, and networks  to support the Nigerian health sector 
After his presentation, the Minister took questions on a range of issues. On cancer, he acknowledged that this is a growing challenge and a lot of work is going on to improve the capacity of our teaching hospitals to deal with these cases, but also advocated for the role of prevention. He acknowledged that sadly, apart from the register in Ibadan, there was no national cancer registry in Nigeria and that we have no way of knowing how big the problem really is – as you cannot really manage what you cannot measure. He promised to look into this. When asked on the Ministry’s work on supporting Nigerians with disabilities, he admitted that this was an area that had not received a lot of attention in Nigeria due to competing priorities. Questioned on the existence of a single cath lab in the country, he threw the question back at colleagues challenging Nigerians in the Diaspora to invest in these high end diagnostics, while government assures access and equity to the majority of the population.

Dr Pate made what was maybe the most important point of the session that the health Sector as it is presently structured was not not as pro- poor as it should be. He illustrated this using a slide on the inequity in health outcomes across the country, but also stated that within cities, with our meager resources - most public expenditure in health disproportionately favours those that need the least - the wealthy. The little access that the poor have in our rural areas is left in the hands of the weakest link of Government – the Local Government. This might sound good on paper, but it is terrible for the patients in real life!

Dr Pate illustrated the challenges around clinical governance, and quality of care with the example of his recent visit to a Teaching hospital in Nigeria, where a patient lost her life after she “fell” off the operating table during surgery. This team of Ministers will be prioritizing this to ensure that Nigerians that do go to the public sector for health care are assured of a standard and quality of care and know how to insist on this, when they do not receive it. This will come as good news to Nigerian patients who have gotten accustomed to often being treated as inanimate objects rather than humans in their care pathways.  

Finally, Dr Pate encouraged Nigerian professionals to develope domestic solutions to local problems, noting that we cannot afford to think in silos that are convenient for professionals, but bad for patients. Referring to innovative approaches he led on while at the NPHCDA, like the deployment of Midwives around the country, he challenged colleagues to imagine what would happen to our health indicators if we could mobilize 200 000 community health workers to support Nigerian mothers and children.  

While it is difficult to gauge the reactions of attendees in such webinars, our team that attended from Nigeria health Watch felt that there was indeed a “breath of fresh air’ in our Ministry of Health. We concluded that we have a team of competent colleagues as Ministers, one who had spent most of his life in the Nigerian public hospital scene, and the other who had spent most of his career working his way through the ranks in the tough US health system, and eventually through the ranks of the World Bank, before returning to turn around one of the most ailing parastatals in the country. If this team of Ministers does not get it right, then we will be at a loss as to who will.

Having said that, make no mistakes about it, our health sector is in a deep deep mess. The Minister has said all the right things….now its time to deliver. For those in the Diaspora, it is time to roll up your sleeves and contribute, with no expectations of a red-carpet reception.

It’s a murky world out there, but its home. 

Monday, 5 September 2011

Nigerian Ministers of Health communicating with new media tools

Communication is critical to leadership, critical to management, and extremely critical to health care; from the nurse to the Minister. Communication lies at the heart of every aspect of health; including disease prevention, health promotion, treatment and care. Therefore; timely, accessible 
and credible health information is critical for improving public health outcomes.

Yet, in our Nigeria, communication has been overlooked, at all stages of contact with the health system - from the nurse to the Minister! The patient (the "population" for us in public health) should be at the centre of all communication about health. Sadly - at best we receive a few tablets and are asked to take it 3 times a day! This is not fit for purpose in 2011. Our doctors, nurses, pharmacists must communicate better, with respect and humility. Our Ministry of Health must communicate better with the population they have been called to serve.

We have highlighted in the past the relatively good website of Nigerian Federal Ministry of Health set up for them by the DFID sponsored Partnership for Transforming Health Systems II. The structure of the website is great, but there are still a lot of improvements possible.The Department of Public Health consists entirely of 1 page of information, while that of the Department of Hospital services, on which the Ministry spends 80% of its resources is "still being developed"...but we are indeed hopeful. The biggest deficit with the website is the absence of any interactive features - so communication is uni-directional; from them to us! But, before any of you reading this complains, visit the website of the Nigerian Federal Ministry of Education - gosh...can't we do better?

But there is some hope in the horizon! Our Minister of Health has signed unto Twitter. Please follow him on @FMOHNigeria....and while you are at it, follow us at @NigHealthWatch!

In addition the Minister of State for Health, Dr Muhammad Ali-Pate, will be speaking and taking questions at a Webinar (short for Web-based Seminar) organised by the Anadach Group. All you need is electricity, a computer and broad band Internet access.  Okay...I realise that these are not easy to achieve in our beloved country - but we are famed for our resilience and innovation so we will find a way to attend.

It holds tomorrow, September 7th 2011, 6 - 7 Central Naija Time, 7 - 8 pm GMT,  2-3pm EST

Details below.... don't miss it. if we do not engage our leaders directly on the issues dear to our heart, then we loose the right to moan to ourselves....

For questions pls go to the website of the organisers.....

Anadach Webinar Series: Please join the Minister of State for Health for Nigeria on Sept 7th 2011 at 2-3pm EST

Wednesday September 7, 2011 from 2:00 PM to 3:00 PM EST
Add to my calendar
Dear Friends,

Nigeria has one of the highest maternal and infant mortality rates in the world. Horror stories from Nigerian hospitals are not uncommon. Are you wondering what the Federal Government is doing to respond to these challenges? Are you trying to figure out how to improve the health system?

Please join the Honorable Minister of State for Health, Dr Muhammed Ali Pate, via a Webinar on September 7th 2011  between 2  to 3 pm EST. The Honorable Minister is also a member of the newly formed economic team.  He will be sharing the Nigerian Government's approach to address some of the key health issues. He also wants to hear from you! What questions have you been wanting to ask?  

This is the first in the series of Anadach Webinars targeting African Health Professionals in the Diaspora.  Please send any questions you might have to  There will be an opportunity to ask the Honorable Minister these questions and others after his presentation.  

For more information on the Webinar and to register, please  click here or go to and look under the new events tabs.    Please feel free to forward to other friends or colleagues who may be interested. Participation is limited so please register as soon as possible.

Tell them to click on the link below to register or RSVP.
Register Now!

Dr Pate is Minister of State for Health in Nigeria. His appointment in July, 2011 follows his success as the Executive Director of the National Primary Health Care Development Agency (NPHCDA) in Nigeria.He also serves on the agenda committee of the World Economic Forum. Dr Pate is an American Board-Certified MD in both Internal Medicine and Infectious Diseases, with an MBA (Health Sector Concentration) from Duke University. A medical graduate of Ahmadu Bello University, he also holds a Masters in Health System Management from the London School of Hygiene & Tropical Medicine, UK. He is currently an Adjunct Professor of Global Health of the Duke University Global Health Institute. He is also a member of the Strategic Advisory Group of Experts (SAGE) on Vaccination and Humanitarian Emergencies at the World Health Organization (WHO) in Geneva.

Fiemu Nwariaku, MD - Associate Dean for the Office of Global Health, Associate Professor and Vice-Chair for Research in the Department of Surgery at The University of Texas Southwestern Medical Center in Dallas.  He is the holder of the Malcolm O. Perry, Professorship in Surgery.  He received his medical degree from University College Hospital, Ibadan, Nigeria and completed his surgical residency at UT Southwestern Medical Center where he also spent two years as a Research Fellow. He currently has an interest in endocrine and minimally invasive surgery.  He maintains an active NIH-funded laboratory studying endothelial signaling during inflammation and angiogenesis.  His clinical interests are in thyroid cancer, hormonally active adrenal tumors and primary hyperparathyroidism.Dr. Nwariaku has held significant interest in Global Health in general and surgical disparities, in particular, and was recently named Associate Dean for the Office of Global Health at UT Southwestern Medical Center at Dallas. His new plans for global health will encompass exchange programs, global research consortia and telemedicine opportunities, as well as identifying funding opportunities to advance global health missions. Dr. Nwariaku served as President of the Association for Academic Surgery during which time he created the global affairs committee for that association.  He has been a leading force in teaching and developing medical training initiatives in West Africa, South America, China, Asia, Australia and the Middle East. Dr. Nwariaku serves on the editorial board of the Journal of Surgical Research and the Journal of Thyroid Research, and as an invited reviewer for journals including the American Journal of Surgery, African Health Sciences and the Journal of Clinical Endocrinology and Metabolism.

Dr Egbe Osifo-Dawodu is a founding partner at Anadach Group. She was previously an Adviser at the new Innovation Practice at the World Bank Institute. Prior to that, she managed the Human Development Group at the World Bank Institute. Egbe has over 23 years experience in the healthcare industry. A medical graduate of University of Ibadan, she also holds an MBA from Cranfield School of Management and an MSc from Oxford University. 


Anadach Group

Friday, 2 September 2011

Call 999 - ABUJA

Once again, as Nigerians, we bow our heads in shame.

On the 1st of October 2010,  there was a bomb blast right next to Eagle Square, at the heart of the Nigerian Government, then there was another one, inside Moghadishu Barracks, Abuja at the heart of the Nigerian military, shortly after another inside the headquarters of the Nigerian Police in Abuja and finally, when it appeared that Nigerian State institutions were no longer able to arouse the desired attention, they struck the UN in the heart of Nigeria's capital. The consequences of this for Nigerians is being well and extensively analysed in various media, much more competent to do so than we are. But the one conclusion we can draw from this is that security cannot be bought with big contracts, cannot be provided by soldiers on road blocks, not by CCTVs all over the city, nor by armoured tanks and assault rifles. Relative security can only be achieved by firstly targeting the root causes, and secondly by diligent, well managed, proactive, intelligence co-ordinated with an effective response force. Sadly, you can buy this off the shelf.

Another thing you cannot buy off the shelf is an emergency medical response service! 

If we showed our gross incompetence in the area of security in preventing the blasts, our incompetence in the emergency health response was even more glaring. Look at the images below from the Nigerian press, taken following the UN blasts, and kindly note the complete absence of anyone resembling medical personnel, look at the the chaos around the ambulance, the state of the patients being carried away....and remember this is not Aba, Jalingo or Ogbomosho (nothing against these beautiful cities), this is Abuja, the capital of Nigeria, 8th largest producer of oil in the world, self acclaimed Giant of Africa, recently re-branded as a great country, with great people.

A lot has been made of the fact that Nigerians responded in masses to calls on radio and social media to go out and donate blood for the healthcare provided by hospitals in Abuja. The question that has not been asked is why this was necessary in the first place. We have a National Blood Transfusion Service, funded by our taxes.Their HQ is on 39 Abidjan Street, Wuse 2, a few minutes from most hospitals in Abuja. Is it really not rocket science to have blood reserves to manage emergencies. And what if there was a really large incident, with more than the 100 people affected here? What would we do?  Blood did not run out after a day, or two, it ran out after an hour! Compare this to the South African Blood Service. Right on their front page they tell you the blood supplies they have available for the entire country, at any point in time. At the time of writing this - it was for 5.2 days!

A lot of kudos has to go to the Minister of Health, and the Minister of State for Health for trying to lead the health response themselves after the incident. While Prof Chukwu tried to co-ordinate the health sector response, Dr Ali-Pate was one of the first at the National Hospital in Abuja. Yet, all they had to work with were their mobile phones, as there is no "Operations centre", anywhere in the Nigerian health sector to manage medical emergencies. There is in fact NO MEDICAL EMERGENCY SERVICE in the nation's capital, Abuja. As the incident unfolded, hospitals that did have ambulances sent them to the scene, the Nigerian Red Cross rallied its troops,  The Federal Road Safety Commission deployed its ambulances (you will find them, manned by drivers, at different corners of Abuja), to the scene. But the lapses were there for all to see. Patients were carried in ways that can cause more harm than good, no competent personnel was available to provide appropriate emergency care before evacuation, chaos reigned. Nigerians will know that our ambulances are better designed to transport the dead than the living. And as if the tragedy of the acute response was not enough, the UN decided that it was unsafe to continue managing the sick at our premier medical facility and had most of the severely ill evacuated to South Africa.

And to the final point - communication. A day after the incident, probably in recognition of the failure in communication of the health response, we noticed the Federal Minister of Health was on Twitter! he had just joined on the 8th of August. There is no way to confirm if he personally was tweeting, or if the Twitter account is also managed by colleagues from PATHS2 currently managing the Ministry's website. But at least he recognised the importance of communication at this time. When we @Nighealthwatch asked him who was leading the health response, @FMOHNigeria obliged us with this response ...."Overall control for health response by me. Incident site control by HMSH/Corp marshall FRSC. Nat Hosp response by CMAC". Since then ...he has been off Twitter....until yesterday's tweet - "Latest on UN bldg: 22 dead - 11 UN staff - 10 Nigns, 1 Norwegian(f); 117 injured-27 on admission, 1 of these in Nat hosp & various other hosps. But for now, he appears busy leading all the very important people on tours to visit the injured at our National Hospital.

We must as a priority for our country, set up emergency medical services in at least all the state capitals in Nigeria. And yes, there is the money to do this. If we can build an 8-lane express way from Abuja Airport to the city and buy 3 new presidential jets, we must have the money to do this - its all about priorities. No, it is not good enough to buy ambulances, or even to put a few telephones together in a call centre as done by FRSC. It must be a MEDICAL service, managed by a multi-disciplinary medical team that can provide emergency medical services from the point of incidence to the intensive care unit. It must be integrated into existing trauma services in the country. We must have a simple, nationally recognisable number to 999! We must train the colleagues, exercise and test the system, and make it work. The good news is that none of this is rocket science! They already exist in most other African countries from Accra to Johannesburg to Cairo! The bad news is that this is Nigeria, and despite all our outcries - we can almost bet, that there will be another major incident or accident, and the medical response will be exactly the same...or worse.

Professor Chukwu - prove us wrong. Take it to the next Federal Executive Council meeting, next Tuesday. They will listen!

....Nigerians follow OUR Minister on Twitter @FMOHNigeria