Tuesday, November 30, 2010

HIV/AIDS in Nigeria: re-evaluating the finances spent in combating the pandemic

Within the week, Nigeria joined the rest of the world to mark World AIDS Day with the theme “Universal access and Human Rights”. On that day (December 1st) health experts and stakeholders across the globe gathered in several fora to raise awareness about the pandemic even as it international solidarity is demonstrated.

While World AIDS day is one of the most visible opportunities for public and private partners to spread awareness about the status of the pandemic and encourage progress in HIV/AIDS prevention, treatment and care in high prevalence countries and around the world have continued to remain a major concern. This is as the 2008 figures released by the World Health Organisation (WHO) reveal that 33.4 million people are living with HIV and an estimated 2.7 million are newly infected with the virus.

Driving this matter home, when the HIV virus was first discovered in Nigeria in 1986, billions of Naira was pumped in through various fronts which were targeted at fighting the scourge. Latest reports suggest that the huge sums spent on the prevention and management of the pandemic may not be over yet in the country as Director General, National Agency for the Control of AIDS (NACA) John Idoko revealed that the country needs about N6 billion to effectively combat the Acquired Immune Deficiency Syndrome (AIDS). Idoko made this disclosure at Abuja while briefing the press on activities lined up to mark the 2010 World AIDS Day.

Been that as it may, Olusoji Adeyangu, a medical expert at Adeoyo Maternity Hospital, Ibadan, who spoke with BusinessDay recently, disclosed that recent statistics of HIV/AIDS, may continue to be scary for the African continent despite all sorts of campaigns and investment, unless something drastic is done.

According to Adeyangu, "There are serious emerging challenges for the continent in terms of treatment. This is the soul of the epidemic- it intersects with the weaknesses of the human condition: sex, drive to procreate, power imbalance between the genders, poverty etc. Don’t forget that gender issues and poverty as the unique drivers of the spread of the virus in sub-Saharan Africa.”

As the United Nations recent report of 4.6 percent as HIV prevalence rate in Nigeria, some school of thought are of the view that the reduction in prevalence rate may not really justify the huge funding that the HIV/AIDS project has gulped so far in the country.

At the moment, it is very difficult to make reference to any credible statistics for Nigeria given the fact that the treatment situation is such that about half a million people among those who are HIV positive in the country need to be on treatment.

From this figure, almost half access their treatment from sources other than that of government, yet, every year, it is believed that HIV/AIDS gulps so much from the federal budget and attracts heavy grants from donor agencies.

According to the Global Fund which is the largest donor agency in Nigeria on HIV/AIDS, Nigeria has attracted approximately $200m over five years to fight HIV/AIDS. This figure, the body said, is outside the yearly budgetary allocations to the agency from government and grants from other donor agencies. The principal recipient of most funding for HIV/AIDS remains the National Agency for the Control of AIDS (NACA).

In 2006, the Global Fund cancelled a grant to Nigeria for reasons that border on non-performance. If the grant for that year was approved, it could have got thousands of People Living with HIV/AIDS (PLWHA) who need treatment on the anti retroviral therapy. Inadequate capacity for efficient programme management of large-scale financial interventions for public health was one important reason the body cited for the cancellation.

Apart from claims that the agency presented questionable data, it also said that NACA favoured a manual accounting system, which was inefficient. To the Global Fund, "funds should not just be spent simply for its own sake, just as a process, or disappear into deep private pockets, but to achieve concrete outcomes in prevention, treatment and lives saved by the interventions funded".

For the United States President’s Emergency Plan for AIDS Relief (PEPFAR), another major funder of HIV/AIDS activities in Nigeria, the size of the population and the nation pose logistical and political challenges particularly due to the policy of the Nigerian Government to achieve health care equity across geopolitical zones.

However, the necessity to coordinate programmes simultaneously at the federal, state and local levels introduces complexity into planning, the body noted.
“The large private sector is largely unregulated and, more importantly, has no formal connection to the public health system where most HIV interventions are delivered. Training and human resource development is severely limited in all sectors and will hamper programme implementation at all levels. Care and support is limited due to the fact that existing staff are overstretched and most have insufficient training in key technical areas to provide complete HIV services,” it stated on its website.

Going further, between 2005 and 2006 alone, a total of N14.7 billion was budgeted to fight HIV/AIDS from the federal allocation.

While efforts are been intensified by NACA, development partners and other relevant stakeholders in the country towards curtailing the economic damage caused by the high level of morbidity resulting from AIDS, it is imminent to state that genuine efforts should be made at channeling the funds earmarked for treatment and management of AIDS should be judicious spent.

For a HIV/AIDS activist, “if the treatment of the virus is the main challenge a country like Nigeria is facing in tackling HIV, then major effort and funding should be directed at making treatment available for all living with HIV and other related infections. And if we are grappling with mobilisation and advocacy or behavioural change, it will be beneficial and better to channel our effort financially and otherwise in that direction.

“Our collective sincere effort and activities that are aimed at reducing the spread of the pandemic must be visible and evident for us to be encouraged and hopeful of a reversal in the spread of the virus. Our effort and the resultant impact must justify the funds that are being received, which would then justify demand for more funds from donors and the government.”

In addition, the plans by the Federal Government to halt and reverse the spread of HIV by 2015 may not be achieved if it doesn’t sincerely provide universal access to HIV prevention, treatment, care and support programmes in the country.

By Alexander Chiejina

CSR: FIDSON donates N1 million to children with special needs at CDC, Lagos

In what can be described as a conscious effort towards living out its motto “We value life”, Fidson Healthcare Plc yesterday extended her life-valuing gesture to people suffering from disabilities as it donated N1 million as part of its Corporate Social Responsibility (CSR) to Children Development Center, Lagos.

Making the donation on behalf of Fidson Healthcare, Oladimeji Oduyebo, Corporate Services Manger, Fidson Healthcare Plc said that the core of the company’s CSR is centered on children’s health, the company deemed it fit to contribute its quota towards improving the quality of life of the children.

Oduyebo noted that it was for this reason that it made the donation towards supporting Children Developmental Center, a non-governmental organisation totally dedicated to the provision of quality support services to children and young adults with disabilities.

In his words “children with various forms of disabilities are like any other children out there. So as a corporate organsation that focus on children’s health, there is the need to support those who take care of these children both financially and otherwise especially during their developmental stages so that they can have a feel of belonging in the larger society.

“However, over the years, we have also extended scholarship schemes to children in Nigeria as part of our CSR. Fidson Healthcare will always be committed towards formulating products and services which is geared towards improving the life and health of children.”

Responding to the donation, Yinka Akindayomi, service director, CDC, thanked the management and staff of Fidson Healthcare for providing financial support to the center. Akindayomi revealed that the primary aim of setting up the center was to add value to the lives of people with disabilities in order to make them stakeholders in nation building.

The service director disclosed that the challenge with running the center has been the negative perception of the community with regards to children with special needs as this has often times made parents with such children not seeing the need to invest in their lives to become leaders of tomorrow.

In her words “the perception of people with disabilities still remains a challenge in our society. We won’t be dissuaded by this singular fact. In CDC, we have in place the following quality service which are focused on improving such children; early intervention unit, pre-school unit, adolescent and young adults educational and vocational unit, physiotherapy and disability advocacy units to mention but a few. We have about 300 children in our care.

“We however solicit to the general public for more funds as it complete its Living and Learning center at Ibeju Lekki (an 8. 35acres of land) estimate to cost N500 million. The Phase One of the project is on-going and when completed will be relevant in meeting the ever changing needs of people with disabilities in Lagos and beyond,” Akindayomi concluded.

It is believed that with support from other corporate organisation in the country, children with disabilities will have a belonging in the outer society following acquisition of skills it must have acquired in centers of this sort.


by Alexander Chiejina

Friday, November 26, 2010

Experts calls for strengthening of antimalarial efficacy

…as national monitoring key in preventing malaria drug resistance

For health experts across the globe, there has been increased worry over the incidence of some malaria medications which is believed not to have been efficacious in delivering the desired cure to people who take such antimalarial drugs.

With complaints on the inability of some drugs regimens to effectively cure malaria, the World Health Organization (WHO) has called on countries to be increasingly vigilant in monitoring antimalarial drug efficacy in order to allow for early detection of artemisinin resistance. This is one among several conclusions of the “Global report on antimalarial drug efficacy and drug resistance: 2000–2010”, which was released recently.

The report is based on 1100 studies conducted by national malaria control programs and research institutes over the ten-year period. The report estimates that only 34 percent of malaria-endemic countries are complying with WHO recommendations to routinely monitor the efficacy of first- and second-line antimalarial medicines.

In February 2009, the WHO confirmed that resistance to artemisinin had emerged on the Cambodia-Thailand border. Although patients infected were cured following treatment with an artemisinin-based combination therapy (ACT), the recovery took more time. In artemisinin-resistant areas, the high cure rates observed depends heavily on the efficacy of the non-artemisinin component of the combination.

Nonetheless, the report found that ACTs currently recommended by national malaria control programmes remain efficacious in treating malaria, with cure rates generally greater than 90 percent. In countries where the currently recommended ACT has a cure rate of less than 90 percent, policy change is ongoing to implement an efficacious replacement treatment for malaria.

In an interview with BusinessDay, Wellington Oyibo, consultant medical Parasitologist, college of medicine, University of Lagos, Idi-araba, Lagos, said that the emergence of artemisinin resistance on the Cambodia-Thailand border has been a wake-up call to the world to prevent its spread, increase monitoring, and preserve ACTs as the only effective treatment we have for falciparum malaria. Oyibo disclosed that it is imminent to state that prompt action will be critical to sustain progress in malaria control and achieve the health-related Millennium Development Goals.

According to him, “Recently, The Federal Ministry of Health (FMOH) carried out a Drug therapeutic efficacy testing (DTET) in seven centres to ascertain assertions of ACT resistance. The last testing was done in 2003 to ascertain chloroquine resistance. However, globally, a WMNET network is trying to track ACT resistance gene as is the case with prophylactic drugs like chloroquine and Fansidar.”

For Shilaj Chakravorty, Consultant Pathologist, BT Health & Diagnostic Complex, LASUTH, Ikeja, Lagos, antimalarial drug resistance is like a cancer which must be fought at every level. Chakravorty stated that affected countries need to be in the frontline in combating the emergence of drug resistance through proper surveillance by states which should ensure that all health institutions submit data of malaria cases with special reference on resistance to anti malaria drug.

According to him “Anytime issues of anti-malaria drug resistance is reported, such should be reported to the state health authorities. Also, there should be the discouragement of Nigerians engaging on across the counter purchase of anti malarial drugs as well as the need to educate the public on the importance of diagnosis before any administration of drugs to the ailing patient.

Importantly, there is need for tertiary malaria research centers have facilities to diagnose and confirm drug resistance as per the WHO guidelines. WHO should be empowered and supported to take a strong lead. It is crucial to protect ACTs as they are the best treatments for millions of people against malaria”

Even as scientists continue to investigate how and why artemisinin resistance specifically emerges, it is noteworthy to state that antimalarial drug resistance first emerges through a rare spontaneous change in the malaria parasite.

The subsequent ability of the drug resistant strain to survive and spread is influenced by many factors, including the use of substandard medicines and artemisinin-based monotherapies. However, it is clear that if the efficacy of artemisinin component continues to decline, there is an increased risk that resistance to non-artemisinin medicines used in the combination will emerge.
Currently, research efforts are ongoing to discover and develop new medicines for the treatment of malaria.

No doubt, efforts to contain the spread of artemisinin resistance on the Cambodia-Thailand border have been ongoing since November 2008. However, there is some early evidence that resistance to artemisinins may also be emerging on the Myanmar-Thailand border. There is also concern that resistance could spread from the Cambodia-Thailand border to Africa, as it did with anti malaria drugs such as chloroquine and sulfadoxine-pyrimethamine in the 1960s and 1970s.

With the Federal Government’s introduction of the use of Small Messaging Service (SMS) for collection of data for malaria control last week, health workers will be able to monitor implementation of health interventions more effectively. In the long run, routine data management as well as antimalarial resistance can be trapped and be effectively nipped in the bud.

By Alexander Chiejina

Funding slows pharmaceutical research institute’s efforts

… Promising therapies now in limbo

Research has been the bedrock of several scientific discoveries and breakthroughs across the globe. With researchers having to contend with the challenge of developing drugs to combat certain ailments, efforts at developing a potential therapy for sickle cell diseases and other ailments by the National Institute for Pharmaceutical Research and Development (NIPRD), Abuja seems to have hit the rock.

This is following recent reports which suggest that the institute, which develops traditional herbal remedies into drug candidates failed to secure the funding it expected this year and this has grounded research at the institute. Following this development, scientists are urging the Nigerian government to provide the financial support needed to save research programmes at the institute.

The institute has already developed a potential therapy for sickle-cell disease (SCD) and has encouraging results for compounds to treat malaria and tuberculosis. Sadly, a key grant from the United States National Institute of Allergy and Infectious Diseases (NIAID) has run out and the Federal Ministry of Health has failed to deliver an expected increase to its contribution. As a result of this, research on all three drugs has come to a standstill.

According to Karniyus Gamaniel, director general, NIPRD, the N49 million (US$325,000) NIPRD institute received this year from the Ministry of Health is not enough to cover the institute’s annual running costs of 265 million naira.

Gamaniel noted that the institute also received N70 million from the ministry in 2010 for capital projects, but lamented that this falls short of the more than US$2 million needed to buy equipment and for other infrastructural projects.

“There are lots of things we don’t do because we have no money. For instance, the institute needs N50 million in addition to its running costs to mount an 800-patient phase III clinical trial on its anti-malaria drug. In addition, one of the institute’s flagship laboratories, set up in 2005 with a grant of US$25 million from the National Institute of Allergy and Infectious Diseases (NIAID), is lying idle. NIPRD needs about N23million a year to cover maintenance costs and ensure a constant supply of electricity,” Gamaniel disclosed.

Joseph Okogun, a consultant phytochemist for NIPRD, said: “Without funding for this lab, it cannot carry out essential analyses of the structures of chemical compounds in their tuberculosis drug candidate, which is a mix of herbal extracts that have been shown to slow the growth of the tuberculosis bacterium. If funded, maybe, in six to 10 years time, we might get something developed into a drug.”

No doubt, the effects of the funding problems on efforts to test Nicosan (Niprisan) might jeopardise the institute’s potential treatment for sickle-cell anaemia — a genetic disease said to be associated with complications and a reduced life expectancy in people affected with the disease.

Patients with the disease have ‘sickle’-shaped red blood cells, which can clump together to block blood vessels, thereby causing strokes or pain. Based on West African plant extracts, Nicosan appeared to slow the clumping of blood cells in lab tests and early trials of the drug in patients suggested that it relieved some of the painful symptoms of the disease.

The Phase IIB (pivotal) trial suggests that Niprisan was effective in reducing episodes of severe painful SCD crisis over a six-month period. It did not affect the risk of severe complications or the level of anaemia. No serious adverse effects were reported. The single trial of Cajanus cajan (Ciklavit) reported a possible benefit to individuals with painful crises, and a possible adverse effect (non-significant) on the level of anaemia.

Furthermore, Nicosan was being produced in the country by the Nigerian subsidiary of US chemical company Xechem International. Just last year, Xechem International closed its factory and despite promises by the Nigerian government that it would restart production, the drug is currently unavailable.

Although the results of phase III clinical trials with Nicosan, funded by NIPRD, are yet to be published, Gamaniel admitted that they were “inconclusive.” In addition, financial constraints have hindered NIPRD from doing more phase III trials of the drug.

Taking a cursory look at the treatment of sickle cell disease, the sickle-cell drug hydroxyurea was marketed nearly two decades ago. However, the list of drugs able to treat the symptoms of the disease has been “abysmally short to nonexistent.”

Though no conclusions can be made regarding the efficacy of Ciklavit currently, based on the published results for Niprisan and in view of the limitations in data collection and analysis of both trials, phytomedicines (medicine derived from plants in their original state) may have a potential beneficial effect in reducing painful crises in SCD. This needs to be further validated in future trials to ascertain the safety and efficacy of phytomedicines in managing SCD.

No doubt, the NIPRD and other research institutes in the country are in a position to develop products or processes which can compete with imported technologies that are saturating the economy if well funded. Furthermore, efforts should be made by the institute, including other research institutes in the country, to draft a proposal for funding to the World Bank, the Global Fund to fight AIDS, tuberculosis and malaria, and other philanthropic organisations for grants. In this way, much of the funding can be used to upgrade the institute’s laboratories so that they can push forward the work on their drug candidates.

By alexander Chiejina

Wednesday, November 24, 2010

Reddington hospital records landmark achievement in medicine

…performs Nigeria’s first device closure of a hole in the heart by non surgical intervention

Another landmark achievement in the field of medicine has been recorded by Reddington Hospital as it has recorded successfully pioneered Nigeria’s First devised closure of the hole in the heart (Patent Ductus Arteriousis) by non surgical invention on Victoria Onuoha, a three year old child.

Making this known to journalists at its Victoria Island office yesterday, Olu Lawani, acting Medical Director, Reddington Hospital said that the achievement was made possible following an intense collaboration by a team of doctors at the Reddington hospital and Lagos State College of Medicine (LASUCOM) and Lagos State University Teaching Hospital (LASUTH), who were supported by cardiac physiologists, cardiac technicians, nurses and biomedical engineers in the spirit of public private partnership.

Olu Lawani revealed that PDA, a congential heart disease (CHD) commonly seen in early childhood, is a condition where the hole in the heart fails to close at birth for various reasons. He noted that while the diagnosis of the three year old child was made in LASUTH 2 years ago, there equipment for conducting such non surgical procedure wasn’t available in Nigeria as the family wasn’t able to muster the financial resources to go abroad.

In his words “the deviced closure of PDA is a common procedure carried out Europe, America, and some developing nations like India and South Africa. We are aware that one of the major challenges in treating CHD us the overall cost of carrying out the procedure, availability of high tech equipment, lot of consumables and devices that were procured from abroad at a huge cost. That is why Edensfield Health Foundation, a non-governmental organisation paid for the procurement of the device that was sourced from abroad.

Depending on the complexity of the disease, it costs between $500 to $5000 to purchase the device for the surgery. As a contribution to this landmark event, the management of the hospital took a decision to wave our charges regarding this patient in our facility. We hope the new low price regime would be effective from January 2011.”

Lending her view, Adeola Animashaun, consultant paediatrician cardiologist, LASUTH, who was part of the team that conducted the surgery, disclosed that this landmark achievement by Reddington Hospital has been used all over the world. Animashaun noted that the advantage of this process is that it has shorter procedure time, shorter hospital stay and no scar for the patient.

According to her “up till now, the only way this cardiac abnormality has been treated in Nigeria is through very complex surgery that involves cutting up the chest cage (ribs and sternum) to be able to have access to the heart before the procedure for the closure of the hole can be carried out. This is usually followed up with long post operative intensive care and hospital stay with its attendant moderate mortality.”

With the feat achieved by this hospital, the healthcare delivery system should be revamped to ensure that tertiary institutions are equipped with adequate facilities for various medical issues as well as capacity development. This is the long run will see endear the country to in medical tourism which countries like India, United States of America, and other countries in Europe enjoy.

By Alexander Chiejina

Monday, November 22, 2010

Stimulating SMEs development in Nigeria

In Europe and other developed nations across the globe, the small and medium enterprises (SMEs) have been responsible for stimulating industrial growth through innovation and competition. Alexander Chiejina writes on what the Bank of Industry in facilitating SME development and its challenges

In developed nations like the United States of America, Britain, Japan, the micro small and medium enterprises (MSMEs) sector play a critical role in the development and growth of its industrial sector and the economy at large. This is in view of the vast potentials the sector offers in creating jobs for the teeming population within the informal sector.

For instance, in Europe, Small and medium Enterprises (SMEs) comprise approximately 99 percent of all firms and employ about 65 million people. In many sectors, SMEs have been responsible for driving innovation and competition. Globally, SMEs account for 99 percent of business numbers and 40 percent to 50 percent of Gross Domestic Product (GDP).
With Nigeria been one of Africa’s most influential countries given its population size, levels of trade and size of markets within the continent and the West African sub-region, the country has the potential to play a more substantial role in regional trade if its MSMEs are well developed viz-a-viz financing and capacity building programmes. This in turn will diversify and promote sustainable growth of the country’s economy.

Sadly, with Nigeria’s dependence in oil, the non-oil producing sectors have been saddled with enormous challenges ranging from harsh operating environment to infrastructural problems, and varying government’s economic policies. This move has led to the suffocation of Small and Medium Enterprises (SMEs) as well as Micro Small and Medium Scale Enterprises (MSMEs) in Nigeria.

Given this glaring reality, the Bank of Industry (BOI), established in October, 2001 following the reconstruction of the Nigerian Industrial Development Bank (NIDB), was charged with the responsibility of diversification of the Nigerian economy from a monolithic oil dependent type to an industrial nation viz-a-viz funding and provision of advisory services

According to reports from the BOI, the bank presently extends at least 85 percent of its loanable resources to the SMEs sub-sector of the manufacturing sector. At present, the Bank’s lending policy is positively favorable towards SMEs, as well as stands ready to be involved in programs targeted towards trade finance and efficiency improvement of the sector.

The Bank is also actively involved in lending to large /corporate enterprises in various sectors of the economy. One of such enhanced financing is ‘Cooperative Cluster Financing’, which is designed to reach the relatively small operators without access to collateral properties.

Though seen as a major paradigm shift, the Bank has as at date approved over N1.360 billion under its Cooperative Financing window to more than 220 Associations involving about 25,000 employment opportunities. This entails the creation of new products/ businesses/cum expansion of existing businesses that are driven through group guarantees as major security option.

Going further, the bank is engaging in continuous advocacy with the state and Federal governments towards improving the operational environment of the MSMEs. This programme ensures matching the funds provided by state governments for onward lending to projects from the partner-states.

Amongst the Bank’s Entrepreneurial Development Programme include organising Boot- Camp workshop primarily to sensitise indigenous existing and potential entrepreneurs to business opportunities, financing, and inculcating successful management skills in local business owners to forestall large scale business failure; Empowerment of the Nigerian entrepreneurs through exposure to international best practices and establishment of global partnership in support of the MSMEs; and collaborating with various Multilateral Development Agencies in the training of local entrepreneurs.

Interestingly, the Bank has over time developed specialised skill and expertise in the Management of special funds which include: The National Automotive Development Council (NAC) Fund, Business Development Fund for Women Entrepreneurs (BUDFOW), Cotton, Textile and Garmenting Development (CTRG) and Rice Processing Fund.

As a further testimony to BOI’s efforts in development of a virile and competitive Industrial Sector, the Bank was considered a collaborator in the implementation of the CBN N500 billion direct intervention fund in the real sector made up of N300 billion for power and aviation sectors and N200 billion for refinancing/ restructuring of banks loans to the manufacturing sector.

Inspite of the intensive and extensive work with the SMEs over the period, BOI found out that finance is not the only major constraint for their development. Other major impediments include infrastructural inadequacies, poor packaged proposals by prospective borrowers, inability of project promoters to contribute equity, policies instability, and lack of entrepreneurial skill/ human capital.

In the agricultural sub-sector, the efficiency in converting the geo-locational comparative advantages of most states into competitive ones had hampered the financing of SMEs due to the inadequacy of post harvest supports as well as legal documentation in terms of delay and cost involved in processing C of O, and poor attitude to loan repayment by borrowers.

Based on BOI’s experience in real sector financing, availability of first class infrastructure in all its ramifications especially power and security, development of modern entrepreneurial skills through human capacity and empowerment, the provision of well articulated incentives that would encourage all the stakeholders particularly concessions to investors by way of reduced cost of land documentation will would induce industrialization in Nigeria.

Following successes achieved in other countries across the globe, the SMEs sector can be seen as a training ground for local skills to be developed. This will lead to a slump in entrepreneurs’ migration from rural areas to urban areas for manpower. Also, its development objectives will serve as a resource base for skill acquisition for multinationals thereby replacing existing foreign sources.

By Alexander Chiejina

Thursday, November 18, 2010

Students Vs ASUU

When two elephants fight…

With the paralysis of academic activities in universities by ASUU over issues relating to proper funding and infrastructural facilities in the nation’s ivory towers, Alexander Chiejina writes that only an adequately funded public education sector can guarantee improved working conditions for education workers.

For Damian Okonkwo, a two-hundred level student in the Department of Industrial Physics, Imo State University, (IMSU), his plans on completing his academic pursuit next year seem to have suffered a big blow, following the paralysis of academic activities in universities as a result of the strike action embarked upon by the Academic Staff Union of Universities (ASUU).

Since finishing his first semester exams in August this year, he had no option than to come back to Lagos, where his parents stay in a bid to see what menial jobs he could do pending when the strike by ASUU is called off.

The same experience can be said of Merit Harrison, a third year law student at Anambra State University, who disclosed to BusinessDay that she has resulted to staying at home since she didn’t have any qualification which would earn her a job at the moment. Harrison revealed that her parents are worried because her younger brother who gained admission to study Medicine at Abia State University, ABSU was affected.

No doubt, the strike embarked upon by ASUU across Universities owned by the State governments since July 2, 2010, generated headlines in print and electronic media across the country. At the last count, more than 10 Universities were on strike action. They are Abia State University (ABSU), Anambra State University, Ebonyi State University, Enugu State University of Technology (ESUT), Imo State University (IMSU), Rivers State University, Rivers State University of Education, Lagos State University (LASU), Cross River University of Technology (CRUTECH), Olabisi Onabanjo University (OOU) and the Tai Solarin University of Education (TASUED).

In Lagos, even education workers' unions of State-owned institutions like the Lagos State Polytechnic (LASPOTECH), Michael Otedola College of Education (MOCPED) and Adeniran Ogunsanya College of Education (AOCOED) have joined the strike action. Meanwhile, all Universities in the five states (Anambra, Abia, Ebonyi, Enugu and Imo States) of the South east have been on strike since August 2010.

Their grouse has been attributed to the refusal of the state governments to fully implement agreement signed between the Federal government and the Staff Unions last year after a 4-month nationwide strike action that paralysed activities in the nation’s ivory towers.

The Federal government had signed agreement covering improved condition of service, education funding, University autonomy and academic freedom. This agreement also prescribed a gradual increase in education funding and the establishment, by all Universities governing council, a budget monitoring committee involving elected representatives of students and staff unions to monitor how the University authorities spend government allocations.

However, a recent communiqué of the meeting of the National Executive Council (NEC) of the Academic Staff Union of Nigerian Universities (ASUU), published in one of the national dallies last month reveal that neither the Federal government nor any state government has fully implemented the agreement. Actually, the Federal government and some state governments only implemented the salary component of the agreement which includes a 53.37 percent pay rise. In reality, none has implemented other components of the agreement like improved funding, university autonomy and academic freedom.

Speaking recently to newsmen, Ukachukwu Awuzie, President ASUU, decried the crisis that has enveloped the nation’s university system which has often led to countless industrial action by the body. Citing a case of Anambra State University, Awuzie noted that there were only five professors, four of which belong to the faculty of science, 20 senior lecturers and 29 lecturers for a student population of about 21,000.

"The above scenario should be situated within the context of the loud cry by all and sundry for improved quality in our universities to make them competitive in the world intellectual market and to raise their ranking. With the above picture, is it not deceitful and wishful thinking to expect the lecturers in these universities to produce world-class graduates? From the above, we have universities with over 21,000 students having fewer than 700 academic staff whereas Harvard University in Boston, that is rated the best in the world, has 11,000 professors for a student population of about 18,000. It is obvious that the political class in the South East has collectively failed their people,” Awuzie stated.

While regretting this anormaly, the ASUU boss hinted that the state of underfunding of the university, has led to the university receiving a mere sum of N50million, barely 50 per cent of the current outdated monthly salary bill while it needs about N180million to pay salaries monthly.

According to the United Nations Development Programme (UNDPP), in its Human Development Index reports of 2005, “Due to poor funding of education, education at all levels suffers from low academic standards; lacks requisite teachers; both in sufficient quantity and quality. Even the few qualified teachers available are no sufficiently motivated in terms of remuneration/ conducive operating environment to maximise their output into the education system. Schools are over-populated and classrooms are over-crowded, facilities are inadequate and over-stressed, library shelves are empty and covered with cobwebs, while laboratories lack up-to-date equipment.”

Current statistics suggest that no Nigerian University can be found among the first 500 in the world and the first 50 in Africa. While the Committee of Directors of Academic Planning of Nigerian Universities (CODAPNU) in a communiqué issued at the end of their 2010 CODAPNU workshop and annual general meeting held at the University of Ilorin, October 24 and 28, 2010, called for the state governors to address this issue as soon as possible so that the affected undergraduates can return to school, they recommended that academic programme curricula review should be broad-based, incorporating inputs from industries and other major stake holders. There are of the view that the review should also be regular, need-based and responsive to development aspirations of the society.

“The academic planning units of our universities should rise up to the challenge of providing direction in the implementation strategy of multi-institutional approach to curricula development, research administration and management of quality instructional service delivery,” it advised. Above all, only an adequately funded public education sector that is placed under public democratic control and management can guarantee improved working conditions and wage for education workers.

BY Alexander Chiejina

Reducing tobacco related deaths in Africa

…as stakeholders advocate the passage of Nigeria Tobacco Control Bill


African nations seem poised to undergo the highest increase in the rate of tobacco use among developing countries. This is as about 90 percent of people on the continent perhaps remain without meaningful protection from second-hand smoke.
Earlier this year, it was estimated that smoking will claim the lives of six million people globally in 2010, 72 per cent of whom reside in low and middle-income countries, Nigeria inclusive. However, it is believed that if current trends continue, tobacco may kill seven million people annually by 2020 and more than 8 million people annually by 2030.

Following health risks associated with tobacco consumption which according to health experts is the second leading cause of death (after hypertension) and currently responsible for the death of one in 10 adults globally, experts are of the view that enacting effective policies towards reducing tobacco consumption in Nigeria will go a long way at saving the lives of people.

In an interview with BusinessDay, Akinbode Oluwafemi, Programme Manager, Environmental Rights in Nigeria/ Friends of the Earth, said that tobacco that cigarette contains about 4000 toxic and cancer-causing chemicals which is responsible for most cases of lung cancer.

While acknowledging the fact that smoking causes various forms of cancer, Akinbode noted that measures aimed at reducing smoking in Europe and America has driven the tobacco industry to developing countries like Nigeria, where the industry continues to flout regulations, marketing to young and impressionable youths, and hooking them on smoking.

According to him “Several African countries are fighting against the tobacco industry‘s aggressive campaigns to stop public health interventions by putting smoke-free laws into place, probably protecting more than 100 million more people since 2007. Smoke-free public places are one example of a low-cost and extremely effective intervention that must be implemented now to protect health.”

For Tosin Orogun, Programme Manager, Africa Tobacco Control Regional Initiative, Nigeria, “the World Health Organisation insists that strong worldwide enforcement and implementation of the Framework Convention on Tobacco Control (FCTC) could save 200 million lives by the year 2050.” Orogun stated that though Nigeria signed the FCTC, which had been ratified by over 168 countries since 2005, there has recording of deaths relating to tobacco, especially cancer.

As Parties to the global tobacco treaty begin their biennial meeting in Uruguay, the African Tobacco Control Consortium (ATCC), a coalition of global and African public health organizations focused on preventing the tobacco epidemic in Africa, there is the need to ensure that adoption of effective guidelines on Article 9 & 10 of WHO’s FCTC which seeks to promote smoke free environment which tobacco multinationals’ are alleging to scuttle.

At the moment, only Osun, Cross River states and the Federal Capital Territory being the only states to have passed the law prohibiting people from smoking tobacco in the public in Nigeria. Giving this reality, there is the need for Nigeria to key into WHO”s FCTC which seeks to protect people from the consequences of tobacco consumption by reducing the demand for and supply of tobacco, call for stronger tax and price measures, regulation of tobacco advertisements and the introduction of strong health messages on tobacco packages, adopting protective measures against exposure to tobacco smoke, the lives of Nigerians would greatly be protected.

It is noteworthy to state that in about less than two years, Kenya and Niger Republic enacted national smoke-free policies, and South Africa, which has been smoke-free since 2007, demonstrated that smoke-free laws could work in Africa. In what seemed as a first for the region, Mauritius recently passed a law that is close to meeting the Framework Convention on Tobacco Control standards, ranking among the most robust anti-smoking measures in the world.

The National Tobacco Control Bill (NTCB), which seeks to prohibit tobacco smoking in places and is now before the National Assembly, saw over 45 Non-Governmental Organisations (NGOs), including local and international organisations, making presentations in support of the bill.

Since the Public Hearing in July 2009, Nigerians and others stakeholders in public health including Babatunde Osotimehin, former health minister; Umar Modibbo, former FCT minister, Nigerians are hoping for Senator Iyabo-Obasanjo Bello, Chairman, Committee on Health at the national assembly to return the bill to plenary for adoption. But for how long will the hope of 150 million people be eventually realized?

Stakeholders are of the view that the bill is passed and enforced, two outcomes are possible: The level of national savings will increase and other forms of consumption expenditure will be substituted for tobacco expenditure.

Studies in several countries have examined the potential economic impact of the complete elimination of tobacco use and production. The evidence shows that elimination of tobacco will not affect the economy. This is because tobacco use has many externalised costs (costs not paid for by smokers or tobacco manufacturers). This involves healthcare costs incurred by governments to take care of smoking -related diseases.

When people no longer spend their money on tobacco, they will spend their money on other things. This alternative spending will stimulate other sectors of the economy. If the money is saved rather than spent, the increased savings are likely to have stimulatory macroeconomic effects.

by Alexander Chiejina

Wednesday, November 10, 2010

African Baby Exhibition to promote infant and maternal survival

Unlike babies in developed countries, many babies in Africa are confronted with the challenge of undernourishment, malnutrition, insufficiencies, inadequate attention and insecurity right from birth. This nauseating condition in Africa has triggered a new kind of attention that is synergistic, connective, communicative and all-embracing.

In recognition of these problems, N-HANSA, a non-governmental organisation is now giving these babies a new lease of life through the African International Baby Exhibition which has been designed as an intervention plan to get the best for infants in a bid to reduce maternal mortality in Africa.

In an interview with BusinessDay, Consultant of Enhancer Exhibition Services, Oscar Odiboh during the unveiling of the project in Lagos recently said the exhibition, which is first of its kind, is a strategic regional partnership with the University Teaching Hospitals in Port Harcourt, Abuja and Lagos.

Giving insight into the programme billed to hold March 2011, Odiboh bemoaned the plight of care babies in Africa are faced with when compared to developed countries.

According to the consultant,” some societal practices does not adhere to guidelines on newborn care. Some of these babies born suffer from hypothermia (extreme cold), because they are bathed immediately after birth. This is very risky as these babies may die, develop pneumonia, feeds less and the amount of glucose or sugar in the blood decreases. This affects the baby's brain and increases risk of infection.
We know that the best place for a child is with a family. Even the best institution, with well-trained housemothers, will fall short of the love and nurturing a child finds with a caring parent. All hands should be on deck to ensure that care is given to babies at their infancy stage so as to reduce the rising rates of maternal and child deaths.”

The 2011 African Baby Exhibition tagged ‘AFRIBABY’ is expected to bring together the private bodies, organisations, professionals that focus on care of infants. The exhibition is to provide a platform for generating and disseminating the latest information through interactive discourses on the survival of new births, maternal joy, protection of lives and provision for the growth of babies in Africa.

For Olayinka Odiboh, Executive Director, N-HANSA, “the exhibition is geared towards raising awareness on adoption and misconception of the motherless babies homes and other issues such as stealing, selling, swapping and trafficking of babies in hospitals as recorded by the security agencies and media. This no doubt has become a subject of concern for years now as enormous pressure is on government agencies to curb the menace.”

It is believed that the programme would create a sustainable way to help motherless babies’ homes get sponsorship by creating massive awareness for them. The fair will also features symposium on the challenges of baby care, training of nannies by nutritionists, as well as free pregnancy and eye tests.

Challenges of cancer management in Nigeria

by Alexander Chiejina
In recent times, cancer has emerged as a major public health problem in many developing countries, matching its effect in industrialised nations. Africa is no exception and with Africa's biggest population, Nigeria has a big share of the problems

Recent reports from the World Health Organisation (WHO) reveal that there are 100,000 new cancer cases in Nigeria annually although observers believe the figure could become higher than the stipulated figure.

With lung, stomach, liver, colon and breast cancer causing most cancer deaths annually and tobacco use been the single most important risk factor for cancer, medical experts have called for a co-ordinated approach towards preventing and treating cancer in Nigeria.

In an interview with Edamisan Temiye, Chairman, Nigerian Medical Association, Lagos State Branch, Temiye said that cancer accounted for 7.4 million deaths or around 13 percent of all deaths globally in 2004 and deaths from cancer are projected to continue rising globally with an estimated 12 million deaths in 2030.

Temiye stated that tobacco use, alcohol use, chronic infections from hepatitis B (HBV), hepatitis C virus (HCV) and some types of Human Papilloma Virus (HPV) are leading risk factors for cancer in low- and middle-income countries, with about one-third of the cancer burden likely to be decreased if cases were detected and treated early.

“In Nigeria, there seem not to have a co-ordinated approach to the prevention and treatment of cancer. The individuals who are stricken with cancer are left to fend for themselves with high cost of treatment, poverty, superstition, lack of appropriate facility for care and other factors which has made cancer an extremely deadly disease in Nigeria,” Temiye revealed.

Lending his view, Samuel Eyesan, consultant orthopaedic oncologist, National Orthopaedic Hospital, Igbobi, Lagos, said that problems of impeded access to health care, ignorance, and poverty have resulted in delayed diagnosis. The consultant orthopaedic oncologist noted that lack of coordination of issues of health education has gone a long way in complicating the management of cancer.

He hinted that the economic cost associated with the management of patients with cancer are expensive, with imaging facilities such as computerized tomography (CT) and Magnetic Resonance Imaging (MRI), used for imaging patients not readily available in every health institution. He added that when such facilities are available, the cost of such studies are prohibitive – putting them out of reach of the average citizen.

“The same argument of high cost applies to chemotherapy. While pathology services are generally available, the scope of services is limited. Molecular diagnostic methods are not widely available and surgery is often performed by surgeons whose primary clinical practice is not oncology, and there is a very limited scope for multidisciplinary cancer care. There is also the challenge of public enlightenment strategy, which is poor, institutional factors (such as infrastructural decay, inadequate trained personnel) etc, which we are a nation are confronted with in the management of cancer,” Eyesan disclosed.

Taking a cursory look at the entire scenario of cancer management, the absence of proper cancer data is a major factor militating against cancer management in the country. This is evident in cancer registration which officially began in 1960 but it was not until 1990 that a National Headquarters of Cancer Registries was established in Ibadan. How functional this registry is still in doubt.

With early detection of cancer based on the observation that treatment is more effective when cancer is detected earlier, educating people through electronic and print media on the need to recognize early signs of cancer and seek prompt medical attention for symptoms, which might include lumps, sores, persistent indigestion, persistent coughing, and bleeding from the body's orifices is of utmost importance.

At the meantime, calls have been made to the federal government to establish a functional cancer registry centre for proper statistical data and analysis of the disease. The centre, when established, would help in the control and management of cancer in the country even as doctors and nurses at the primary health care level should be trained to diagnose cancer to help in early detection.

For Temiye “we need to encourage the government at all levels to assist the populace by way of providing care to those who are affected. Non-governmental organisations specializing in the provision of education materials and support for the prevention and treatment of cancer should be encouraged and supported by all concerned. For successful management of cancer, team work is needed by all concerned in the treatment.”

In the estimation of Lewis Nwoku, Professor of Oral, maxillofacial plastic surgery at the Lagos University Teaching Hospital (LUTH), Idi-Araba, “there is the need to increase political commitment for cancer prevention and control; Develop standards and tools to guide the planning and implementation of interventions for prevention, early detection, treatment and care; Facilitate broad networks of cancer control partners at regional and national levels; as well as strengthen health systems at national and local levels.”

Polio eradication in Nigeria and the challenges ahead

by Alexander Chiejina

Over the years, the nation’s healthcare has been saddled with the challenge of eradicating the incidence of wild poliovirus (WPV). Sadly, this disease has placed Nigeria among countries like India, Afghanistan and Pakistan (PAIN) known to be endemic with the polio virus. This no doubt spurred authorities in the country’s health sector to seek lasting solutions towards addressing this anomaly and reversing the trend.

Hence, governors of the 36 states in February 2009, collectively signed the “Abuja commitments to Polio Eradication', by providing the necessary leadership to eradicate polio. Also, with the relentless efforts of community health workers, traditional and religious leaders who pledged to provide active leadership via allocating adequate human and financial resources to the polio immunization activities, including mop-up plans and feedback, marked improvements in several previously high-risk states were noted. Currently, the nation has recorded just 8 polio cases in 2010, compared to 382 this time last year and 798 in 2008 – an unprecedented drop.

As Nigeria and the international community continue to applaud the success recorded in Nigeria in fighting against the dreaded poliomyelitis scourge which experts describe as the single largest drop in polio cases ever recorded, there are fears that possible resurgence of the WPV might scuttle plans to totally eradicate polio in Nigeria. This fear is coming as the Experts Review Committee (ERC) on Polio Eradication Initiative (PEI) has envisioned that within the next six months, polio should have been eradicated within the six geopolitical zones of the country.

Speaking to newsmen in Lagos recently, Oyewale Tomori, Experts Review Committee Chairman on PEI, said that so far, Nigeria has recorded 98 percent reduction in polio cases within 12 months which is a remarkable achievement within a short period of time. Tomori stated that attaining this percentage reduction is not enough in eradicating a disease like polio as efforts must be made to attain 100 percent success.

Tomori, who is a professor of virology and Vice Chancellor Redeemer’s University noted that Nigeria should double its efforts to eradicate the disease, as any attempt to relent in plans to achieve positive result could be disastrous for, not only the country, but the entire world.

In his words “In order to achieve the desired success within the proposed time-frame, the National Primary Healthcare Development Agency (NPHCDA) and development partners in the fight against polio should engage in aggressive mop up strategies in areas where new cases have been recorded. Also, government at all levels should continue with their support, as development partners were still willing to fund the project.”

Lending his view at the recent World Polio Day, Muhammad Pate, Executive Director, NPHCDA, revealed that Nigeria is one of the last frontiers in the global campaign to eradicate polio. Pate stated that as long as there’s polio anywhere, the threat of polio exists everywhere.

The Executive Director disclosed that since polio threatens children in Nigeria and other neighbouring countries, the Honourable Minister of Health Onyebuchi Chukwu was leading a special effort to ensure cross-border coordination of immunization and disease control with our neighbours, including Cameroun, Chad and Niger.

According to Pate; “Leadership at all levels will make the difference between success/failure. We have seen unprecedented leadership from our Executive Governors and Local Government Chairmen who have provided oversight and resources, particularly in the Northern states where the risks of polio are greater. We benefit from essential support for the polio fight from our traditional leaders who are helping to plan campaigns, mobilize communities and ensure families understand the threat of polio and the benefits of the oral polio vaccine.

Stopping polio means that our families will never again lose another child to this crippling and disfiguring disease. Over time, eradication will save billions of naira, and we can invest the funds in other health priorities. The infrastructure we have built and the lessons learnt from polio eradication are a spearhead to tackle other health challenges. If we can eradicate polio, we can save our children from other killer childhood diseases, protect our mothers in childbirth and deliver better health services to all Nigerians.

In Nigeria, we have the vaccine technology and the knowledge to contribute to the worldwide mission to eliminate polio. Now, we need continued leadership to ensure our children are immunized. Polio eradication is a priority worthy of our investment.”

With the ERC report, which covers October 2009 to October 2010, warned that despite the success recorded, some gaps still existed that threaten the achievement of 100 percent polio eradication in the country among which was that not all high risk areas have significantly improved, it is important the country adopt an aggressive and intensive mop-up strategy to respond effectively to the menace.

For Shilaj Chakravorty, Consultant Pathologist, BT Health and Diagnostic Centre, Lagos State University Teaching Hospital (LASUTH), the National Immunization Days should be intensified together with mop-up operations to see that the initiatives of eradicating polio succeed. Also, all tiers of government should work in concert to see that polio is wiped out of Nigeria. He pointed out the fact that since this is a global initiative, no country should pull the rest of the world back. In other words, every country must ensure that the initiative succeeds.

Furthermore, Government should mount vigorous media campaigns in English, Pidgin and local languages to sensitize the public on the programme. In addition, all health-related Non-Governmental Organizations (NGOs) should regard themselves as relevant partners in the effort to achieve this laudable goal.

Till date, four countries – Afghanistan, India, Nigeria and Pakistan – are still harbouring the disease, which attacks the nervous system and can cause irreversible paralysis and the global health body-WHO- should pay special attention to these four countries that still have reservoir of the virus.

Friday, November 5, 2010

Federal Government urged to focus on Pneumonia eradication

…As Pfizer launches Prevenar 13 pneumococcal vaccine

Alexander Chiejina

There is no gain saying that Nigeria is the economic powerhouse of West Africa. However, despite been one of the wealthiest countries on the African continent, its health indices is a course of major concern to health experts in the country giving the fact that about a million children under the age of 5 die every year from preventable childhood illnesses.

Only recently, the World Health Organisation (WHO) revealed that pneumonia is the single largest cause of death in children globally with an estimated that 1.8 million children under the age of five years dying from the disease and another 155 million cases of childhood pneumonia reported annually.

Driving this matter home, the burden of pneumococcal diseases in the world has placed Nigeria first in Africa and second in the world after India on the list of 15 countries, with an estimated 700, 000 infants affected by the disease thus recording three-quarters of childhood pneumonia cases in the world. Also, Nigeria lies in the Pneumococcal Meningitis belt of Africa where mortality in children and adults has remained high since the seventies despite availability of antibiotics for treatment.

Giving this worrisome indices, experts at a program organised by Pfizer Inc. to launch its pneumococcal polysaccharide conjugate vaccine Prevanar 13 in Lagos have tasked the Federal Government to increase vaccination of children with a view of nipping this disease in the bud.

Explaining the aetiology, Christy Okoromah, Consultant Cardiology/Infection Disease Unit, Department of Paediatrics, Lagos University Teaching Hospital (LUTH), Idi Araba, said that Pneumonia is a form of acute respiratory infection which affects the lungs.

Okoromah disclosed that the most common cause of this life threatening childhood pneumonia is caused by the bacterium Streptococcus pneumoniae; Haemophilus influenzae type b (Hib) – the second most common cause of bacterial pneumonia; and in infants infected with HIV, Pneumocystis jiroveci which is responsible for at least one quarter of all pneumonia deaths in HIV-infected infants.

According to her; “the normal inhabitant of S. pneumonia is in the nasopharnyx of humans. It can be spread via air-borne droplets from a cough or sneeze. In addition, pneumonia may spread through blood, especially during and shortly after birth. The symptoms of pneumonia include rapid or difficult breathing, cough, fever, chills and wheezing (more common in viral infections).
When pneumonia becomes severe, children may experience lower chest wall indrawing, where their chests move in or retract during inhalation (in a healthy person, the chest expands during inhalation). Infants may be unable to feed or drink and may also experience unconsciousness, hypothermia and convulsions.”

For Adegoke Falade, Consultant Paediatrician, University College Hospital, UCH, Ibadan, while most healthy children can fight the infection with their natural defences, children whose immune systems are compromised are at higher risk of developing pneumonia. Falade stated that pre-existing illnesses, such as symptomatic HIV infections and measles, also increase a child's risk of contracting pneumonia.

In his words “the bacterium S. Pneumonia is invasive, invisible and has got many deadly serotypes in the country that are resistant to antibiotics. However, drivers that predisposes to antibiotic resistance include the prescription of most antibiotics for the treatment of pneumonia which is not necessary. Another major concern is the low dose and long duration of illness when antibiotic is used for treatment. It is noteworthy to state that indoor air pollution caused by cooking and heating with biomass fuels (such as wood or dung), overcrowding can increase a child's susceptibility to pneumonia.”

Even as Nigeria continues in its quest to attain the Millellium Development Goals (MDGs) by2015, there is the need to prevent pneumonia in children which is an essential component of a strategy to reduce child mortality. Hence, immunization against Hib, pneumococcus, measles and whooping cough (pertussis) is the most effective way to prevent pneumonia.

For Enrico Liggeri, country Manager, Pfizer Nigeria and the African region, since pneumococcal disease is the number 1 vaccine preventable cause in children under the age of 5 years globally, the launch of the New Prevenar 13 vaccine which is already in use in over 50 countries will go a long way in preventing babies dying in their thousands from preventable infection when immunized by the vaccine.

“Prevenar 13, which is a pneumococcal conjugate vaccine, helps to protect against the disease caused by 13 of the most prevalent pneumococcal serotypes globally (1,3,4,5,6A, 6B,7F, 9V, 14, 18C, 19A,19F and 23F which causes invasive pneumococcal disease including sepsis, meningitis, bacteria in blood, bacteria)etc. Hence, as many pathogens other than pneumococcal serotypes represented in the vaccine may contribute to pneumonia burden in children, protection against all clinical pneumonia is expected to be lower than for invasive pneumococcal disease (IPD)”, Amgad Gamil, Regional Medical Director, Vaccines, Pfizer Dubai revealed.

In addition, adequate nutrition is key to improving children's natural defences starting with exclusive breastfeeding for the first six months of life. This is also effective in preventing pneumonia and reducing the length of the illness. Also, addressing environmental factors such as indoor air pollution (by providing affordable clean indoor stoves) and encouraging good hygiene in crowded homes also reduces the number of children who fall ill with pneumonia.

There is the need for the Ministry of Health to collaborate with the National Primary Health Care Development Agency (NPHCDA) to ensure that pneumonia vaccines are included in 2011 strategy plans in the country’s routine immunisation process.
More importantly, the Federal, State and Local Governments should ensure through appropriate intervention, that the mortality and morbidity of this ‘forgotten killer’ (Streptococcus pneumonia) be curtailed at all levels, bearing in mind the resolution of the World Health Assembly in May 2010. However, the inauguration of a National Advisory Committee on Vaccination and Immunisation as found in developed countries such as the United States of America and Germany is recommended.

With this in place, understudying and understanding the pattern of infectious diseases in Nigeria whether periodic or seasonal and use evidence - based research epidemiology and surveillance will guide the nation.

Urbanization in Nigeria; a challenge to public health

By Alexander Chiejina

Nigeria as a nation has over the years been experiencing an accelerated shift of her populations from rural to urban areas. This rapid rate of urbanization has no doubt engendered several challenges and problems similar to situations in other parts of the world.

Sadly, most problems confronting cities, towns and their inhabitants as identified in Agenda 21 in Nigeria include inadequate financial resources, lack of employment opportunities, spreading homelessness and expansion of squatter settlements, increased poverty, growing insecurity and rising crime rates, inadequate and deteriorating building stock, services and infrastructure.

Other problems include substandard and inadequate housing, slums, transportation problems, low productivity, crime and juvenile delinquency, lack of health and educational facilities, improper land use, insecure land tenure, rising traffic congestion, increasing pollution, lack of green spaces, inadequate water supply and sanitation, uncoordinated urban development and an increasing vulnerability to disaster.

Giving this daunting reality which stares everyone in the face, health experts in the country have called for actions which should be directed towards reorganising the chaotic development that is rife in the cities and return the people to healthy development and living conditions.

Speaking to BusinessDay recently at the 2010 Physician Week organised by the Lagos State Branch of the Nigerian Medical Association (NMA), Edamisan Temiye, Lagos State Chairman of NMA, said that the growing urbanisation has become one of the biggest health challenges of the 21st century to Nigeria and the African continent.

Temiye disclosed that health is a major urban policy issue in Nigeria because poverty and slum conditions pose a serious public health threat to the country's rapidly expanding urban population. He stated that in vast areas of Nigerian and other African cities, inadequate sanitation and waste management and poor state of public health infrastructure have led to the spread of a wide variety of water-borne and other communicable disease.

In his words “those of us who are living in the megacity of Lagos are very much aware of the constraints for space and the rapidly disappearing neighbouring meeting places for relaxation. We are well aware of the slums often located in the vicinity of comfortable living and well constructed neighbourhood. Our actions as individuals, community, corporate organisations and government should be focused towards taking actions to mitigate the challenges of urbanization.”

For Akin Osibogun, Chief Medical Director, Lagos University Teaching Hospital (LUTH), Idi-Araba, though urbanization has its positive effect, one of the health problems urbanization is confronted with is the issue of mental health as evident in the number of people with stress, depression and anxiety.

Osibogun noted that urban cities have the increased risk factors for non communicable diseases and their risk factors such as tobacco use, unhealthy diets, physical inactivity, harmful use of alcohol as well as risks associated with disease outbreaks.

“River pollution is particularly found to be worse where rivers pass through cities and the most widespread is contamination from human excreta, sewage and oxygen loss. In many cities in the country, there is limited access to clean drinking water. The quality of several watercourses is poor, with pollutant levels higher than the WHO’s standards.

Sadly, pesticide contamination from urban agriculture, residues from sawmills and manufacturing industries, wastewater from urban drains and municipal dumping of waste especially human excreta pollute drinking water sources that affect the health of the urban and peri-urban populations. In the long- term, treatment of sewage would be required for safer vegetable production and to reduce water pollution,” Osibogun stated.

It is noteworthy to state that ill equipped settlements characterised by inefficient and uncoordinated urban governance, poor economic and resource base of cities, lack of community participation in urban development, poor urban land management and unsustainable development have endangered the lives of people living in urban areas.

Giving these realities, there is the need for all levels of government to take responsibilities to address these challenges by showing serious commitment to overcoming them through various planned strategies as evident in Lagos state with the megacity development.

For Muiz Banire, Commissioner for Environment, Lagos State, “when people become aware of the effects of their unwise use of the environment and well- equipped with the techniques of environmental management, the goals of the national Policy on environment will be easy to achieve. There is also the need for environmental awareness (Education) to institutions (primary and post primary) curricula.

The challenge of inadequate professional and supporting technical staff as well as inadequacy of current digitized data and information on urban conditions should be scaled up. This is because effective urban management strategies depend on comprehensive and up to-date information base.”

More importantly, governments at all levels including relevant stakeholders should be engaged in promoting urban planning for healthy behaviours and safety, improve urban living conditions, ensure participatory governance, build inclusive cities that are accessible and age-friendly and make cities resilient to disasters and emergencies.

Monday, November 1, 2010

Nigerian donates cornea for transplant

… As experts call for local harvest of cornea in the country

The first successful cornea transplant operation on two patients by a local donor recently has received commendation by members of the medical community, friends and family of the donors and recipients of the cornea in Lagos.

The two patients- names withheld, had a successful cornea transplant in August 2010 following the death of Kola Shodipo, a 47 year old man who prior to his death on the 18th of the same month, pledged to donate the cornea in his eyes which were removed some hours after his death. The corneas were later used to restore sight to two individuals who had cornea blindness in one eye each.

Speaking to journalists at a recent press conference at Lagos State University Teaching Hospital (LASUTH),Ikeja, Lagos, Mosun Faderin, Medical Director of Eye Bank for Restoring Sight, Nigeria, said that cornea blindness encompasses a range of eye conditions that ultimately affect the transparency of the cornea, leading to blindness.

Faderin stated that though cornea blindness is reversible giving the fact that it is only the front part of the eye that is damaged, the aftereffects of bacterial, fungal, or viral infections, eye trauma, traditional medicine or home remedies, which often harm the eye rather than relieve pain or improve eyesight have been implicated in the cause of blindness.

In her words “Attacking the root causes of corneal blindness is the best path to blindness prevention. When that part is damaged, the person cannot see but with a successful surgery which involves the replacement of the damaged cornea with another got from another human, sight can be restored. For the cornea to be useful for a transplant, it must be removed within 12 hours after death with the consent of either the deceased, given before death, or the family members.”

Olaseinde Akinsete, Chairman of the Board of Eye Bank, recalled that although corneal transplant is lawful in Nigeria under Decree No.23, titled Cornea Grafting Decree 1973, not many corneal grafting operations have been carried out in the country.

“Under the decree, any person can either by writing or orally in the presence of two or more witnesses authorizes the excision of his or her eyes after death. The law stipulates that the person lawfully in custody of the body after death may unless he has reason to believe that the request was subsequently withdrawn, authorize removal of eyes. Notwithstanding the promulgation of the above mentioned decree, not many corneal grafting operations were carried out in Nigeria.”

While giving an insight to the number of people with cornea blindness in Nigeria, Akinsete added: “Nigeria has about 1,170,000 blind people, based on a blindness rate of 0.78 percent. Cornea blindness is about 7.9percent that is 92,430. It is the latter that may benefit from corneal grafting.”

Taking a cursory look at cornea transplant in Nigeria, late Shodipo is the first Nigerian to donate his eyes for a cornea transplant. Until now, all cornea transplants in Nigeria have been done with corneas got from other countries, mostly from India.

However, since the Eye bank became a reality when the Nigeria Society for the Blind and the Ophthalmological Society of Nigeria (OSN) got together to give birth to the Eye Bank from the money donated for cornea grafting in 2004, not a single cornea has been harvested locally until very recently. Sadly, the biggest challenge the country is faced with is that the public first of all don’t believe they should donate any part of their body after death. This is as pertinent as it is not possible to restore sight to a ‘blind’ person. In order to convince the public that someone who has cornea blindness (and this group accounts for about 33 percent of those with reversible or curable blindness worldwide), that the Board of the Eye Bank decided to source for corneas from abroad.

There is no gain saying that late Shodipo made his intention of donating his eyes in 2008 because of his love for people and applauded his humanitarian work. The first locally harvested corneas from a Nigerian donor who had pledged/donated his eyes after he saw and heard the experiences of two cornea graft recipients prior to his passing on have to be commended.

For Femi Olugbile, Chief Medical Director of LASUTH, the transplant is a landmark achievement even as he commended the family for ensuring that they obeyed Shodipo’s wish. Olugbile however called for the creation of proper legislation that would make it possible for unclaimed dead bodies and bodies of destitute be used for the extraction of useful body parts that can help sustain lives of those who have serious medical condition which would need transplant.

“The challenge of harvesting corneas and other body tissues for use on live patients in our country is a major one. Unfortunately, these bodies cannot be touched for cornea transplant and that is a major waste. There has to be a way in which that can be tidied up. A practical law creation exercise needs to be embarked upon to get access to these corneas,” Olugbile stated.

It is noteworthy to state that in 1994, the Government of India passed the Transplantation of Human Organs Act that legalised the concept of brain death and, for the first time, facilitated organ procurement from heart beating, brain dead donors this was borne out the fact that thousands of lives were lost in India annually from heart and liver failure since transplantation of unpaired organs like heart, liver and pancreas were either difficult or impossible from living donors.

Hence, organ and tissue donation is a way to help others- by allowing organs or tissues to be taken from a death individual and transplanted in someone else’s body. It may save another person’s life. Organ and tissue donation is a way of “giving something back” to society. It costs nothing, it does not change your own life, and it can mean a huge improvement to others’ lives.

Organ failure can strike anybody at any time as a result of illness or infection. For most people who experience organ failure, a transplant is their only realistic treatment option. If one dies, the organs could help several people through organ transplants and many others through tissue grafts. For instance a person who is attached to a dialysis machine could return to full-time work after receiving one kidney. Every effort is made to save one’s life before donation is considered as donation doesn’t disfigure the body.

Delivering excellence through customer care

As the globe celebrates customer service week which is a period set aside to reinforce the significance of providing a quality experience for the consumer, Alexander Chiejina writes on how First City Monument Bank (FCMB) hinges on customer care to drive its business to new heights

Good customer service no doubt has over the years been the lifeblood of any business. As it is the case with most organisations in Nigeria and the world at large, they may offer promotions and slash prices to bring in as many new customers as they want but unless one can get some of those customers to come back, such a business won’t be profitable for long.

However for Ebele Enuani, a staff with CAP plc, good customer service is all about bringing customers back. And about sending them away happy – happy enough to pass positive feedback about one’s business along to others, who may then try the product or service you offer for themselves and in turn become repeat customers.

“If you are a good salesperson, you can sell anything to anyone once. But it will be your approach to customer service that determines whether or not you will ever be able to sell that person anything else. The essence of good customer service is forming a relationship with customers – a relationship that that individual customer feels that he would like to pursue. How do you go about forming such a relationship? By remembering the one true secret of good customer service and acting accordingly- “You will be judged by what you do, not what you say,” Enuani disclosed.

Hence, as service-oriented organizations across the globe mark this year’s Customer Service Week, a period set aside in the month of October when customers are celebrated and appreciated by organizations, First City Monument Bank Plc (FCMB) has announced it is using the customer week which begins from Monday October 25th to 29th to appreciate the patronage and relationship it has shared with its esteemed customers over the years.

Making this known to newsmen in Lagos, Ladi Balogun, FCMB Group Managing Director revealed that the week is meant to celebrate and appreciate the esteemed customers including entrepreneurs for their loyalty and focus on their feedback which has gone a long way in improving its level of service and customer intimacy.
With the theme for this year Customer Service Week - ‘Customer First’, Balogun stated that “its focus in hinged on three main points: “re-emphasizing our Customer First strategy, re-affirming our commitment to building a long lasting relationship which supports their businesses and provide true memorable customer experiences”

According to the Group Managing Director, “During the week, the bank would be appreciating its customers nationwide, organizing Customer Forum to connect via providing clients with business ideas and opportunities and more importantly, obtain feedback on how they can be better served. It will also be an opportunity to renew its commitment to continually deliver on its Customer First strategy which forms the basis of the partnership. The bank had in 2008 launched the second phase of its advertising campaign, My Bank and I to refresh its promise to customers and other key stakeholders.”

Balogun disclosed that “the campaign titled “Commitment” was an extension of the success of the “My Bank and I” phase one which was launched the previous year.
“FCMB the previous year unveiled the first phase of the corporate campaign, which set a new standard in bank-customer relationship. It was designed to build a stronger relationship with the bank’s customers, cutting away the differentiator and making it a kind of partnership relationship where customers have as much stake as the bank in the daily business operations. The objective of the new campaign underscores the secret of the bank’s successes over the years and its unique selling proposition going forward.

In My Bank & I Phase 2, what we are saying to our customers and the larger stakeholders is that our service offerings have gone beyond the basic relationship and partnership. We are now talking about commitment, which is the bedrock of any good partnership. We do this by anticipating our customers’ needs in order to provide solutions to those needs,” Balogun concluded.

No doubt, Customer Service Week , which is been celebrated across countries like the United States of America, the United Kingdom, etc, it provides a unique opportunity for service and support professionals to join in a celebration of the important role that customer service plays in every organization.

It is noteworthy to state that core goals of the week celebration include boosting morale, motivation and teamwork, reward frontline reps for the important work they do all year long, raise companywide awareness of the importance of customer service, let clients know about the organization’s commitment to customer satisfaction.

There is no gain saying that customers have more options than ever before-and feel less loyalty. They want products and services fast, cheap, quick from whoever will provide them. That means that the competitive advantage is now in the firm’s ability to keep customers and build repeat business. This business firms in Nigeria should emulate as in this way, one continually delivers on Customer First strategy which forms the basis of partnership.

Need for quality health services re-echoes at WAH 2010

The need for quality in healthcare services in the country was last week re-echoed at the just concluded fifth West African Health Exhibition (WAH) as over 500 experts who brain-stormed identified poor hospital services and management as a major factor that has plagued the development of the health sector in Nigeria.

In a chat, the Chairman National Consultative Committee on Cancer Control in Nigeria, Prof. Francis Abayomi Durosinmi – Etti who was also the chairman of the occasion said “Although the necessity of introducing quality and health care risk management procedures in health care institutions is no longer contested, it must be recognised that total quality control is coming to hospitals very slowly”

Speaking during the opening ceremony of 2010 WAH in Lagos, Durosinmi – Etii who applauded the theme “Delivering Quality Healthcare Services in West Africa” noted quality of healthcare services determines the desired health outcomes and are consistent with current professional knowledge.

His words, “Indeed, quality management is a profound change in the hospital that leads to transformation of its organisation. This transformation concerns every actor within the organisation; implying a change in culture, habits and behaviour and disrupting the sociological hierarchy and power systems”

While noting that hospitals across the country are searching for ways to improve quality of care and promote effective quality improvement strategies, he pointed out that in more developed countries, essential elements of a successful strategy must include developing the right culture, attracting and retaining the right people, devising and updating the right in – house processes and giving staff the right tools to do the job.

He further added that external influences, such as local market competition and public or private health quality initiatives and standards also have an impact in quality health care service delivery. To ensure quality, the Chairman told the participants that first, is the need for healthcare institutions to attract and retain the right people.

“High- quality physicians, nurses, administrators, and ancillary staff are critical to producing high – quality outcomes and effective quality improvement. Successful recruitment and retention of nursing staff is tied to an absolute respect for and empowerment of nurses who must be treated as full partners in patient care and given opportunities for advancement. All are expected to be good team players, able to participate in multi- disciplinary teams for both quality improvement and patient care management.”

He further stressed the need for health care institutions to equip and give their staff the right tools to do the job. “ Our hospitals must give their physicians, nurses and other staff the tools and support they need to practice high – quality medicine on a daily basis and to identify and investigate quality problems when they do surface. This, he said, must include; investments in information technology as well as quality improvement/performance improvement departments with qualified staff who abstract medical records, analyse data, and facilitate the quality improvement process.”

Durosinmi – Etii however, regretted that hospital environment in Nigeria is not a favourable terrain for such changes as they are institutional organisations charactered by a high level of involvement on the part of health care professionals, particularly doctors in the decision making process.

He noted that professional bureaucracy has limited power, contrary to the mechanical bureaucracies found in the industry. The Chairman enjoined stakeholders that in setting up quality management, they should take into account these obstacles adding that no matter what quality management model retained, great importance must be placed on implementation strategies necessary to achieve the goals of quality management.

In his welcome address, the Executive Director, Global Resources, Dr. Wale Alabi said the theme of the conference was chosen to highlight one of the biggest issues still hampering the ability to deliver 21st century medicine and quality healthcare in the country’s healthcare service delivery, processes and systems.

Alabi stressed that before we can experience any meaningful development in the health sector, the country must adequately put in place protocols and processes that would support quality assurance and raise the standard of care in healthcare institutions across the country.

A comprehensive approach, supported by strong national leadership, governance and information systems, is needed to ensure skilled, motivated and supported health workers in the right place at the right time. For example, national authorities may focus on rapidly increasing the outputs of education and training programmes, along with measures to improve recruitment, performance and retention of workers - especially in rural and underserved areas - and actions to address imbalances in the mix and use of skills within a primary health care framework.

Lagos Floods: Residents, businesses count their losses

With many of the victims of the recent flood disaster in Lagos relocated to a relief camp and some still fighting marooned The victims of the recent ALEX CHIEJINA write that it would take some time before business activities would be restored in the affected areas

Cletus Attah had always been the envy of his contemporaries. His shop in Ikorodu area of Lagos had a rich display of all kinds of foodstuffs which he stocked in sacks. And with a large customer base frequently thronging his shop, Attah became a happy- go- lucky trader who regularly smiled to the bank.

But that was before the floods came and swept away his shop and his residence that was just behind the shop. Today he is an emotional wreck; helpless, homeless and denied of a place in the relief camp set up by Lagos State government to temporary cater for the victims of the flood disaster.

For Attah, and many others living in Ajegunle in Ikorodu area of Lagos as well as in such communities as Mile 12, Ikosi Ketu Owode Elede, Thomas Laniyan Estate, Owode Onirin, Agboyi Ketu, Owode Orile, Odo Ogun, Itowoloa and Agiliti, both in Lagos and Ogun State, this is definitely not the best of times.

They are still reliving their experience with the recent floods that had submerged residential, commercial buildings with massive loss of household items, and schools. Children and adults had to swim through flooded roads to get out of their houses. Those who could not swim had to hire canoes.

Some community folks who spoke to journalists assessing the impact of the flood said that though flooding in the communities had been a regular occurrence since 2007, the current flooding which started early October 2010 has remained their worst experience. The situation was occasioned by the release of excess water from Oyan Dam by Ogun State River Basin Authority and enhanced precipitation. On the other hand, the River Basin Authority said the release of the water was targeted at stopping the dam from bursting following incessant rains which had made the facility take in more water than required.

Not only has the recent flooding left scores of residents in these communities homeless, business activities in the flood-ravaged areas may take a long time to come alive again as workers and business people gradually come to terms with the situation.

Already, businesses worth millions of naira have done down with the flood. The inability of many to run their daily businesses, among other hardship, has turned the affected residents into refugees in their own land. When Business Day visited the affected communities last week lock-up shops, private schools, several companies, and houses were still under lock and key as the owners have been forced to relocate temporarily.

At Owode Elede, a popular livestock market near Ojodu-Berger, it was discovered that the surge has almost completely overran the market and forced livestock owners to move their cows and goats to safer areas. The market which used to be a bee-hive of activity is now like a ghost of itself.

At Odogun Oniyanrin in Ajegunle, known for its huge number of upholstery makers, it was learnt that most of the traders were taken unawares by the flood. This is due to the fact that only a few were seen trying to salvage some of their chairs and tables that were not ruined by the flood. They lamented their fate as they moved their drenched cushioned seats out of the lock-up shops for sun-drying.

At Ojodu-Berger, virtually all the state-owned and private schools on either side of the Lagos/Ibadan Expressway close to the Lagos Toll Gate are shut following the pool of water which has made it impossible for both pupils and teachers alike to gain access to the schools.

Speaking to BusinessDay, Ikedioha James, an Upholstery maker at Owode-Elede near Ojodu-Berger said "I have never seen flooding like this in all my life. It was a surprise to me that the lockup shop that I left the day before the flooding was totally covered by water when I returned a day after and all the cushioned chairs and wood for my work were totally soaked in water. Since the incident I have depended on goodwill of the public to feed. Government should come to our rescue"

In the meantime, activities at the usually bustling markets like the Mile 12, Agiliti, as well as supermarkets, shops and restaurants have either been halted or scaled down considerably. Yemisi Oyeleke, a trader said she had never seen Mile 12 dry like this ever since the flood began.

"Trading is not moving as usual ever since the flood enveloped some of the neighbouring communities. It is as though people are in a mourning period. No doubt, business has not been flourishing. I am contemplating whether to suspend coming to the market until things improve," Oyeleke revealed.

The same goes for Joy Omame, a trader at Odogun Oniyanrin Community area of Mile 12 who disclosed that the flood had affected her trading in foodstuff as people, many of them having host their possession, are no longer in a position to maintain their patronage. According to her, "my greatest dilemma is the plan of the Lagos State government to demolish our buildings. I was born and brought up here and my grandparents lived here; so how can we leave here because of the dam which was not here when we started living here. Breaking our houses is not the solution. The solution is the upgrading and reconstruction of the Odogun Road which leads to Mile 12. "

Apparently disenchanted, Babatunde Owolabi, a livestock seller in Odogun Oniyanrin community told Business Day that it would be almost impossible for him to recover from the misfortune: "My wife and three children are at the Agbowa relief camp and it pains me to see what they feed them there. Most of my property got missing in the confusion that followed the flood so I am already at a loss but we have no option because my business is already ruined. Water is supposed to be a blessing but this one is the action of man and it has brought destruction".

It will be recalled that about a fortnight ago, President Goodluck Jonathan approved the sum of N2.1 billion to victims of the recent flood disasters in Lagos, Ogun and Jigawa states in a view to mitigate the effects of the disaster. Each state was to receive the sum of 700 million Naira.

While sympathising with the victims in Isheri Olofin community in Ogun state and Ajegunle community in Lagos state, President Jonathan assured them that apart from the cash assistance, the federal government was assembling a team of experts to undertake a comprehensive study of the recurring floods with a view to finding a permanent solution to the recurring problem of floods.

No doubt, some of the destruction could have been avoided or its effects mitigated if proper environmental rules had been observed and the authorities had not been lax in enforcing building codes. In some parts of the country, flooding has become something of a seasonal occurrence during the rainy season. As such, communities often prepare for the impacts of such floods, and take precautionary measures.

As is the case with some parts of Lagos, areas prone to flooding have blocked drainages and waterways, and absence of proper drainage system. Sadly, either by design or default, permits are given to developers to erect structures that interfere with waterways.

Given the discomfort being suffered by the residents whose communities were ravaged by the flood, many people have called on Lagos and Ogun State governments as well as concerned federal institutions to adequately provide for them in their time of need.

James wants the Ogun/Osun River Basin Authority to "some extent take responsibility for the disaster and compensate the impacted people and imbibe international best practices in its operations to forestall recurrence of the flood incident."
However, Tony Akanbe, a Ketu resident who was not really affected by the flood believes that members of the communities also have a role to play in guarding against similar damage in the future.

"Community leaders have a role to play in guiding the people to imbibe good environmental habits. They could do this by assisting municipal authorities propagate information about the need to keep drainages provided in the community free of dumps that might clog the waterways and cause flooding during the rains. More importantly, municipal authorities should ensure they construct culverts, drainage channels and storm drains in the cities, and provide an efficient refuse disposal system that would lessen the tendency among residents to dump domestic waste in water passages, thereby blocking them."

Wednesday, October 20, 2010

EU, UNICEF signs agreement for rural water and sanitation in six states.

Recently, the European Union (EU) signed an agreement with UNICEF that will bring sustainable and integrated water supply and sanitation as well as hygiene promotion to 200,000 people in rural communities in selected states and local governments.

The EU’s investment of 9 million Euros (1.9 billion naira), which will be funded under the Support to Reforming Institutions Programme, is to stimulate accountability and transparency in State and Local Government Area (LGAs) budgeting processes in six states: Anambra, Osun, Cross River, Kano, Jigawa and Yobe. UNICEF will implement the programme over the next two (2) years.

Speaking at the occasion, David MacRae, Ambassador/Head of the EU Delegation to Nigeria said “We at the EU believe that the provision of water and sanitation and the promotion of hygiene are essential public services. They protect populations from diseases that particularly affect children, including cholera and diarrhoea, and they help contain malaria. We will be pleased to support the state and local governments that are leaders in this area.”

The first phase of the agreement is for a public expenditure management and financial accountability review in the six states to assess their public finance management; the extent of their investment in water, sanitation and hygiene so far; and the activities required to bring water and sanitation to rural areas.

Only states and local governments that the review shows to have committed to and made progress on reform, particularly in public finance management, will win EU investments in the second phase. The second phase will comprise a series of activities in the selected local governments and states, including mobilizing schools, communities and local governments to develop community action plans for promoting sanitation and hygiene; building the capacity of communities and local governments for delivering sustainable water and sanitation services; establishing community-based water, sanitation and hygiene models in rural communities, including increasing access to improved source of water for about 200,000 rural people; raising awareness and visibility of accountability and transparency practices that contribute to good governance in the water and sanitation sector; strengthening monitoring and evaluation systems at community, local government and state levels.

For Suomi Sakai, Representative of UNICEF in Nigeria, “We are proud to partner with the EU on this innovative programme. Communities and governments that provide sanitation and safe water can promote good hygiene as well - save lives, particularly of children.”