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.”
Wednesday, October 20, 2010
Lagosians groan as hospital remains shut for over two months
…as Nigerians call for dialogue to resolve the impasse
Lagosians who think they will soon access medical care from any Lagos state owned hospital may have to wait longer as the payment of the Consolidated Medical Salary and Professional Allowance (CONMESS) by the Federal Government to doctors working in federal health institutions have caused ripples in the health sector as doctors under the employ of the state government have vowed to continue its 9 weeks old industrial strike over the non- payment of the CONMESS.
To any individual following the development, the industrial strike which began from August 12 2010 till date has no doubt brought untold hardship and misery to Lagosians thus leaving the clinics and wards of the state owned hospitals open with no doctor attending to any patient. Interestingly, most private hospitals, of which one may not be able to guarantee its operational ability, have now become the last resort of most people who believe are reaping the gains of the current strike action by charging exorbitant fees for medical care.
A visit to Lagos University Teaching Hospital (LUTH), the only functional health institution, within the last 2 weeks has witnessed large number of patients awaiting medical attention. Most wards like the Accident and Emergency session, Radiography, Olikoye Ransome Children Emergency Centre, to name but a few are filled to the bream with little or no space to admit more patients. Already, the hospital management expressed fears that the large number of people waiting for treatment might lead to the outbreak of an epidemic. However, this situation has also increased the hours patients have to wait before been attended to by a physician.
Lamenting his ordeal to BusinessDay, Ebele Enuani, a patient at LUTH said he had to wait for over an hour before doing his x-ray examination due to the large number of people waiting to be examined. He stated that this is has placed much pressure on facilities at the hospital as patients wait endlessly to be attended to.
“I can’t be able to afford the huge bills which private hospitals are currently charging. They are already making some fortune from the strike. Currently, I have to bear with the situation; it’s just that I have to wait for long hours and this is frustrating.”
For Amaka Okoye, she had to spend over three hours before she could do two medical tests and collect her drugs at LUTH. The same cannot be said of Taiwo Okundayo who lost the father due to late referral from a private hospital where he was receiving treatment.
In his words: “I took my father to one of the private hospitals at Apapa, Lagos where we were told a compulsory consultancy fee of five thousand Naira. We did as we were told. When his health worsened, the doctor never said referred us to LUTH till he was in a critical shape. En route LUTH, he died. While I was at LUTH to deposit his body at the morgue on Saturday last week, about eight bodies were deposited within a space of five hours with people wailing the loss of their loved ones.” And the list goes on and on.
In a bid to know current efforts made to resolve the strike action which has made patients pass through trying times, Ayobode Williams, Chairman, Medical Guild, which is the umbrella body for all doctors in the service of Lagos State with affiliates drawn from the Medical and Dental Consultants Association in General Hospitals along with the Association of Resident Doctors of LASUTH, said the Guild made only one demand to the Lagos State Government-the payment of the CONMESS with effect from August 2010 and their arrears withheld as from January to July this year.
Speaking to BusinessDay, he revealed that In September 2009, the Federal Government approved the payment of CONMESS package for medical and dental practitioners with effect from January 2010. According to him, in November 2009, the Medical and Dental Council of Nigeria (MDCAN) General Hospital wrote a letter to the Executive Governor of Lagos State Babatunde Fashola concerning the payment of the new salary.
“Currently, doctors in the service of Lagos State earn less than half of the monthly income of their colleagues in the Federal service despite the fact that they work more than their counterpart in the other states. We are ready for negotiation but the letter from the State Government stated that the government will pay us whatever it thinks fit and I am not sure we have asked for ‘whatever.’ Other requests include the reinstatement of our immediate past chairman, Ibrahim Olaifa, who was unlawfully dismissed, our union dues, and over taxation which we demand be corrected,” Williams disclosed.
With scores of people dying on a daily basis due to the inability of doctors to attend to them, calls have been made from several quarters towards seeking a lasting solution through effective dialogue between the Government and the doctors.
Executive Chairman, Yaba Local Council Development Area (LCDA), Jide Jimoh appealed to the striking doctors in Lagos to resume work as a matter of urgency in order to save the lives of patients who are dying in the hospitals. He stated this recently while donating an ambulance to the Harvey Health Centre in Yaba, Lagos.
According to Jimoh “It is unfortunate that doctors are on strike and patients in the hospitals are dying. This is the time for the state government and the resident doctors to dialogue and find a lasting solution to the incessant strikes. Though strike actions are bound to happen, the state government and the striking doctors should be considerate because they were playing with the lives of people.”
For Babatunde Fashola, Governor of Lagos state, while at the commissioning ceremony of the haemodialysis centre donated by MTN Foundation to Alimosho General Hospital within the week said appealed to doctors to come back to work as no amount of money paid to them can bring back those who have died during the strike action even as the government is open to dialogue with the doctors.
While Lagosians await the end of the strike which has crippled hospital activities, efforts should be made to resolve the various differences as more people are bound to lose their lives if nothing urgently is done.
Alexander Chiejina
Lagosians who think they will soon access medical care from any Lagos state owned hospital may have to wait longer as the payment of the Consolidated Medical Salary and Professional Allowance (CONMESS) by the Federal Government to doctors working in federal health institutions have caused ripples in the health sector as doctors under the employ of the state government have vowed to continue its 9 weeks old industrial strike over the non- payment of the CONMESS.
To any individual following the development, the industrial strike which began from August 12 2010 till date has no doubt brought untold hardship and misery to Lagosians thus leaving the clinics and wards of the state owned hospitals open with no doctor attending to any patient. Interestingly, most private hospitals, of which one may not be able to guarantee its operational ability, have now become the last resort of most people who believe are reaping the gains of the current strike action by charging exorbitant fees for medical care.
A visit to Lagos University Teaching Hospital (LUTH), the only functional health institution, within the last 2 weeks has witnessed large number of patients awaiting medical attention. Most wards like the Accident and Emergency session, Radiography, Olikoye Ransome Children Emergency Centre, to name but a few are filled to the bream with little or no space to admit more patients. Already, the hospital management expressed fears that the large number of people waiting for treatment might lead to the outbreak of an epidemic. However, this situation has also increased the hours patients have to wait before been attended to by a physician.
Lamenting his ordeal to BusinessDay, Ebele Enuani, a patient at LUTH said he had to wait for over an hour before doing his x-ray examination due to the large number of people waiting to be examined. He stated that this is has placed much pressure on facilities at the hospital as patients wait endlessly to be attended to.
“I can’t be able to afford the huge bills which private hospitals are currently charging. They are already making some fortune from the strike. Currently, I have to bear with the situation; it’s just that I have to wait for long hours and this is frustrating.”
For Amaka Okoye, she had to spend over three hours before she could do two medical tests and collect her drugs at LUTH. The same cannot be said of Taiwo Okundayo who lost the father due to late referral from a private hospital where he was receiving treatment.
In his words: “I took my father to one of the private hospitals at Apapa, Lagos where we were told a compulsory consultancy fee of five thousand Naira. We did as we were told. When his health worsened, the doctor never said referred us to LUTH till he was in a critical shape. En route LUTH, he died. While I was at LUTH to deposit his body at the morgue on Saturday last week, about eight bodies were deposited within a space of five hours with people wailing the loss of their loved ones.” And the list goes on and on.
In a bid to know current efforts made to resolve the strike action which has made patients pass through trying times, Ayobode Williams, Chairman, Medical Guild, which is the umbrella body for all doctors in the service of Lagos State with affiliates drawn from the Medical and Dental Consultants Association in General Hospitals along with the Association of Resident Doctors of LASUTH, said the Guild made only one demand to the Lagos State Government-the payment of the CONMESS with effect from August 2010 and their arrears withheld as from January to July this year.
Speaking to BusinessDay, he revealed that In September 2009, the Federal Government approved the payment of CONMESS package for medical and dental practitioners with effect from January 2010. According to him, in November 2009, the Medical and Dental Council of Nigeria (MDCAN) General Hospital wrote a letter to the Executive Governor of Lagos State Babatunde Fashola concerning the payment of the new salary.
“Currently, doctors in the service of Lagos State earn less than half of the monthly income of their colleagues in the Federal service despite the fact that they work more than their counterpart in the other states. We are ready for negotiation but the letter from the State Government stated that the government will pay us whatever it thinks fit and I am not sure we have asked for ‘whatever.’ Other requests include the reinstatement of our immediate past chairman, Ibrahim Olaifa, who was unlawfully dismissed, our union dues, and over taxation which we demand be corrected,” Williams disclosed.
With scores of people dying on a daily basis due to the inability of doctors to attend to them, calls have been made from several quarters towards seeking a lasting solution through effective dialogue between the Government and the doctors.
Executive Chairman, Yaba Local Council Development Area (LCDA), Jide Jimoh appealed to the striking doctors in Lagos to resume work as a matter of urgency in order to save the lives of patients who are dying in the hospitals. He stated this recently while donating an ambulance to the Harvey Health Centre in Yaba, Lagos.
According to Jimoh “It is unfortunate that doctors are on strike and patients in the hospitals are dying. This is the time for the state government and the resident doctors to dialogue and find a lasting solution to the incessant strikes. Though strike actions are bound to happen, the state government and the striking doctors should be considerate because they were playing with the lives of people.”
For Babatunde Fashola, Governor of Lagos state, while at the commissioning ceremony of the haemodialysis centre donated by MTN Foundation to Alimosho General Hospital within the week said appealed to doctors to come back to work as no amount of money paid to them can bring back those who have died during the strike action even as the government is open to dialogue with the doctors.
While Lagosians await the end of the strike which has crippled hospital activities, efforts should be made to resolve the various differences as more people are bound to lose their lives if nothing urgently is done.
Alexander Chiejina
Scaling up HIV/AIDS interventions in Nigeria through universal access and ART adherence
When antiretroviral drugs (ARVs) were introduced in Nigeria in the early 1990s, they were only available to those who paid for them. With calls towards achieving universal access to HIV/AIDS beyond 2010, Alexander Chiejina calls for renewed political and funding commitments in the wake of ART usage.
Over the years, Human immuno Virus (HIV) epidemic has continued to remain a major global public health challenge with a total of 33.4 million people living with HIV globally. In 2008 alone, 2.7 million people were newly infected with HIV globally.
Coming home, the 2007 National HIV/ AIDS and Reproductive Health Survey (NARHS Plus) in Nigeria showed that the national HIV prevalence of people living with HIV and AIDS is 3.6 percent (females 4.0 percent; males 3.2 percent with increasing cases in the rural areas in some parts of the country.
Although HIV prevalence is much lower in Nigeria than in other African countries such as South Africa and Zambia, the size of Nigeria’s population (around 150 million) meant that by the end of 2010, over 4.5 million people will be living with the virus. With AIDS claiming so many lives, Nigeria’s life expectancy has declined significantly with latest figures suggesting that the figures had fallen to 48 for women and 46 for men.
Inspite of this shortfalls, since 2006 when United Nations Member States committed to scaling up services and interventions towards the goal of universal access to HIV prevention, treatment, care and support by 2010, the World Health Organisation (WHO), United Nations Children Emergency Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) sought to monitor key components of the health sector response to the HIV epidemic worldwide.
The year 2009 saw continuing progress in expanding access to HIV testing, prevention, treatment and care in low- and middle-income countries. The report assessed HIV/AIDS progress in 144 low- and middle-income countries in 2009 stated the following: 15 countries, including Botswana, Guyana and South Africa, were able to provide more than 80 percent of HIV-positive pregnant women in need, the services and medicines to prevent mother-to-child HIV transmission; 14 countries, including Brazil, Namibia and Ukraine, provided HIV treatment to more than 80 percent of the HIV-positive children in need; and eight countries, including Cambodia, Cuba and Rwanda, have achieved universal access to antiretroviral treatment (ART) for adults.
Though the development of potent anti retroviral therapy (ART) has dramatically improved treatment of HIV, medical experts and stakeholders in the country have stressed the need delivering universal access must be scaled up even as strict adherence to ART medication is required.
Speaking at a recent program organised by Journalist against AIDS (JAAIDS) at Ikeja, Lagos, Deborah Igbokwe, a medical expert at APIN clinic, Nigerian Institute of Medical Research, NIMR, Yaba, Lagos said that adherence is a major issue in HIV treatment given the fact that it affects how well anti-HIV medications decrease the patient’s viral load as well as help prevent drug resistance.
Igbokwe stated that HIV treatment regimens can be complicated as most regimens involve taking multiple pills each day; some anti-HIV medications requires one to take medication on an empty stomach, while others must be taken with meals, and before or after doses of other medications.
In her words “This can be difficult for many people, especially for those who are sick or are experiencing HIV symptoms or negative side effects caused by their medications. Other factors that can make it difficult to adhere to an HIV treatment regimen include experiencing unpleasant side effects after taking one’s medications, travelling away from home, being too busy, forgetting to take medications just to name but a few.”
For Ogechi Onuoha, a member of JAAIDS, findings from an earlier project implemented in 2009 by JAAIDS with funding support from SIDACTION France revealed that people living with HIV/AIDS (PLWHA) faced challenges of long waiting time at clinics, inadequate doctor/client interaction, limited capacity of counselors and infrequent adherence counseling, as well as low knowledge level of the treatment received and how it works.
According to her “the project study which was carried out in Lagos and Oyo states in February 2010 revealed that only a few sites truly offer comprehensive ART services – all expense paid, some PLWH were sometimes unable to afford meals and transport to the clinic, some PLWH were deceived into abandoning their treatment to seek for “miracle cures” and positive mothers who are forced due to cultural influence to breast feed their infants and risk transmitting the virus to their babies and this seriously affected the treatment regimen spelt out by the physician.”
It is noteworthy to state that obstacles to scaling up HIV treatment include funding shortages, limited human resources, and weak procurement and supply management systems for HIV drugs and diagnostics and other health systems bottlenecks which persists in most countries. It is believed that one third of countries reported at least one or more cases when supply of HIV medicines had been interrupted in 2009.
In Nigeria, resources needed to provide sufficient treatment and care for those living with HIV in Nigeria are seriously lacking. A study of health care providers found many had not received sufficient training on HIV prevention and treatment and many of the health facilities had a shortage of medications, equipment and materials. The government's National HIV/AIDS Strategic Framework for 2005 to 2009 set out to provide ARVs to 80 percent of adults and children with advanced HIV infection and to 80 percent of HIV-positive pregnant women in 2010.
Currently, about 34 percent of people with advanced HIV infection are said to be receiving ARVs in the country this year. In the revised framework (from 2010 to 2015), the treatment goals were set back to 2015. Going further, availability and safety of blood and blood products continue to be a concern for HIV prevention. While 99 percent and 85 percent of blood donations in high- and middle-income countries respectively were screened in a quality-assured manner in 2009, in low-income countries the comparable figure was 48 percent. And the list is endless.
No doubt, steps towards achieving universal access beyond 2010 calls for a clear set of actions to be taken by Nigeria and the international community includes renewing political and funding commitments to achieve universal access to HIV/AIDS prevention, treatment and care; improving integration and linkages between HIV/AIDS and related services such as tuberculosis, maternal and child health, sexual health and harm reduction for drug users.
More importantly, special approaches remain necessary to address the particular circumstances and needs of those populations at greater risk for HIV infection. Programmes must be designed and delivered in ways that ensure equity in access, including for children and women. There is no gain saying that only such a combined commitment to programme planning and delivery, built upon a solid primary healthcare framework can fully capture synergies between interventions, ensure programmatic sustainability and maximize coverage and impact.
Over the years, Human immuno Virus (HIV) epidemic has continued to remain a major global public health challenge with a total of 33.4 million people living with HIV globally. In 2008 alone, 2.7 million people were newly infected with HIV globally.
Coming home, the 2007 National HIV/ AIDS and Reproductive Health Survey (NARHS Plus) in Nigeria showed that the national HIV prevalence of people living with HIV and AIDS is 3.6 percent (females 4.0 percent; males 3.2 percent with increasing cases in the rural areas in some parts of the country.
Although HIV prevalence is much lower in Nigeria than in other African countries such as South Africa and Zambia, the size of Nigeria’s population (around 150 million) meant that by the end of 2010, over 4.5 million people will be living with the virus. With AIDS claiming so many lives, Nigeria’s life expectancy has declined significantly with latest figures suggesting that the figures had fallen to 48 for women and 46 for men.
Inspite of this shortfalls, since 2006 when United Nations Member States committed to scaling up services and interventions towards the goal of universal access to HIV prevention, treatment, care and support by 2010, the World Health Organisation (WHO), United Nations Children Emergency Fund (UNICEF) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) sought to monitor key components of the health sector response to the HIV epidemic worldwide.
The year 2009 saw continuing progress in expanding access to HIV testing, prevention, treatment and care in low- and middle-income countries. The report assessed HIV/AIDS progress in 144 low- and middle-income countries in 2009 stated the following: 15 countries, including Botswana, Guyana and South Africa, were able to provide more than 80 percent of HIV-positive pregnant women in need, the services and medicines to prevent mother-to-child HIV transmission; 14 countries, including Brazil, Namibia and Ukraine, provided HIV treatment to more than 80 percent of the HIV-positive children in need; and eight countries, including Cambodia, Cuba and Rwanda, have achieved universal access to antiretroviral treatment (ART) for adults.
Though the development of potent anti retroviral therapy (ART) has dramatically improved treatment of HIV, medical experts and stakeholders in the country have stressed the need delivering universal access must be scaled up even as strict adherence to ART medication is required.
Speaking at a recent program organised by Journalist against AIDS (JAAIDS) at Ikeja, Lagos, Deborah Igbokwe, a medical expert at APIN clinic, Nigerian Institute of Medical Research, NIMR, Yaba, Lagos said that adherence is a major issue in HIV treatment given the fact that it affects how well anti-HIV medications decrease the patient’s viral load as well as help prevent drug resistance.
Igbokwe stated that HIV treatment regimens can be complicated as most regimens involve taking multiple pills each day; some anti-HIV medications requires one to take medication on an empty stomach, while others must be taken with meals, and before or after doses of other medications.
In her words “This can be difficult for many people, especially for those who are sick or are experiencing HIV symptoms or negative side effects caused by their medications. Other factors that can make it difficult to adhere to an HIV treatment regimen include experiencing unpleasant side effects after taking one’s medications, travelling away from home, being too busy, forgetting to take medications just to name but a few.”
For Ogechi Onuoha, a member of JAAIDS, findings from an earlier project implemented in 2009 by JAAIDS with funding support from SIDACTION France revealed that people living with HIV/AIDS (PLWHA) faced challenges of long waiting time at clinics, inadequate doctor/client interaction, limited capacity of counselors and infrequent adherence counseling, as well as low knowledge level of the treatment received and how it works.
According to her “the project study which was carried out in Lagos and Oyo states in February 2010 revealed that only a few sites truly offer comprehensive ART services – all expense paid, some PLWH were sometimes unable to afford meals and transport to the clinic, some PLWH were deceived into abandoning their treatment to seek for “miracle cures” and positive mothers who are forced due to cultural influence to breast feed their infants and risk transmitting the virus to their babies and this seriously affected the treatment regimen spelt out by the physician.”
It is noteworthy to state that obstacles to scaling up HIV treatment include funding shortages, limited human resources, and weak procurement and supply management systems for HIV drugs and diagnostics and other health systems bottlenecks which persists in most countries. It is believed that one third of countries reported at least one or more cases when supply of HIV medicines had been interrupted in 2009.
In Nigeria, resources needed to provide sufficient treatment and care for those living with HIV in Nigeria are seriously lacking. A study of health care providers found many had not received sufficient training on HIV prevention and treatment and many of the health facilities had a shortage of medications, equipment and materials. The government's National HIV/AIDS Strategic Framework for 2005 to 2009 set out to provide ARVs to 80 percent of adults and children with advanced HIV infection and to 80 percent of HIV-positive pregnant women in 2010.
Currently, about 34 percent of people with advanced HIV infection are said to be receiving ARVs in the country this year. In the revised framework (from 2010 to 2015), the treatment goals were set back to 2015. Going further, availability and safety of blood and blood products continue to be a concern for HIV prevention. While 99 percent and 85 percent of blood donations in high- and middle-income countries respectively were screened in a quality-assured manner in 2009, in low-income countries the comparable figure was 48 percent. And the list is endless.
No doubt, steps towards achieving universal access beyond 2010 calls for a clear set of actions to be taken by Nigeria and the international community includes renewing political and funding commitments to achieve universal access to HIV/AIDS prevention, treatment and care; improving integration and linkages between HIV/AIDS and related services such as tuberculosis, maternal and child health, sexual health and harm reduction for drug users.
More importantly, special approaches remain necessary to address the particular circumstances and needs of those populations at greater risk for HIV infection. Programmes must be designed and delivered in ways that ensure equity in access, including for children and women. There is no gain saying that only such a combined commitment to programme planning and delivery, built upon a solid primary healthcare framework can fully capture synergies between interventions, ensure programmatic sustainability and maximize coverage and impact.
Wednesday, October 13, 2010
Over 2.5 million Nigerians aged 40 blinded by glaucoma in Nigeria---Stastitics
...as the world celebrate 'Sight Day'
The eyes no doubt are one of the numerous organs in the human body, whose function is very vital given its role of providing sight. Sadly, many people pay little attention to eye health, let alone eye exam. Hence, protecting it from developing any impairment is one issue "Vision 2020: The Right to Sight", is a global advocacy effort to prevent blindness which was created by the World Health Organisation (WHO) and the International Agency for the Prevention of Blindness (IAPB) is built on. This call is coming at a time as Nigeria joins the rest of the world to mark World Sight Day (held on second Thursday in October).
In the light of this, medical experts in the country have called on Nigerians to visit their physician frequently to avoid developing one form of visual impairment or the other as global attention on blindness, visual impairment and rehabilitation of the visually impaired is brought to the fore.
In an interview with BusinessDay, Adeola Onakoya, Consultant Ophthalmologist, college of medicine, Lagos University Teaching Hospital (LUTH), said that the global target was to ultimately reduce blindness prevalence to less than 0.5 percent in all countries in keeping with the Vision 2020; The Right to Sight.
Onakoya disclosed that the new data based on the world population of 2002 showed a reduction in the number of people who are blind or visually impaired, in particular, those who are blind because of infectious causes. However, there is an increase in the number of people who are blind or visually impaired due to increasing longevity and the increase of non-communicable chronic diseases.
According to the Consultant Ophthalmologist, “the main causes of visual impairment include cataract, glaucoma, refractive errors and low vision, childhood blindness, diabetic retinopathy, age related macular degeneration, genetic eye diseases as well as trachoma (which is caused by Chlamydia trachomatis and is spread by direct contact with eye, nose, and throat secretions from affected individuals, or contact with inanimate objects such as towels and/or washcloths) and Onchocerciasis (river blindness).”
She revealed that the increase of diabetes among many population groups has caused diabetic retinopathy to be added to the priority list while glaucoma, an eye disease of the nerves known for centuries, remains on the public health agenda due to difficulties in its early diagnosis and frequent necessity of lifelong treatment as well as uncorrected refractive errors which is now an emerging important cause of visual impairment.
For Kunle Hassan, National President, Ophthalmological Society of Nigeria (OSN), much advocacy is made on glaucoma because it causes progressive damage of the optic nerve at the point where it leaves the eyes which carries visual information to the brain affected. Hassan stated that glaucoma is the second cause of irreversible blindness globally and the main cause of blindness in Nigeria progresses without warning or obvious symptoms to the patient.
In his words: “Certain factors such as high intraocular pressure (IOP), family history, ethnic background (mostly blacks), age or optic nerve appearance, have been implicated in people who develop glaucoma. However, most Nigerians who visit eye centres for screening more often than not present the later stage.”
According to a survey conducted in Nigeria in 2007, over 16.7 percent (over 2.5 million) of Nigerians aged 40 years were suffering from glaucoma and more Nigerians at present are predisposed to the disease giving lack of awareness of the disease. Already, an estimated 80 million people is anticipated to suffer from glaucoma globally by the year 2020 if awareness and continuous eye screening is not done. In addition, approximately 314 million people worldwide live with low vision and blindness. Of this number, 45 million people are blind and 269 million have low vision.
Giving these alarming figures, there is no gain saying that periodic eye and vision examinations are an important part of preventive health care. Many eye and vision problems have no obvious signs or symptoms. As a result, individuals are often unaware that problems exist.
Forging a way forward for Nigerians, Onakoya stated that for Nigerians who have no family history of eye defect/ disease, they should visit an optometrist /ophthalmologist at least once a year so as to detect any eye disease which may further lead to visual impairment if not detected in time.
In her words “Some problems might not be easily found until they come to late stage. But they can be easily detected through certain eye checks. In other words, most of these eye problems can be well prevented or slowed down if detected at early stage. On the whole, regular eye exam can do people a lot of benefits. But what should the frequency be. People who are younger than forty should get one eye exam at least annually as annual check is needed as they age.”
BY Alexander Chiejina
The eyes no doubt are one of the numerous organs in the human body, whose function is very vital given its role of providing sight. Sadly, many people pay little attention to eye health, let alone eye exam. Hence, protecting it from developing any impairment is one issue "Vision 2020: The Right to Sight", is a global advocacy effort to prevent blindness which was created by the World Health Organisation (WHO) and the International Agency for the Prevention of Blindness (IAPB) is built on. This call is coming at a time as Nigeria joins the rest of the world to mark World Sight Day (held on second Thursday in October).
In the light of this, medical experts in the country have called on Nigerians to visit their physician frequently to avoid developing one form of visual impairment or the other as global attention on blindness, visual impairment and rehabilitation of the visually impaired is brought to the fore.
In an interview with BusinessDay, Adeola Onakoya, Consultant Ophthalmologist, college of medicine, Lagos University Teaching Hospital (LUTH), said that the global target was to ultimately reduce blindness prevalence to less than 0.5 percent in all countries in keeping with the Vision 2020; The Right to Sight.
Onakoya disclosed that the new data based on the world population of 2002 showed a reduction in the number of people who are blind or visually impaired, in particular, those who are blind because of infectious causes. However, there is an increase in the number of people who are blind or visually impaired due to increasing longevity and the increase of non-communicable chronic diseases.
According to the Consultant Ophthalmologist, “the main causes of visual impairment include cataract, glaucoma, refractive errors and low vision, childhood blindness, diabetic retinopathy, age related macular degeneration, genetic eye diseases as well as trachoma (which is caused by Chlamydia trachomatis and is spread by direct contact with eye, nose, and throat secretions from affected individuals, or contact with inanimate objects such as towels and/or washcloths) and Onchocerciasis (river blindness).”
She revealed that the increase of diabetes among many population groups has caused diabetic retinopathy to be added to the priority list while glaucoma, an eye disease of the nerves known for centuries, remains on the public health agenda due to difficulties in its early diagnosis and frequent necessity of lifelong treatment as well as uncorrected refractive errors which is now an emerging important cause of visual impairment.
For Kunle Hassan, National President, Ophthalmological Society of Nigeria (OSN), much advocacy is made on glaucoma because it causes progressive damage of the optic nerve at the point where it leaves the eyes which carries visual information to the brain affected. Hassan stated that glaucoma is the second cause of irreversible blindness globally and the main cause of blindness in Nigeria progresses without warning or obvious symptoms to the patient.
In his words: “Certain factors such as high intraocular pressure (IOP), family history, ethnic background (mostly blacks), age or optic nerve appearance, have been implicated in people who develop glaucoma. However, most Nigerians who visit eye centres for screening more often than not present the later stage.”
According to a survey conducted in Nigeria in 2007, over 16.7 percent (over 2.5 million) of Nigerians aged 40 years were suffering from glaucoma and more Nigerians at present are predisposed to the disease giving lack of awareness of the disease. Already, an estimated 80 million people is anticipated to suffer from glaucoma globally by the year 2020 if awareness and continuous eye screening is not done. In addition, approximately 314 million people worldwide live with low vision and blindness. Of this number, 45 million people are blind and 269 million have low vision.
Giving these alarming figures, there is no gain saying that periodic eye and vision examinations are an important part of preventive health care. Many eye and vision problems have no obvious signs or symptoms. As a result, individuals are often unaware that problems exist.
Forging a way forward for Nigerians, Onakoya stated that for Nigerians who have no family history of eye defect/ disease, they should visit an optometrist /ophthalmologist at least once a year so as to detect any eye disease which may further lead to visual impairment if not detected in time.
In her words “Some problems might not be easily found until they come to late stage. But they can be easily detected through certain eye checks. In other words, most of these eye problems can be well prevented or slowed down if detected at early stage. On the whole, regular eye exam can do people a lot of benefits. But what should the frequency be. People who are younger than forty should get one eye exam at least annually as annual check is needed as they age.”
BY Alexander Chiejina
Placing health research in Nigeria’s healthcare sector
Taking a cursory look at healthcare delivery across the globe, there is no gain saying that health research plays a pivotal role in the development of any nation. This is in view of its contribution to the provision of solutions to health problems, providing evidence for addressing communicable and non-communicable diseases, reducing health disparities, strengthening national health systems as well as deliver healthcare services. Little wonder the World Health Organisation (WHO) revealed that improvement in healthcare delivery has closely been associated with advances in medical research.
Sadly, with Nigeria not in the driving seat of health research in sub Saharan Africa let alone the entire globe, medical experts have called for the Government to provide the necessary leadership in the development and sustainability of health research, create enabling policies, guidelines, ethics and legal framework in lieu of current health challenges in- country and at global levels.
Speaking recently at a program organised by the Nigeria Institute of Medical Research, (NIMR), Yaba, Lagos on the theme “Nigeria at 50; Health Research for National Development” Lecky Mohammed, Director, Health, Planning, Research and Statistics in the Federal Ministry of Health, Abuja said that till date, medical research has provided the strongest support for preventive and curative medicine.
Lecky revealed that medical research began to develop in Nigeria in 1920 when the Rockfeller Foundation established the Yellow Fever Commission and seminar initiatives like the International Conference on Health Research priorities for Nigeria in the 1990s, National seminar on Essential National Health Research (ENHR) etc. to name but a few were held but regretted that certain policy directives to champion health research in the country is still yet to be implemented thus stalling the advancement of medical research in Nigeria.
According to Lecky “The National Health Research Policy and the National Health Research Priorities, which were drafted in 2001 and revised in 2006, is still awaiting implementation into the mainstream of the nation’s health system. Although the National Ethical Research Committee is on place, there is poor adherence to ethical guidelines in medical research resulting probably from absence of ethical review boards in most states and higher institutions. Also, monitoring, and evaluation of research is limited and researchers are not adequately motivated.”
He added that factors responsible for the inadequacies in health research in nigeria includes lack of co-ordination, lack of regular forum to discuss health research, poor linkage between research and policy, dearth of research infrastructures, sub-optimal capacity building strategies, ineffectual documentation.
For Okey Nwanyanwu, Country Director, Centre for Diseases and Country, (CDC) Nigeria, irregular and insufficient funding of health institutes (such as Nigerian Institute of Medical Research and National Institute for Pharmaceutical Research Development NIPRD), human resources challenges, shortage of specialised expertise, inadequate prioritization by development partners and other funding bodies have negatively contributed in the relegation of medical research in the country
Nwanyanwu noted that currently, health research is not a priority of governments and most funding agencies, weak linkages with the academia, governance and industry even as health research is considered not attractive due to time constraints, bearing in mind the high technical expertise and a diversion of intervention resources.
He added that “there is the need to promote public-private partnerships, advocate improved funding for public health research, encourage philanthropy to invest in health research like Ford Foundation, Bill & Melinda Gates Foundation, partner to include research into all interventions and encourage the use of research findings in services”
It is worthy to state that the increased longevity of humans over the past century can be significantly attributed to advances resulting from medical research. Among the major benefits have been vaccines development for measles and polio, insulin treatment for diabetes, classes of antibiotics for treating a host of maladies, medication for high blood pressure, improved treatments for AIDS, statins and increasingly successful treatments for cancer and other emerging diseases.
Furthermore, research funding in many countries emanates from research bodies which distribute money for equipment and salaries. For instance, in the United Kingdom, funding bodies such as the Medical Research Council derive their assets from UK tax payers, and distribute this to institutions in a competitive manner.
In 2003, The National Institutes of Health and pharmaceutical companies in the United States collectively contributed 26.4 billion dollars and 27.0 billion dollars, respectively which constitute 28 percent and 29 percent of the total as at 2003 to medical research.
Other significant contributors included biotechnology companies, medical device companies, other federal, state and local governments as well as foundations and charities, led by the Bill and Melinda Gates Foundation.
With developed nations setting the pace globally, Nigeria can’t afford to lag behind bearing in mind its vision of becoming one of the twenty leading economies in the year 2020 as well as meeting with the Millennium Development Goals deadline of improved healthcare by 2015.
For Innocent Ujah, Director General, NIMR, “Key requirements for health research success include strategic research planning, sustainable funding of research, strengthening identifiable health research institutions at all levels such as NIMR, NIPRD, teaching hospitals, Federal Medical Centres, linking research to global and national initiatives and objectives, develop transparent approach for using research findings to aid evidence based policy at all levels and undertake research at critical areas already identified in different forums.”
More importantly, at the institutional level, there is the need to generate innovative development plan based on the National Strategic Health Development Plan (NSHDP- which is a heath component of Vision 20;2020) which is to serve as a tool for resource mobilization, develop plans that are aligned to NSHDP. In addition, at the national level, it is eminent to progressively increase investment in health research, pursue the passage of the Health bill and approve Health Research Policy and priorities, and establish a robust database of health research for better co-ordination.
ALEXANDER CHIEJINA
Sadly, with Nigeria not in the driving seat of health research in sub Saharan Africa let alone the entire globe, medical experts have called for the Government to provide the necessary leadership in the development and sustainability of health research, create enabling policies, guidelines, ethics and legal framework in lieu of current health challenges in- country and at global levels.
Speaking recently at a program organised by the Nigeria Institute of Medical Research, (NIMR), Yaba, Lagos on the theme “Nigeria at 50; Health Research for National Development” Lecky Mohammed, Director, Health, Planning, Research and Statistics in the Federal Ministry of Health, Abuja said that till date, medical research has provided the strongest support for preventive and curative medicine.
Lecky revealed that medical research began to develop in Nigeria in 1920 when the Rockfeller Foundation established the Yellow Fever Commission and seminar initiatives like the International Conference on Health Research priorities for Nigeria in the 1990s, National seminar on Essential National Health Research (ENHR) etc. to name but a few were held but regretted that certain policy directives to champion health research in the country is still yet to be implemented thus stalling the advancement of medical research in Nigeria.
According to Lecky “The National Health Research Policy and the National Health Research Priorities, which were drafted in 2001 and revised in 2006, is still awaiting implementation into the mainstream of the nation’s health system. Although the National Ethical Research Committee is on place, there is poor adherence to ethical guidelines in medical research resulting probably from absence of ethical review boards in most states and higher institutions. Also, monitoring, and evaluation of research is limited and researchers are not adequately motivated.”
He added that factors responsible for the inadequacies in health research in nigeria includes lack of co-ordination, lack of regular forum to discuss health research, poor linkage between research and policy, dearth of research infrastructures, sub-optimal capacity building strategies, ineffectual documentation.
For Okey Nwanyanwu, Country Director, Centre for Diseases and Country, (CDC) Nigeria, irregular and insufficient funding of health institutes (such as Nigerian Institute of Medical Research and National Institute for Pharmaceutical Research Development NIPRD), human resources challenges, shortage of specialised expertise, inadequate prioritization by development partners and other funding bodies have negatively contributed in the relegation of medical research in the country
Nwanyanwu noted that currently, health research is not a priority of governments and most funding agencies, weak linkages with the academia, governance and industry even as health research is considered not attractive due to time constraints, bearing in mind the high technical expertise and a diversion of intervention resources.
He added that “there is the need to promote public-private partnerships, advocate improved funding for public health research, encourage philanthropy to invest in health research like Ford Foundation, Bill & Melinda Gates Foundation, partner to include research into all interventions and encourage the use of research findings in services”
It is worthy to state that the increased longevity of humans over the past century can be significantly attributed to advances resulting from medical research. Among the major benefits have been vaccines development for measles and polio, insulin treatment for diabetes, classes of antibiotics for treating a host of maladies, medication for high blood pressure, improved treatments for AIDS, statins and increasingly successful treatments for cancer and other emerging diseases.
Furthermore, research funding in many countries emanates from research bodies which distribute money for equipment and salaries. For instance, in the United Kingdom, funding bodies such as the Medical Research Council derive their assets from UK tax payers, and distribute this to institutions in a competitive manner.
In 2003, The National Institutes of Health and pharmaceutical companies in the United States collectively contributed 26.4 billion dollars and 27.0 billion dollars, respectively which constitute 28 percent and 29 percent of the total as at 2003 to medical research.
Other significant contributors included biotechnology companies, medical device companies, other federal, state and local governments as well as foundations and charities, led by the Bill and Melinda Gates Foundation.
With developed nations setting the pace globally, Nigeria can’t afford to lag behind bearing in mind its vision of becoming one of the twenty leading economies in the year 2020 as well as meeting with the Millennium Development Goals deadline of improved healthcare by 2015.
For Innocent Ujah, Director General, NIMR, “Key requirements for health research success include strategic research planning, sustainable funding of research, strengthening identifiable health research institutions at all levels such as NIMR, NIPRD, teaching hospitals, Federal Medical Centres, linking research to global and national initiatives and objectives, develop transparent approach for using research findings to aid evidence based policy at all levels and undertake research at critical areas already identified in different forums.”
More importantly, at the institutional level, there is the need to generate innovative development plan based on the National Strategic Health Development Plan (NSHDP- which is a heath component of Vision 20;2020) which is to serve as a tool for resource mobilization, develop plans that are aligned to NSHDP. In addition, at the national level, it is eminent to progressively increase investment in health research, pursue the passage of the Health bill and approve Health Research Policy and priorities, and establish a robust database of health research for better co-ordination.
ALEXANDER CHIEJINA
Wednesday, October 6, 2010
Kidney failure on the rise in Nigeria
...As calls have been made for regular medical check up
The human kidney is one essential organ responsible for the removal of waste products and excess fluids from the body. Aside this, the kidney helps in reabsorbing useful substances like glucose, protein and electrolysis into the body in precise levels needed for proper body functioning as well as produce hormones which help various organs carry out their specific functions.
Despite the critical role this organ plays, medical experts are worried on the increasing cases of kidney failure or end stage renal disease which is becoming a major issue in Nigeria giving the increasing incidence of the medical ailment.
Recent statistics indicate that kidney failure is increasing worldwide by approximately 7 to 8 percent annually even as incidence in Nigeria could be as high as 10 per million population. In addition, about 12 to 14 cases of patients aged between 20 and 50 years come for kidney dialysis in Lagos University Teaching Hospital (LUTH), idi-araba, Lagos on a weekly basis.
With a significant number of Nigerians who fall within the working population likely to be affected, medical experts have called for Nigerians to maintain healthy lifestyles, go for medical checkups giving the fact that the threat to the future of Nigeria’s economy is at stake.
Speaking at a Kidney Rejoice Program in Lagos recently, Toyin Amira, Consultant Nephrologist, Lagos University Teaching Hospital (LUTH), Idi-araba, Lagos, said that kidney failure results from damages to one or both kidneys giving rise to accumulation of waste and fluids in the body.
Amira stated that the damage to the kidneys can be sudden (as in acute failure) with adequate co-progressive and irreversible insult to the kidney, often referred to as End Stage Kidney Failure.
According to Amira: “Healthy kidneys work 24 hours a day to remove waste products from the blood that build up mainly from the food that we eat. These waste products include urea, creatinine, potassium, sodium, phosphorus and fluids. However, kidney failure may show no symptoms until it reaches an advanced stage. However, some identified causes include hypertension, diabetes, glomerulonephrities, HIV/AIDS, analgesic nephropathy, certain diseases like polycystic kidney diseases, to name but a few. “
She hinted that a failure of the kidneys could lead to so many negative complications and gradually affect the other organs of the body which may eventually make the patient succumb to death except treated by dialysis or transplantation.
For Hadunni Ogunjumelo, co-coordinator, Kidney Rejoice, a non-governmental organsation targeted at creating awareness of Kidney issues in Nigeria said that “Because hypertension-often referred to as a “silent killer”-cause no symptoms and medications are expensive and may cause unwanted side effects, many find compliance with required treatment difficult and this further compound the problem of hypertension related kidney disease.
In her words “Poverty has been identified as a major problem in the bid to reduce this casualty. In advanced countries, they have extensive prevention programmes on kidney while for us in Nigeria we need to depend even more on prevention modes. Unfortunately, quite a high number of patients in Nigeria end up with no treatment option. In other words, they just wait to die due to unawareness, inability to afford treatments and inaccessibility to good treatment modes. Don’t forget that a typical renal patient has a 3 to 5 hour dialysis treatment; three times per week. For instance, in Nigeria, each session of dialysis treatment will cost an average of N25, 000. 00 (twenty-five thousand naira) or over seventy–five thousand naira per week, a cost much more than the average Nigerian worker cannot bear.”
With the World Health Organization (WHO) statistics of 2002 which put death rate from intrinsic kidney and urinary tract disease at one million and the prevalence of impaired kidney function estimated to range between 10 percent and 20 percent of adult population in most countries worldwide, it is evident that urgent attention needs to be paid to the risk factors for chronic kidney disease and to instituting interventions to slow the progression of renal disease.
For Joe Okei-Odumakin, President, Women Arise for Change initiative, whose brother was diagnosed of kidney failure three months before he died, stated that since the kidney is a sensitive organ in the body, Nigerians should endeavour to consult their health care provider for prescription of drugs as unregulated across the shelf consumption of drugs could affect the kidney without the person knowing about that.
“Make efforts to check your blood pressure since chronic high blood pressure have been identified as one of the most common causes of acute kidney failure in adult men and women; quitting cigarette smoke lowers the blood pressure, which is important for preventing kidney failure; and maintaining healthy lifestyle by checking what you eat/ drink is also important. You can reduce the strain on your kidneys by cutting all alcoholic drinks out of your lifestyle. These drinks require that your kidneys work very hard and not drinking them can help prevent kidney problems,” Okei-Odumakin added.
alexander Chiejina
The human kidney is one essential organ responsible for the removal of waste products and excess fluids from the body. Aside this, the kidney helps in reabsorbing useful substances like glucose, protein and electrolysis into the body in precise levels needed for proper body functioning as well as produce hormones which help various organs carry out their specific functions.
Despite the critical role this organ plays, medical experts are worried on the increasing cases of kidney failure or end stage renal disease which is becoming a major issue in Nigeria giving the increasing incidence of the medical ailment.
Recent statistics indicate that kidney failure is increasing worldwide by approximately 7 to 8 percent annually even as incidence in Nigeria could be as high as 10 per million population. In addition, about 12 to 14 cases of patients aged between 20 and 50 years come for kidney dialysis in Lagos University Teaching Hospital (LUTH), idi-araba, Lagos on a weekly basis.
With a significant number of Nigerians who fall within the working population likely to be affected, medical experts have called for Nigerians to maintain healthy lifestyles, go for medical checkups giving the fact that the threat to the future of Nigeria’s economy is at stake.
Speaking at a Kidney Rejoice Program in Lagos recently, Toyin Amira, Consultant Nephrologist, Lagos University Teaching Hospital (LUTH), Idi-araba, Lagos, said that kidney failure results from damages to one or both kidneys giving rise to accumulation of waste and fluids in the body.
Amira stated that the damage to the kidneys can be sudden (as in acute failure) with adequate co-progressive and irreversible insult to the kidney, often referred to as End Stage Kidney Failure.
According to Amira: “Healthy kidneys work 24 hours a day to remove waste products from the blood that build up mainly from the food that we eat. These waste products include urea, creatinine, potassium, sodium, phosphorus and fluids. However, kidney failure may show no symptoms until it reaches an advanced stage. However, some identified causes include hypertension, diabetes, glomerulonephrities, HIV/AIDS, analgesic nephropathy, certain diseases like polycystic kidney diseases, to name but a few. “
She hinted that a failure of the kidneys could lead to so many negative complications and gradually affect the other organs of the body which may eventually make the patient succumb to death except treated by dialysis or transplantation.
For Hadunni Ogunjumelo, co-coordinator, Kidney Rejoice, a non-governmental organsation targeted at creating awareness of Kidney issues in Nigeria said that “Because hypertension-often referred to as a “silent killer”-cause no symptoms and medications are expensive and may cause unwanted side effects, many find compliance with required treatment difficult and this further compound the problem of hypertension related kidney disease.
In her words “Poverty has been identified as a major problem in the bid to reduce this casualty. In advanced countries, they have extensive prevention programmes on kidney while for us in Nigeria we need to depend even more on prevention modes. Unfortunately, quite a high number of patients in Nigeria end up with no treatment option. In other words, they just wait to die due to unawareness, inability to afford treatments and inaccessibility to good treatment modes. Don’t forget that a typical renal patient has a 3 to 5 hour dialysis treatment; three times per week. For instance, in Nigeria, each session of dialysis treatment will cost an average of N25, 000. 00 (twenty-five thousand naira) or over seventy–five thousand naira per week, a cost much more than the average Nigerian worker cannot bear.”
With the World Health Organization (WHO) statistics of 2002 which put death rate from intrinsic kidney and urinary tract disease at one million and the prevalence of impaired kidney function estimated to range between 10 percent and 20 percent of adult population in most countries worldwide, it is evident that urgent attention needs to be paid to the risk factors for chronic kidney disease and to instituting interventions to slow the progression of renal disease.
For Joe Okei-Odumakin, President, Women Arise for Change initiative, whose brother was diagnosed of kidney failure three months before he died, stated that since the kidney is a sensitive organ in the body, Nigerians should endeavour to consult their health care provider for prescription of drugs as unregulated across the shelf consumption of drugs could affect the kidney without the person knowing about that.
“Make efforts to check your blood pressure since chronic high blood pressure have been identified as one of the most common causes of acute kidney failure in adult men and women; quitting cigarette smoke lowers the blood pressure, which is important for preventing kidney failure; and maintaining healthy lifestyle by checking what you eat/ drink is also important. You can reduce the strain on your kidneys by cutting all alcoholic drinks out of your lifestyle. These drinks require that your kidneys work very hard and not drinking them can help prevent kidney problems,” Okei-Odumakin added.
alexander Chiejina
Experts seek means to improve mental healthcare in Nigeria
…as the world celebrates World Health Day
To medical experts, physical and mental health is intertwined hence, mental health is seen as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.
Taking a cursory look at the Nigerian society, people with mental and psychosocial disabilities are among the most marginalized group. Even though development actors have pledged to focus their work on the most vulnerable in a community, many programmes continue to ignore and exclude this vulnerable group. Sadly, the treatment gap for mental, neurological and substance use disorders is alarming especially in poor resource countries with Nigeria not left out of this frame.
As Nigeria joins the rest of the world to celebrate World Mental Health Day every October 10- a day set aside to raise public awareness about mental health issues, promote more open discussion of mental disorders, and investments in prevention and treatment services, medical experts in the country have tasked the government on the need for availability and access to mental care to Nigerians.
Speaking recently to newsmen in Lagos, Olufemi Olugbile, Chief Medical Director, Lagos State University Teaching Hospital (LASUTH) said that it has been estimated that at least, about 90 percent of people with clear-cut mental health syndromes do not even get any treatment at all in Nigeria which is an atrocious figure and everybody knows the issue.
Olugbile, who is also a consultant psychiatrist stated that the specialists, such as psychiatrist nurses, social welfare officers, occupational therapists and all those who form members of the mental health team, are very few in numbers, grossly inadequate even as the number of hospital units available for the treatment of mental disorders is also very low.
According to him “Mental healthcare is supposed to be one of the elements of primary healthcare in Nigeria but that is only seen on papers. Most of the people at the level of the primary health care don’t know much about mental health, don’t have interest in it and don’t have facilities, including simple drugs for treating mental illness. We believe that if we reverse all these three things, giving them knowledge, facilities and supervision, mental healthcare would reach its optimal goal. Right now, there are more people outside the net than inside the net.
The problem is not all about non-availability of specialists but the way, services are organized currently do not make for appropriate coverage. Of course, when people do not have access to the so-called mental healthcare services, what are they supposed to do? They patronize people closer to them the traditional healers. What Lagos State has done is that, it has set up a body to coordinate the traditional healthcare and also to help standardize it so that they would be doing some kind of certification, inspecting what people are doing, checking both their environments and the details of their practice.”
He added that “In the United Kingdom and other nations of the world, mentally-ill people are actually not treated by mental health specialists but by General health Practitioners. Most illnesses are of such an order that they can actually be substantially treated and relieved by lower level of care, non specialized care, such as what is available in primary health care centres and in general practices.”
For Oye Gureje, President, Association of Psychiatrists in Nigeria (APN), mental health conditions are responsible for a great deal of mortality and disability, accounting for 8.8 percent and 16.6 percent of the total burden of disease due to health conditions in low and middle-income countries, respectively according to latest reports from the World Health Organsation (WHO).
Guruje disclosed that “this report calls for development actors to address the needs of people with mental and psychosocial disabilities in development work by: recognizing the vulnerability of this group and including them in all development initiatives, scaling up services for mental health in primary care; involving people themselves in the design of development programmes and projects; and improving social services for people with mental and psychosocial disabilities as the nation may not be able to achieve the lofty dreams of Millennium Development Goals (MDGs) if proper attention is not paid to the burning issue of mental welfare of the nation.”
It is eminent to state that In Africa, less than 50 percent of countries have a mental health policy. In Nigeria, the progressive 1991 primary health care policy states that mental health should be integrated at the primary care level but this is still yet to be implemented.
However, the most severe mental illnesses require long-term treatment. Although this treatment when given in the community is not expensive, the system of paying out-of-pocket means that many families find it hard to afford the care their loved ones need month after month. It is unclear whether the National Health Insurance Scheme will adequately cover mental ill health.
Some schools of thought believe that monies expended by the Federal government for mental health is what is being used to run the eight psychiatric hospitals that the Federal government has. If this is what it really is, it means there may be insufficient funds for programmes such as initiative and public education, as well as the scourge of debilitating mental disorder in our nation.
No doubt, to revamp mental healthcare in Nigeria, there must be equal attention, even more attention, paid to advocacy and programmes meant to change the pattern and reverse the statistics which suggest that about 90 percent of people lack access to mental care. This is a paradigm shift which the government has to make.
Alexander Chiejina
To medical experts, physical and mental health is intertwined hence, mental health is seen as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.
Taking a cursory look at the Nigerian society, people with mental and psychosocial disabilities are among the most marginalized group. Even though development actors have pledged to focus their work on the most vulnerable in a community, many programmes continue to ignore and exclude this vulnerable group. Sadly, the treatment gap for mental, neurological and substance use disorders is alarming especially in poor resource countries with Nigeria not left out of this frame.
As Nigeria joins the rest of the world to celebrate World Mental Health Day every October 10- a day set aside to raise public awareness about mental health issues, promote more open discussion of mental disorders, and investments in prevention and treatment services, medical experts in the country have tasked the government on the need for availability and access to mental care to Nigerians.
Speaking recently to newsmen in Lagos, Olufemi Olugbile, Chief Medical Director, Lagos State University Teaching Hospital (LASUTH) said that it has been estimated that at least, about 90 percent of people with clear-cut mental health syndromes do not even get any treatment at all in Nigeria which is an atrocious figure and everybody knows the issue.
Olugbile, who is also a consultant psychiatrist stated that the specialists, such as psychiatrist nurses, social welfare officers, occupational therapists and all those who form members of the mental health team, are very few in numbers, grossly inadequate even as the number of hospital units available for the treatment of mental disorders is also very low.
According to him “Mental healthcare is supposed to be one of the elements of primary healthcare in Nigeria but that is only seen on papers. Most of the people at the level of the primary health care don’t know much about mental health, don’t have interest in it and don’t have facilities, including simple drugs for treating mental illness. We believe that if we reverse all these three things, giving them knowledge, facilities and supervision, mental healthcare would reach its optimal goal. Right now, there are more people outside the net than inside the net.
The problem is not all about non-availability of specialists but the way, services are organized currently do not make for appropriate coverage. Of course, when people do not have access to the so-called mental healthcare services, what are they supposed to do? They patronize people closer to them the traditional healers. What Lagos State has done is that, it has set up a body to coordinate the traditional healthcare and also to help standardize it so that they would be doing some kind of certification, inspecting what people are doing, checking both their environments and the details of their practice.”
He added that “In the United Kingdom and other nations of the world, mentally-ill people are actually not treated by mental health specialists but by General health Practitioners. Most illnesses are of such an order that they can actually be substantially treated and relieved by lower level of care, non specialized care, such as what is available in primary health care centres and in general practices.”
For Oye Gureje, President, Association of Psychiatrists in Nigeria (APN), mental health conditions are responsible for a great deal of mortality and disability, accounting for 8.8 percent and 16.6 percent of the total burden of disease due to health conditions in low and middle-income countries, respectively according to latest reports from the World Health Organsation (WHO).
Guruje disclosed that “this report calls for development actors to address the needs of people with mental and psychosocial disabilities in development work by: recognizing the vulnerability of this group and including them in all development initiatives, scaling up services for mental health in primary care; involving people themselves in the design of development programmes and projects; and improving social services for people with mental and psychosocial disabilities as the nation may not be able to achieve the lofty dreams of Millennium Development Goals (MDGs) if proper attention is not paid to the burning issue of mental welfare of the nation.”
It is eminent to state that In Africa, less than 50 percent of countries have a mental health policy. In Nigeria, the progressive 1991 primary health care policy states that mental health should be integrated at the primary care level but this is still yet to be implemented.
However, the most severe mental illnesses require long-term treatment. Although this treatment when given in the community is not expensive, the system of paying out-of-pocket means that many families find it hard to afford the care their loved ones need month after month. It is unclear whether the National Health Insurance Scheme will adequately cover mental ill health.
Some schools of thought believe that monies expended by the Federal government for mental health is what is being used to run the eight psychiatric hospitals that the Federal government has. If this is what it really is, it means there may be insufficient funds for programmes such as initiative and public education, as well as the scourge of debilitating mental disorder in our nation.
No doubt, to revamp mental healthcare in Nigeria, there must be equal attention, even more attention, paid to advocacy and programmes meant to change the pattern and reverse the statistics which suggest that about 90 percent of people lack access to mental care. This is a paradigm shift which the government has to make.
Alexander Chiejina
Monday, September 27, 2010
Telemedicine and e-health: Antidote towards reaching Nigeria’s MDGs
There is no gain saying that the nation’s healthcare sector since independence has been plagued with the challenge of achieving the delivery of quality healthcare to the majority of its populace. These are evident in the state of inadequate infrastructure and lack of basic amenities some healthcare institutions in the country are confronted with.
Though several governments in the past and present have carried out one form of refurbishment of facilities at these health institutions, some existing health services are either not affordable or inaccessible to the vulnerable group especially the poor and people living in rural and underdeveloped area.
This can be reflected in the nation’s health induces which shows that Nigeria has one of the worst maternal, newborn and child mortality statistics in the world with an estimated 52,900 Nigerian women and 250,000 newborn dying annually from causes that are largely preventable if appropriate interventions are made available by Skilled Birth Attendants (the midwives) in the rural communities.
In the light of this, medical experts at the recent 4th Nigerian conference on telemedicine and ehealth with the theme “Driving eHealth and Telemedicine in Nigeria” called for the deploying telemedicine and e-health (electronic health) tools which will go a long way in improving the quality and accessible healthcare delivery in the country.
In an interview with BusinessDay, Olajide Adebola, President, Society for Telemedicine and e-Health in Nigeria, (SFTeHIN) said that telemedicine involves the use of medical information transferred from one site to another through electronic communications to improve patient’s health care including diagnosis and treatment.
Adebola hinted that whereas telemedicine may be as simple as two medical professionals discussing a case over the telephone, or as advanced as using video teleconferencing systems, eHealth involves the acquisition and transmission of patient’s medical data such as radiological studies, laboratory results and biomonitoring information to a physician at a convenient time for assessment offline.
According to Adebola “It is time to enact changes in the health care sector in Nigeria through the use of information communications technology (ICT) to improve quality and extension of health care services for the development of the nation. Public health monitoring, disease surveillance, research and quality monitoring require data that depends on the wide spread adoption of eHealth tools & services.
It will be recalled that on the 17th October 2006, there was a meeting of the Society with the then President Olusegun Obasanjo, the minister of health and the ministry key staff with head of other key agencies to discuss on developing eHealth in Nigeria. It was agreed that the committee will be constituted and Nigeria will have a national budget for eHealth in 2007.
The Society was informed about the creation of the national telemedicine programme under the department of Hospital services in the ministry of Health mid 2007 but no policy or guidelines on the programme is available for all stakeholders to know which areas of activities is the focus for deployment of eHealth tools and services till date. We will continue to engage the government on the need to have eHealth governance mechanism in Nigeria because without this, telemedicine/ehealth and Health ICT in general will not thrive.
For his part, Muhammad Ali Pate, Executive Director/CEO, National Primary Health Care Development Agency, (NPHCDA) stated that there is therefore a compelling need for multi-sectoral collaboration among healthcare providers/institutions and the telecommunication industry to ensure the delivery of quality healthcare services to hitherto underserved populations in rural and sub-urban communities of our country given the reality that maternal, newborn and child mortality constitutes a grave challenge to human capital development and the attainment of MDGs 4 and 5 in Nigeria.
In his words “In recognition of the critical role of ICT in strengthening health care development, the NPHCDA conceptualised the Midwives Service Scheme (MSS) with an ICT-based rapid reporting and communication tool which involves data transmission via internet, SMS and voice calls among the various drivers of the scheme. The MADEX (Mobile Application Data Exchange) Application as it is called is Nigeria’s initial footprint on the great sands of mHealth which is driven by the NPHCDA. At the moment, about 1000 mobile phone lines, distributed among 652 health facilities in rural hard-to reach locations linked to 163 referral General Hospitals. These facilities are distributed across all states of the federation and are involved in the collection, transmission and dissemination of health statistics for the purpose of monitoring and evaluation of health service delivery at the primary health care level.”
No doubt, given the increasingly important role of telemedicine and eHealth in contemporary healthcare delivery, there is the need for aggressive advocacy to telecommunications operators to support telemedicine and ehealth initiatives as the government cannot do it alone.
For participants who spoke to BusinessDay at the conference, there should be
National eHealth Committee comprising all stakeholders such as SFTeHIN, Federal Ministry of Health, Federal Ministry of Communications, and the Nigeria Communications Commission (NCC), National Information Technology Development Agency, National Primary Healthcare Development Agency, National Space Research and development Agency (NASRDA), etc. which should be set up.
Also, the subject should be introduced in the curriculum of health science schools; Centres of Excellence where short-course training in telemedicine and eHealth can be conducted should be identified.
However, the committee to be constituted should as a matter of urgency, work out modalities for the development of a national strategy, policy and draft legislation required to successfully implement and sustain telemedicine and eHealth programmes in Nigeria. Aside this, government should formulate policies that will create the enabling business environment and provide incentives for telecommunications operators, so as to encourage existing telemedicine programmes and development of new ones, particularly in the private sector.
alexander chiejina
Though several governments in the past and present have carried out one form of refurbishment of facilities at these health institutions, some existing health services are either not affordable or inaccessible to the vulnerable group especially the poor and people living in rural and underdeveloped area.
This can be reflected in the nation’s health induces which shows that Nigeria has one of the worst maternal, newborn and child mortality statistics in the world with an estimated 52,900 Nigerian women and 250,000 newborn dying annually from causes that are largely preventable if appropriate interventions are made available by Skilled Birth Attendants (the midwives) in the rural communities.
In the light of this, medical experts at the recent 4th Nigerian conference on telemedicine and ehealth with the theme “Driving eHealth and Telemedicine in Nigeria” called for the deploying telemedicine and e-health (electronic health) tools which will go a long way in improving the quality and accessible healthcare delivery in the country.
In an interview with BusinessDay, Olajide Adebola, President, Society for Telemedicine and e-Health in Nigeria, (SFTeHIN) said that telemedicine involves the use of medical information transferred from one site to another through electronic communications to improve patient’s health care including diagnosis and treatment.
Adebola hinted that whereas telemedicine may be as simple as two medical professionals discussing a case over the telephone, or as advanced as using video teleconferencing systems, eHealth involves the acquisition and transmission of patient’s medical data such as radiological studies, laboratory results and biomonitoring information to a physician at a convenient time for assessment offline.
According to Adebola “It is time to enact changes in the health care sector in Nigeria through the use of information communications technology (ICT) to improve quality and extension of health care services for the development of the nation. Public health monitoring, disease surveillance, research and quality monitoring require data that depends on the wide spread adoption of eHealth tools & services.
It will be recalled that on the 17th October 2006, there was a meeting of the Society with the then President Olusegun Obasanjo, the minister of health and the ministry key staff with head of other key agencies to discuss on developing eHealth in Nigeria. It was agreed that the committee will be constituted and Nigeria will have a national budget for eHealth in 2007.
The Society was informed about the creation of the national telemedicine programme under the department of Hospital services in the ministry of Health mid 2007 but no policy or guidelines on the programme is available for all stakeholders to know which areas of activities is the focus for deployment of eHealth tools and services till date. We will continue to engage the government on the need to have eHealth governance mechanism in Nigeria because without this, telemedicine/ehealth and Health ICT in general will not thrive.
For his part, Muhammad Ali Pate, Executive Director/CEO, National Primary Health Care Development Agency, (NPHCDA) stated that there is therefore a compelling need for multi-sectoral collaboration among healthcare providers/institutions and the telecommunication industry to ensure the delivery of quality healthcare services to hitherto underserved populations in rural and sub-urban communities of our country given the reality that maternal, newborn and child mortality constitutes a grave challenge to human capital development and the attainment of MDGs 4 and 5 in Nigeria.
In his words “In recognition of the critical role of ICT in strengthening health care development, the NPHCDA conceptualised the Midwives Service Scheme (MSS) with an ICT-based rapid reporting and communication tool which involves data transmission via internet, SMS and voice calls among the various drivers of the scheme. The MADEX (Mobile Application Data Exchange) Application as it is called is Nigeria’s initial footprint on the great sands of mHealth which is driven by the NPHCDA. At the moment, about 1000 mobile phone lines, distributed among 652 health facilities in rural hard-to reach locations linked to 163 referral General Hospitals. These facilities are distributed across all states of the federation and are involved in the collection, transmission and dissemination of health statistics for the purpose of monitoring and evaluation of health service delivery at the primary health care level.”
No doubt, given the increasingly important role of telemedicine and eHealth in contemporary healthcare delivery, there is the need for aggressive advocacy to telecommunications operators to support telemedicine and ehealth initiatives as the government cannot do it alone.
For participants who spoke to BusinessDay at the conference, there should be
National eHealth Committee comprising all stakeholders such as SFTeHIN, Federal Ministry of Health, Federal Ministry of Communications, and the Nigeria Communications Commission (NCC), National Information Technology Development Agency, National Primary Healthcare Development Agency, National Space Research and development Agency (NASRDA), etc. which should be set up.
Also, the subject should be introduced in the curriculum of health science schools; Centres of Excellence where short-course training in telemedicine and eHealth can be conducted should be identified.
However, the committee to be constituted should as a matter of urgency, work out modalities for the development of a national strategy, policy and draft legislation required to successfully implement and sustain telemedicine and eHealth programmes in Nigeria. Aside this, government should formulate policies that will create the enabling business environment and provide incentives for telecommunications operators, so as to encourage existing telemedicine programmes and development of new ones, particularly in the private sector.
alexander chiejina
Sanofi Aventis, medical experts brainstorm on the management of peptic disorders
…as it launches antacid ‘Maalox’ into Nigeria
Alexander Chiejina
More often than not, some Nigerians develop one form of abdominal pain, bloating and abdominal fullness, nausea, copious vomiting, painful sensation at the chest while eating, copious vomiting etc. no name but a few. This discomfort experience by these individuals propels them to purchase pain relieving drugs like NSAIDs (non-steroid anti-inflammatory drugs) like aspirin, diclofenac, ibuprofen, ketoprofen etc. across the counter without the prescription of a physician.
To some, after consumption of this drug without eating, or side effects end up with sudden large bleeding which at the end may become life-threatening. For some, it may degenerate to the development of a stomach disorder which results in the erosion of the gastro-intestinal wall and the spillage of stomach or intestinal content into the abdominal cavity. Giving this avoidable realty, experts have called for the care in the use of antacids in the management of acid peptic disorders.
Speaking at the launch of Maalox, an antacid developed by Sanofi Aventis in Lagos recently, Funmilayo Lesi, consultant gastroenterologist, College of Medicine, University of Lagos, said that acid peptic disorder encompass a broad range of clinical disorders involving the oesophagus, stomach and duodenum with significant impact of the disease on morbidity and quality of life, economic activity and productivity. Lesi revealed that a major causative factor of gastric and duodenal ulcers in humans is chronic inflammation by bacterium Helicobacter pylori which colonizes the antral mucosa of the stomach.
The medical expert stated that the immune system is unable to clear the infection, despite the appearance of antibodies hence the bacterium cause a chronic active gastritis (type B gastritis), resulting in a defect in the regulation of gastrin production by that part of the stomach, and gastrin secretion which can either be decreased or increased.
In her words “Gastrin stimulates the production of gastric acid by parietal cells and, in H. pylori colonization responses that increase gastrin, the increase in acid can contribute to the erosion of the mucosa and therefore ulcer formation. However, the timing of the symptoms in relation to the meal may differentiate between gastric and duodenal ulcers.
A gastric ulcer would give epigastric pain during meal as gastric acid is secreted or after the meal as the alkaline duodenal contents reflux into the stomach. Symptoms of duodenal ulcers would manifest mostly before the meal when acid (production stimulated by hunger) is passed into the duodenum. However, this is not a reliable sign in clinical practice. Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the patient's age.
Furthermore, typical ulcers tend to heal and recur and as a result the pain may occur for few days and weeks and then wane. Pain is usually caused by the ulcer but may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the breastbone; it may last from few minutes to several hours and may be worse when the stomach is empty. Also, sometimes the pain may flare at night and it can commonly be temporarily relived by taking anti-acid medication.] However, peptic ulcer disease symptoms may be different for every sufferer,” Lesi disclosed.
Lesi noted that another major cause of ulcer is the use of NSAIDs and stress which as a possible cause, or at least complication, leads in the development of ulcers.
Explaining the dynamics of antacids used to the treatment of ulcer, Chijioke Onyia, managing director, Pinecrest Healthcare limited revealed that antacid performs a neutralization reaction, i.e. they buffer gastric acid, raising the pH to reduce acidity in the stomach.
Onyia stated that when gastric hydrochloric acid in the stomach reaches the nerves in the gastrointestinal mucosa, they signal pain to the central nervous system. He noted that this happens when these nerves are exposed, as in peptic ulcers. The gastric acid may also reach ulcers in the esophagus or the duodenum.
In his words “antacids like Maalox show the most rapid onset of action and provide faster relief of symptoms. However they may cause an "acid rebound not suitable for all patients owing to its components like calcium carbonate and sodium bicarbonate which counteracts stomach acidity.”
No doubt, with stomach pain been the first to signal a peptic ulcer, it is important that people who develop this see their physician as they may treat ulcers without diagnosing them with specific tests and observe if the symptoms resolve, meaning their primary diagnosis was accurate.
For Frank Umeh, Medical Manager, North East Zone, Sanofi Aventis Pharmaceuticals, Maalox chewable tablets are used for relieving pressure, bloating, and gas in the digestive tract. Umeh hinted that It may also be used for other conditions as determined by your doctor.
“Maalox chewable tablet is an antiflatulent. It works by breaking up gas bubbles, which makes gas easier to eliminate. Contact your doctor or health care provider right away prior to the usage of the drug. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you: if you are pregnant, planning to become pregnant, or are breast-feeding, if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement etc. This is because some medicine may interact with Maalox. However, no specific interactions with Maalox Anti-Gas Chewable Tablets are known at this time. More importantly, Check with your health care provider before you start, stop, or change the dose of any medicine,” Umeh concluded.
Alexander Chiejina
More often than not, some Nigerians develop one form of abdominal pain, bloating and abdominal fullness, nausea, copious vomiting, painful sensation at the chest while eating, copious vomiting etc. no name but a few. This discomfort experience by these individuals propels them to purchase pain relieving drugs like NSAIDs (non-steroid anti-inflammatory drugs) like aspirin, diclofenac, ibuprofen, ketoprofen etc. across the counter without the prescription of a physician.
To some, after consumption of this drug without eating, or side effects end up with sudden large bleeding which at the end may become life-threatening. For some, it may degenerate to the development of a stomach disorder which results in the erosion of the gastro-intestinal wall and the spillage of stomach or intestinal content into the abdominal cavity. Giving this avoidable realty, experts have called for the care in the use of antacids in the management of acid peptic disorders.
Speaking at the launch of Maalox, an antacid developed by Sanofi Aventis in Lagos recently, Funmilayo Lesi, consultant gastroenterologist, College of Medicine, University of Lagos, said that acid peptic disorder encompass a broad range of clinical disorders involving the oesophagus, stomach and duodenum with significant impact of the disease on morbidity and quality of life, economic activity and productivity. Lesi revealed that a major causative factor of gastric and duodenal ulcers in humans is chronic inflammation by bacterium Helicobacter pylori which colonizes the antral mucosa of the stomach.
The medical expert stated that the immune system is unable to clear the infection, despite the appearance of antibodies hence the bacterium cause a chronic active gastritis (type B gastritis), resulting in a defect in the regulation of gastrin production by that part of the stomach, and gastrin secretion which can either be decreased or increased.
In her words “Gastrin stimulates the production of gastric acid by parietal cells and, in H. pylori colonization responses that increase gastrin, the increase in acid can contribute to the erosion of the mucosa and therefore ulcer formation. However, the timing of the symptoms in relation to the meal may differentiate between gastric and duodenal ulcers.
A gastric ulcer would give epigastric pain during meal as gastric acid is secreted or after the meal as the alkaline duodenal contents reflux into the stomach. Symptoms of duodenal ulcers would manifest mostly before the meal when acid (production stimulated by hunger) is passed into the duodenum. However, this is not a reliable sign in clinical practice. Also, the symptoms of peptic ulcers may vary with the location of the ulcer and the patient's age.
Furthermore, typical ulcers tend to heal and recur and as a result the pain may occur for few days and weeks and then wane. Pain is usually caused by the ulcer but may be aggravated by the stomach acid when it comes into contact with the ulcerated area. The pain caused by peptic ulcers can be felt anywhere from the navel up to the breastbone; it may last from few minutes to several hours and may be worse when the stomach is empty. Also, sometimes the pain may flare at night and it can commonly be temporarily relived by taking anti-acid medication.] However, peptic ulcer disease symptoms may be different for every sufferer,” Lesi disclosed.
Lesi noted that another major cause of ulcer is the use of NSAIDs and stress which as a possible cause, or at least complication, leads in the development of ulcers.
Explaining the dynamics of antacids used to the treatment of ulcer, Chijioke Onyia, managing director, Pinecrest Healthcare limited revealed that antacid performs a neutralization reaction, i.e. they buffer gastric acid, raising the pH to reduce acidity in the stomach.
Onyia stated that when gastric hydrochloric acid in the stomach reaches the nerves in the gastrointestinal mucosa, they signal pain to the central nervous system. He noted that this happens when these nerves are exposed, as in peptic ulcers. The gastric acid may also reach ulcers in the esophagus or the duodenum.
In his words “antacids like Maalox show the most rapid onset of action and provide faster relief of symptoms. However they may cause an "acid rebound not suitable for all patients owing to its components like calcium carbonate and sodium bicarbonate which counteracts stomach acidity.”
No doubt, with stomach pain been the first to signal a peptic ulcer, it is important that people who develop this see their physician as they may treat ulcers without diagnosing them with specific tests and observe if the symptoms resolve, meaning their primary diagnosis was accurate.
For Frank Umeh, Medical Manager, North East Zone, Sanofi Aventis Pharmaceuticals, Maalox chewable tablets are used for relieving pressure, bloating, and gas in the digestive tract. Umeh hinted that It may also be used for other conditions as determined by your doctor.
“Maalox chewable tablet is an antiflatulent. It works by breaking up gas bubbles, which makes gas easier to eliminate. Contact your doctor or health care provider right away prior to the usage of the drug. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you: if you are pregnant, planning to become pregnant, or are breast-feeding, if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement etc. This is because some medicine may interact with Maalox. However, no specific interactions with Maalox Anti-Gas Chewable Tablets are known at this time. More importantly, Check with your health care provider before you start, stop, or change the dose of any medicine,” Umeh concluded.
Experts task Nigerians on regular cardiovascular checks and healthy living
…as the world celebrates World Heart Day
Alexander Chiejina
More often than not, some Nigerians have been confronted with the issue of managing cardiovascular diseases (CVDs) like heart attacks and strokes, mainly caused by a blockage that prevents blood from flowing to the heart or brain, which experts believe is number one cause of death globally.
Sadly, recent statistics from the World Health Organisation (WHO) suggests that more people die annually from CVDs than from any other cause with an estimated 17.1 million people dying from CVDs in 2004, which represents 29 percent of all global deaths. Of these deaths, an estimated 7.2 million were due to coronary heart disease and 5.7 million were due to stroke.
In the report, low and middle income countries are disproportionally affected: 82 percent of CVD deaths take place and occur almost equally in men and women. However, it is projected that by 2030, almost 23.6 million people will die from CVDs, mainly from heart disease and stroke.
As Nigeria joins the rest of the world to celebrate World Heart Day every September 27th, medical experts in the country have tasked Nigerians to observe regular checkups and live healthy lives in a bid to safeguard themselves from this impending danger.
In a recent interview with BusinessDay, Anam Mbakwem, consultant nephrologist at the Lagos University Teaching Hospital (LUTH), Idi-araba, Lagos said that cardiovascular disease is caused by disorders of the heart and blood vessels, and includes coronary heart disease (heart attacks), cerebrovascular disease (stroke), raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure
Mbakwem stated that though no country wide data on CVD in Nigeria, available data from 1990 national survey on NCDs in Nigeria shows that they have hypertension with only 11.2 percent of Nigerians having hypertension with only 33.8 percent of these aware that they have hypertension.
In his words “The burden of CVDs in the world is enormous and the majority of those affected are in developing countries. Patients denied access to health care for CVD or deterred by high costs from seeking it cause public health systems to incur even greater health care costs in the long run. This is as a result of the need to treat the same patients later at greater expense because the disease is more advanced. The potential costs of this CVD epidemic for African countries are staggering.
However, cardiovascular disease (direct and indirect) is estimated to cost the United States about US$300 billion annually, equal to the entire gross domestic product of the African continent. Clearly, even a fraction of such cost has the potential to cause enormous damage to the economies and development trajectories of African countries.”
Lending his view, Olufemi Fasanmade, Consultant Endocrinologist at LUTH stated the most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity and tobacco use. Fasanmade disclosed that the effects of unhealthy diet and physical inactivity may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity are intermediate risk factors to one developing CVDs.
In his words “The good news is that 80 percent of premature heart attacks and strokes are preventable. Healthy diet, regular physical activity, and not using tobacco products are the keys to prevention. More importantly, having one’s blood pressure checked, knowing one’s blood sugar and body lipids is essential. This is because raised blood glucose (diabetes) and blood cholesterol increases the risk of heart attacks and strokes. Blood cholesterol needs to be controlled through a healthy diet and, if necessary, by appropriate medications.”
Giving this economic management of this disease which negatively affects the GDP of nations, there is the need for a comprehensive action which seeks to reduce the risks in Nigeria with strategies that target individuals at high risk of CVDs. Examples of population wide interventions to reduce CVDs include comprehensive tobacco control policies, taxation to reduce the intake of foods that are high in fat, sugar and salt, building walking and cycle ways to increase physical activity, providing healthy school meals to children.
For instance, in the United Kingdom, a government-promoted program in consort with the food and drink manufacturing industry successfully reduced salt content in almost a quarter of manufactured foods over several years. In Finland, community-based and national interventions, including health promotion and nutrition interventions, led to population-wide reductions in cholesterol and other risks, closely followed by a precipitous decline in heart disease and stroke mortality.
For Solomon Kadiri, Consultant Nephrologist, University College Hospital (UCH), Ibadan, there is a need for increased government investment through national programmes aimed at prevention and control of CVDs and other non communicable diseases.
In his words “CVD risk factors can be reduced through community based programmes for integrated prevention of NCDs, development of standards of care and cost-effective case management for CVD, developing feasible surveillance methods to assess the pattern and trends of major CVDs and risk factors and to monitor prevention and control initiatives.”
Alexander Chiejina
More often than not, some Nigerians have been confronted with the issue of managing cardiovascular diseases (CVDs) like heart attacks and strokes, mainly caused by a blockage that prevents blood from flowing to the heart or brain, which experts believe is number one cause of death globally.
Sadly, recent statistics from the World Health Organisation (WHO) suggests that more people die annually from CVDs than from any other cause with an estimated 17.1 million people dying from CVDs in 2004, which represents 29 percent of all global deaths. Of these deaths, an estimated 7.2 million were due to coronary heart disease and 5.7 million were due to stroke.
In the report, low and middle income countries are disproportionally affected: 82 percent of CVD deaths take place and occur almost equally in men and women. However, it is projected that by 2030, almost 23.6 million people will die from CVDs, mainly from heart disease and stroke.
As Nigeria joins the rest of the world to celebrate World Heart Day every September 27th, medical experts in the country have tasked Nigerians to observe regular checkups and live healthy lives in a bid to safeguard themselves from this impending danger.
In a recent interview with BusinessDay, Anam Mbakwem, consultant nephrologist at the Lagos University Teaching Hospital (LUTH), Idi-araba, Lagos said that cardiovascular disease is caused by disorders of the heart and blood vessels, and includes coronary heart disease (heart attacks), cerebrovascular disease (stroke), raised blood pressure (hypertension), peripheral artery disease, rheumatic heart disease, congenital heart disease and heart failure
Mbakwem stated that though no country wide data on CVD in Nigeria, available data from 1990 national survey on NCDs in Nigeria shows that they have hypertension with only 11.2 percent of Nigerians having hypertension with only 33.8 percent of these aware that they have hypertension.
In his words “The burden of CVDs in the world is enormous and the majority of those affected are in developing countries. Patients denied access to health care for CVD or deterred by high costs from seeking it cause public health systems to incur even greater health care costs in the long run. This is as a result of the need to treat the same patients later at greater expense because the disease is more advanced. The potential costs of this CVD epidemic for African countries are staggering.
However, cardiovascular disease (direct and indirect) is estimated to cost the United States about US$300 billion annually, equal to the entire gross domestic product of the African continent. Clearly, even a fraction of such cost has the potential to cause enormous damage to the economies and development trajectories of African countries.”
Lending his view, Olufemi Fasanmade, Consultant Endocrinologist at LUTH stated the most important behavioural risk factors of heart disease and stroke are unhealthy diet, physical inactivity and tobacco use. Fasanmade disclosed that the effects of unhealthy diet and physical inactivity may show up in individuals as raised blood pressure, raised blood glucose, raised blood lipids, and overweight and obesity are intermediate risk factors to one developing CVDs.
In his words “The good news is that 80 percent of premature heart attacks and strokes are preventable. Healthy diet, regular physical activity, and not using tobacco products are the keys to prevention. More importantly, having one’s blood pressure checked, knowing one’s blood sugar and body lipids is essential. This is because raised blood glucose (diabetes) and blood cholesterol increases the risk of heart attacks and strokes. Blood cholesterol needs to be controlled through a healthy diet and, if necessary, by appropriate medications.”
Giving this economic management of this disease which negatively affects the GDP of nations, there is the need for a comprehensive action which seeks to reduce the risks in Nigeria with strategies that target individuals at high risk of CVDs. Examples of population wide interventions to reduce CVDs include comprehensive tobacco control policies, taxation to reduce the intake of foods that are high in fat, sugar and salt, building walking and cycle ways to increase physical activity, providing healthy school meals to children.
For instance, in the United Kingdom, a government-promoted program in consort with the food and drink manufacturing industry successfully reduced salt content in almost a quarter of manufactured foods over several years. In Finland, community-based and national interventions, including health promotion and nutrition interventions, led to population-wide reductions in cholesterol and other risks, closely followed by a precipitous decline in heart disease and stroke mortality.
For Solomon Kadiri, Consultant Nephrologist, University College Hospital (UCH), Ibadan, there is a need for increased government investment through national programmes aimed at prevention and control of CVDs and other non communicable diseases.
In his words “CVD risk factors can be reduced through community based programmes for integrated prevention of NCDs, development of standards of care and cost-effective case management for CVD, developing feasible surveillance methods to assess the pattern and trends of major CVDs and risk factors and to monitor prevention and control initiatives.”
New cement policy and the effect on construction industry
Currently, Nigeria has huge percent of cement raw materials that can be tapped to grow the nation’s economy. However, the new policy by the Federal Government has thrown stakeholders in the building and construction sector into various argument as to what good this recent pronouncement holds for the sector writes Alexander Chiejina.
Recently, the media has been awash with claim and counter claims of plans to flood the nation's construction industry with imported cement products. This development may have pitched local cement producers and importers at each other’s throats. This is believed to be connected with the imposition of a 35 percent levy by the Federal Government on the latest importation quotas for bulk cement, effective July 1 2010.
The 35 percent levy comprises the reinstatement of 20 percent import duty on bulk cement, and a new 15 percent surcharge on the cost, insurance and freight price of bulk cement to substitute the N500 per tonnes that was in force before the new policy. The added 15 percent will be towards the development of the Cement Technology Institute.
Other measures rolled out include immediate cancellation of all unutilized cement import licenses from 2002 to 2008; annual review of local production in order to determine the need for cement import license or otherwise and that investors without operational terminals will no longer be considered for cement import license from 2011. In addition, the new policy seeks the importation of 2,500,000 metric tonnes of bulk cement by six local manufacturers to cover the second half of the year.
For the Ministries of Finance, and Commerce and Industry, the new allocation is part of the federal government’s Cement Backward Integration Policy aimed at making the country self-sufficient in cement manufacturing in the next three years. It was also taken as a measure to accelerate the growth of local capacity in cement production and provide the possibility to eventually export the product to other African nations and beyond.
The ministry through the letter notified the Customs Service and the pre-shipment agents of the immediate cancellation of all unused cement import licenses issued between 2002 and 2008. According to the ministry, annual review of local production will be undertaken in order to determine the need for cement import licenses or otherwise.
It said that importers without operational land terminals will no longer be considered for cement import from next year, even as the ministry re-instated the 20 percent import duty on bulk cement, as applicable to other finished products in tandem with the ECOWAS Common External Tariff.
While the new policy on cement is targeted at boosting the local production of cement in the country, this latest development has elicited various reactions from stakeholders as to what this new policy on cement holds for the building and construction sector in the country.
Speaking to BusinessDay, Omo Aisagboni, President/Chief Executive Officer, Omais Investment Group, said that the increase of duty payable on imported cement from 5 percent to 35 percent will no doubt contribute to the ballooning of the price of cement in the country as well as have its tow on real estate developers who will need it for construction.
Aisagboni stated the introduction of 15 percent Cement Technology Institute Levy by the government on a mere 2.5 million tonnes of imported cement to cover only six months of July to December 2010, as cement import will end in 2010, is not investment friendly.
In his words “The gap between demand and locally produced cement is huge and to frame a policy around this may plunge us into crisis. Before the end of the year when the import permits that have been issued out have be exhausted by the allotees, we will find that the locally produced cement will be unable to satisfy the demand for the product and then there will be scarcity.
However, what does the government want to achieve now with 35percent levy on imported cement? Create scarcity and increase in cost of cement? But it is wrong, because the people will be the ultimate losers while a few will be the beneficiaries and profit from the expected rise in price of the essential product.
This is because prices will not go down but will swing upward and may be out of reach of the ordinary people who will intend to construct their own homes. Don’t forget the construction industry is the one of the largest employer of labour with those involved in housing and real estates in the lot. And if this happens, your guess is as good as mine,” Aisagboni stated.
For Toyin Banjo, Managing Director/CEO Cornerstone Savings and Loans, the Federal Government plan to impose 35 percent duty on cement importation is a welcome development.
Banjo stated that before cement import license is given to interested individuals, the government should ensure that they are manufacturers and have a known number of people under the employ of such manufacturer to discourage every Tom, Dick and Harry from coming into the sector.
According to Banjo “the 20 percent import duty on bulk cement should go into a special fund for construction firms whereby they can access this fund for the development of the construction industry. Don’t forget that the import duty is going to affect everyone in the construction sector- from real estate developers to builders, etc. but if this common fund from the duty can be pulled together, people can easily access it with the input of a mortgage bank at a single digit interest rate. This also should be a repayment plan for 15 years with 10 down payments. If this is in place, people won’t mind to building their houses whether the price of cement increase a little.”
However, for Joseph Makoju, Cement Manufacturers Association of Nigeria (CEMAN), he stated that he is happy with the Government on the recent policies and is sure that as a body, Nigeria will not have need for imported cement again and would have been wholly self sufficient before the end of 2011.
Makoju revealed that the boost in production was due to the Federal Government’s policy to encourage local production and ban the issuance of license for importation. According to him, the cement policy was formulated in 2003 but was not implemented until recently.
“The Federal Government’s step is a complete implementation of the road map that would enable the country to be self-sufficient in cement production to the benefit of all. What we have in place now is that the gap between local production and demand will be imported in the short run and it is no longer an all comers’ affair. However, with the huge investment in cement production across the country, the price of cement would soon drop.”
He added that because of the high production of cement, many companies were already exploring ECOWAS countries and beyond for export. He said that cement companies such as Ibese, Benue Cement Plc, Obajana, plants belonging to Dangote Group, would produce more than 20 million tonnes annually.
“Besides, there is also the 4.5 million tonnes of cement from the Nigeria Flour Mills, owners of UniCem while BUA Cement is expected to produce 500,000 tonnes annually. The Bendel Cement plant, AVA Company and other new factories are coming on stream and Nigeria has 95 percent of the raw materials. Such comparative advantage was long overdue to be tapped to grow the nation’s economy and export the commodity to other countries. Don’t forget that nations with less potential had been flooding the Nigerian market with substandard cement, leading to building and construction failure”, Makoju concluded.
No doubt, cement production is not only needed for housing, but is just as critical for infrastructure development. Like all developing countries, Nigeria suffers from a huge housing and infrastructure deficit and is in a mad rush to plug that gap.
In addition, projected economic expansion and high oil prices all point to the fact that the three tiers of government will deploy considerable resources in roads and railway construction, new airports and seaports, the education and healthcare sectors, and agriculture and electricity, which are all dependent on the availability of cement as a critical component of the construction industry.
Moreover, the impression created is that some of more advanced countries don’t
import cement may not be completely true. This is because recent reports suggest that The United States of America, Russia, the United Arab Emirates and Spain still import and producers of cement. With the US President Barack Obama recent plan to plough $50 billion in infrastructure spending over the next five years, the US is believed that local production of cement may not be sufficient for the meet the needed infrastructural plans.
What this implies is that importers of bulk cement still have a critical role to play in making the commodity available and affordable, a goal that can be achieved if levies are not high. In essence, controlled importation of bulk cement can exist side by side local production, until a time producers can match and exceed domestic demand.
Recently, the media has been awash with claim and counter claims of plans to flood the nation's construction industry with imported cement products. This development may have pitched local cement producers and importers at each other’s throats. This is believed to be connected with the imposition of a 35 percent levy by the Federal Government on the latest importation quotas for bulk cement, effective July 1 2010.
The 35 percent levy comprises the reinstatement of 20 percent import duty on bulk cement, and a new 15 percent surcharge on the cost, insurance and freight price of bulk cement to substitute the N500 per tonnes that was in force before the new policy. The added 15 percent will be towards the development of the Cement Technology Institute.
Other measures rolled out include immediate cancellation of all unutilized cement import licenses from 2002 to 2008; annual review of local production in order to determine the need for cement import license or otherwise and that investors without operational terminals will no longer be considered for cement import license from 2011. In addition, the new policy seeks the importation of 2,500,000 metric tonnes of bulk cement by six local manufacturers to cover the second half of the year.
For the Ministries of Finance, and Commerce and Industry, the new allocation is part of the federal government’s Cement Backward Integration Policy aimed at making the country self-sufficient in cement manufacturing in the next three years. It was also taken as a measure to accelerate the growth of local capacity in cement production and provide the possibility to eventually export the product to other African nations and beyond.
The ministry through the letter notified the Customs Service and the pre-shipment agents of the immediate cancellation of all unused cement import licenses issued between 2002 and 2008. According to the ministry, annual review of local production will be undertaken in order to determine the need for cement import licenses or otherwise.
It said that importers without operational land terminals will no longer be considered for cement import from next year, even as the ministry re-instated the 20 percent import duty on bulk cement, as applicable to other finished products in tandem with the ECOWAS Common External Tariff.
While the new policy on cement is targeted at boosting the local production of cement in the country, this latest development has elicited various reactions from stakeholders as to what this new policy on cement holds for the building and construction sector in the country.
Speaking to BusinessDay, Omo Aisagboni, President/Chief Executive Officer, Omais Investment Group, said that the increase of duty payable on imported cement from 5 percent to 35 percent will no doubt contribute to the ballooning of the price of cement in the country as well as have its tow on real estate developers who will need it for construction.
Aisagboni stated the introduction of 15 percent Cement Technology Institute Levy by the government on a mere 2.5 million tonnes of imported cement to cover only six months of July to December 2010, as cement import will end in 2010, is not investment friendly.
In his words “The gap between demand and locally produced cement is huge and to frame a policy around this may plunge us into crisis. Before the end of the year when the import permits that have been issued out have be exhausted by the allotees, we will find that the locally produced cement will be unable to satisfy the demand for the product and then there will be scarcity.
However, what does the government want to achieve now with 35percent levy on imported cement? Create scarcity and increase in cost of cement? But it is wrong, because the people will be the ultimate losers while a few will be the beneficiaries and profit from the expected rise in price of the essential product.
This is because prices will not go down but will swing upward and may be out of reach of the ordinary people who will intend to construct their own homes. Don’t forget the construction industry is the one of the largest employer of labour with those involved in housing and real estates in the lot. And if this happens, your guess is as good as mine,” Aisagboni stated.
For Toyin Banjo, Managing Director/CEO Cornerstone Savings and Loans, the Federal Government plan to impose 35 percent duty on cement importation is a welcome development.
Banjo stated that before cement import license is given to interested individuals, the government should ensure that they are manufacturers and have a known number of people under the employ of such manufacturer to discourage every Tom, Dick and Harry from coming into the sector.
According to Banjo “the 20 percent import duty on bulk cement should go into a special fund for construction firms whereby they can access this fund for the development of the construction industry. Don’t forget that the import duty is going to affect everyone in the construction sector- from real estate developers to builders, etc. but if this common fund from the duty can be pulled together, people can easily access it with the input of a mortgage bank at a single digit interest rate. This also should be a repayment plan for 15 years with 10 down payments. If this is in place, people won’t mind to building their houses whether the price of cement increase a little.”
However, for Joseph Makoju, Cement Manufacturers Association of Nigeria (CEMAN), he stated that he is happy with the Government on the recent policies and is sure that as a body, Nigeria will not have need for imported cement again and would have been wholly self sufficient before the end of 2011.
Makoju revealed that the boost in production was due to the Federal Government’s policy to encourage local production and ban the issuance of license for importation. According to him, the cement policy was formulated in 2003 but was not implemented until recently.
“The Federal Government’s step is a complete implementation of the road map that would enable the country to be self-sufficient in cement production to the benefit of all. What we have in place now is that the gap between local production and demand will be imported in the short run and it is no longer an all comers’ affair. However, with the huge investment in cement production across the country, the price of cement would soon drop.”
He added that because of the high production of cement, many companies were already exploring ECOWAS countries and beyond for export. He said that cement companies such as Ibese, Benue Cement Plc, Obajana, plants belonging to Dangote Group, would produce more than 20 million tonnes annually.
“Besides, there is also the 4.5 million tonnes of cement from the Nigeria Flour Mills, owners of UniCem while BUA Cement is expected to produce 500,000 tonnes annually. The Bendel Cement plant, AVA Company and other new factories are coming on stream and Nigeria has 95 percent of the raw materials. Such comparative advantage was long overdue to be tapped to grow the nation’s economy and export the commodity to other countries. Don’t forget that nations with less potential had been flooding the Nigerian market with substandard cement, leading to building and construction failure”, Makoju concluded.
No doubt, cement production is not only needed for housing, but is just as critical for infrastructure development. Like all developing countries, Nigeria suffers from a huge housing and infrastructure deficit and is in a mad rush to plug that gap.
In addition, projected economic expansion and high oil prices all point to the fact that the three tiers of government will deploy considerable resources in roads and railway construction, new airports and seaports, the education and healthcare sectors, and agriculture and electricity, which are all dependent on the availability of cement as a critical component of the construction industry.
Moreover, the impression created is that some of more advanced countries don’t
import cement may not be completely true. This is because recent reports suggest that The United States of America, Russia, the United Arab Emirates and Spain still import and producers of cement. With the US President Barack Obama recent plan to plough $50 billion in infrastructure spending over the next five years, the US is believed that local production of cement may not be sufficient for the meet the needed infrastructural plans.
What this implies is that importers of bulk cement still have a critical role to play in making the commodity available and affordable, a goal that can be achieved if levies are not high. In essence, controlled importation of bulk cement can exist side by side local production, until a time producers can match and exceed domestic demand.
Friday, September 10, 2010
Unsafe injection, others spur HIV, Hepatitis transmission
Without a doubt, the administration of injections is one of the most common healthcare procedures at health institutions across the country. But that is all the more reason for care because the World Health Organisation (WHO) says a safe injection is one that is given by means of appropriate equipment and does not harm the recipient, nor expose the provider to avoidable risks.
Figures from the WHO put the resultant infection profile resulting from unsafe injections at 250,000 HIV infections, 2,000,000 Hepatitis C infections and 21,000,000 Hepatitis B infections, leading to 1,300,000 deaths.
Even with the considerable improvement in immunisation services in Nigeria, medical experts insist that poor injection and sharp waste disposal practices pose an avoidable risk of transmission of deadly diseases such as HIV/AIDS, Hepatitis B and Hepatitis C to consumers, healthcare providers and the whole community.
Speaking with BusinessDay, Bennett Ogbokor, a practising pharmacist in Lagos, said that the normal disposable syringes are actually very dangerous and inimical to Safe Health and Safe Injection Practices, especially in a country like Nigeria where statistics of infections contracted from unsafe injections are lacking.
Ogbokor stated that the administration of injections have completely overtaken their real need, reaching an all-time proportion that is beyond Standard Medical Practice, as over 90 percent of patients visiting a primary healthcare centre receive at least one injection in developing countries including Nigeria.
According to Ogbokor, “Due to staggering WHO statistics and concern for the health of Nigerians, the then Director General, National Agency for Food and Drug Administration and Control (NAFDAC), Dora Akunyili, gave a 24-month deadline for discontinuation of the use of normal disposable syringes on July 27, 2007, at a forum organised by the Nigerian Medical Association (NMA) and Medical and Dental Council of Nigeria (MDCAN)
NAFDAC, NMA and MDCAN agreed the phase-out of the normal disposable plastic syringes for the auto disable syringes should be done in stages, and the importation of these syringes should stop in 18 months, beginning from August 1, 2007 and their usage should cease 24 months from same date. This move was targeted at aligning the country with the rest of the world in the use of Auto-Disable (AD) syringes. Sadly, though, months after the deadline, conventional syringes are still sold openly in the markets, pharmacies and used in hospitals across the country.
On his part, Emmanuel Okechukwu, chief executive, Action Family Foundation (AFF) , stated that there is an urgent need to use injections safely and appropriately to prevent nosocomial and HIV infections.
“In an Abuja study, it was found that 18 percent of healthcare facilities burnt their solid wastes in local brick incinerators, 36. 3 percent disposed their waste at municipal dumpsites; over 91 percent buried their solid waste. However, none practised waste segregation at source. Again, results of a baseline survey by AFF for National Action Committee Agency (NACA), three projects in four states, Lagos, Ebonyi, Enugu and Borno States, showed that Nigeria still has a long way to go," Okechukwu disclosed.
A close look at compliance with the utilisation of auto-disable syringes in the curative medical sector, as currently practised in many African countries including Uganda, reveal that the Ministry of Health embarked on large-scale sensitisation of health workers and the public across the country on the benefits of the use of auto-disable syringes.
The auto-disable syringes were developed to contribute to safer injection practices and prevent the re-use of syringes, thus the transmission of disease. Auto-disable (AD) syringes virtually eliminate the risk of patient-to-patient infection with blood borne pathogens (such as hepatitis B or HIV) because they cannot be reused. The private sector was also called upon to begin stocking syringes with re-use prevention features in order to respond to created demand.
Uganda’s Ministry of Health proactively advised all importers of syringes not to enter into any new procurement arrangement for the standard disable syringes. This, Nigeria can learn from since Ghana, Kenya, Tanzania and South Africa have also embraced Injection Safety Policy.
Proffering a solution to the current situation, Ogbokor urged the Director General NAFDAC, Paul Orhii, as well as his counterpart in the Federal Ministry of Health, to do their best to be the leaders for the advocacy of safe Injections Policy in West Africa, thus paving the way for its ECOWAS neighbours to follow suit.
He pointed out that NAFDAC would be seen as truly safeguarding the lives of Nigerians when the ban on re-usable spurious disposable syringes is enforced and the use of syringes with re-use prevention features becomes the norm.
It is pertinent to state that advocacy strategies for injection safety should be developed to target not only managers of immunisation services but also government decision-makers and managers, health workers, and the general population. However, promoting the safe use of injections requires a behavioural change strategy, which must involve consumers as well as public, private and traditional health workers.
While the use of AD syringes will greatly reduce the risk of transmitting blood-borne infections, their introduction alone will not ensure immunisation safety. Proper equipment must be accompanied by careful planning, management, training and supervision in the safe use and disposal of AD syringes.
Finally, the experience gained in ensuring injection safety should be used as a model to ensure that all medical injections, including those for preventive and therapeutic services, are safely administered and used injection equipment is safely disposed of after use.
BY Alexander Chiejina
Figures from the WHO put the resultant infection profile resulting from unsafe injections at 250,000 HIV infections, 2,000,000 Hepatitis C infections and 21,000,000 Hepatitis B infections, leading to 1,300,000 deaths.
Even with the considerable improvement in immunisation services in Nigeria, medical experts insist that poor injection and sharp waste disposal practices pose an avoidable risk of transmission of deadly diseases such as HIV/AIDS, Hepatitis B and Hepatitis C to consumers, healthcare providers and the whole community.
Speaking with BusinessDay, Bennett Ogbokor, a practising pharmacist in Lagos, said that the normal disposable syringes are actually very dangerous and inimical to Safe Health and Safe Injection Practices, especially in a country like Nigeria where statistics of infections contracted from unsafe injections are lacking.
Ogbokor stated that the administration of injections have completely overtaken their real need, reaching an all-time proportion that is beyond Standard Medical Practice, as over 90 percent of patients visiting a primary healthcare centre receive at least one injection in developing countries including Nigeria.
According to Ogbokor, “Due to staggering WHO statistics and concern for the health of Nigerians, the then Director General, National Agency for Food and Drug Administration and Control (NAFDAC), Dora Akunyili, gave a 24-month deadline for discontinuation of the use of normal disposable syringes on July 27, 2007, at a forum organised by the Nigerian Medical Association (NMA) and Medical and Dental Council of Nigeria (MDCAN)
NAFDAC, NMA and MDCAN agreed the phase-out of the normal disposable plastic syringes for the auto disable syringes should be done in stages, and the importation of these syringes should stop in 18 months, beginning from August 1, 2007 and their usage should cease 24 months from same date. This move was targeted at aligning the country with the rest of the world in the use of Auto-Disable (AD) syringes. Sadly, though, months after the deadline, conventional syringes are still sold openly in the markets, pharmacies and used in hospitals across the country.
On his part, Emmanuel Okechukwu, chief executive, Action Family Foundation (AFF) , stated that there is an urgent need to use injections safely and appropriately to prevent nosocomial and HIV infections.
“In an Abuja study, it was found that 18 percent of healthcare facilities burnt their solid wastes in local brick incinerators, 36. 3 percent disposed their waste at municipal dumpsites; over 91 percent buried their solid waste. However, none practised waste segregation at source. Again, results of a baseline survey by AFF for National Action Committee Agency (NACA), three projects in four states, Lagos, Ebonyi, Enugu and Borno States, showed that Nigeria still has a long way to go," Okechukwu disclosed.
A close look at compliance with the utilisation of auto-disable syringes in the curative medical sector, as currently practised in many African countries including Uganda, reveal that the Ministry of Health embarked on large-scale sensitisation of health workers and the public across the country on the benefits of the use of auto-disable syringes.
The auto-disable syringes were developed to contribute to safer injection practices and prevent the re-use of syringes, thus the transmission of disease. Auto-disable (AD) syringes virtually eliminate the risk of patient-to-patient infection with blood borne pathogens (such as hepatitis B or HIV) because they cannot be reused. The private sector was also called upon to begin stocking syringes with re-use prevention features in order to respond to created demand.
Uganda’s Ministry of Health proactively advised all importers of syringes not to enter into any new procurement arrangement for the standard disable syringes. This, Nigeria can learn from since Ghana, Kenya, Tanzania and South Africa have also embraced Injection Safety Policy.
Proffering a solution to the current situation, Ogbokor urged the Director General NAFDAC, Paul Orhii, as well as his counterpart in the Federal Ministry of Health, to do their best to be the leaders for the advocacy of safe Injections Policy in West Africa, thus paving the way for its ECOWAS neighbours to follow suit.
He pointed out that NAFDAC would be seen as truly safeguarding the lives of Nigerians when the ban on re-usable spurious disposable syringes is enforced and the use of syringes with re-use prevention features becomes the norm.
It is pertinent to state that advocacy strategies for injection safety should be developed to target not only managers of immunisation services but also government decision-makers and managers, health workers, and the general population. However, promoting the safe use of injections requires a behavioural change strategy, which must involve consumers as well as public, private and traditional health workers.
While the use of AD syringes will greatly reduce the risk of transmitting blood-borne infections, their introduction alone will not ensure immunisation safety. Proper equipment must be accompanied by careful planning, management, training and supervision in the safe use and disposal of AD syringes.
Finally, the experience gained in ensuring injection safety should be used as a model to ensure that all medical injections, including those for preventive and therapeutic services, are safely administered and used injection equipment is safely disposed of after use.
BY Alexander Chiejina
Anti-malaria drug resistance worries stakeholders
…experts discourage ‘across the shelf’ drug purchases
Malaria prevention is one issue that has spurred researchers across the globe to effectively combat the parasite Plasmodium species, which is transmitted via infected mosquito bites. However, despite the use of prophylactic drugs like Fansidar, Quinine, Chloroquine, etc. in areas where mosquitoes are common, little has been achieved, even as issues of partial immunity development in individuals infected with the parasite have arisen.
Interestingly, research by the World Health Organisation (WHO) suggests that the best available treatment is a combination of drugs known as artemisinin-based combination therapies (ACT). Nonetheless, the discovery of low quality supplies of the drugs in some countries has given real cause for concern, besides dampening Nigerians confidence since evidence shows malaria is unrelenting in the level of devastation it causes.
Figures from National Malaria Control Programme (NMCP) show that 50 percent of the population will have at least one attack in a year, with malaria currently accounting for about 130 million clinically diagnosed cases and about 60 percent of all clinic attendance and 30 percent hospital admissions.
Furthermore, some Nigerians have complained of the inability of drugs regimens, including some Artemisinin based Combination Therapies (ACTs), to cure their malaria, prompting concerns from the Federal Ministry of Health.
Only recently, a survey of anti-malaria drugs in three African countries found that the drugs were of poor quality. The joint US and World Health Organisation (WHO) study discovered that up to 40 percent of artemisinin-based drugs in Senegal, Madagascar, and Uganda, failed quality tests. Also, researchers found out that between 26 and 44 percent of the malaria pills tested was of low quality, as some of the the drugs had included impurities or pills not containing enough active ingredients.
Although an inquest to authenticate these claims has been commissioned in Nigeria, medical experts opine that several things could account for the poor quality of the drugs.
Shilaj Chakravorty, consultant pathologist, BT health and Diagnostic centre, Lagos State University Teaching Hospital, (LASUTH), Ikeja, noted that what can cause treatment failure of malaria include incorrect drug dosage, poor drug quality, non-compliance of drug regimen and consumption of substandard anti-malaria drugs, as insufficient active ingredients could hinder the effectiveness of the ACT drug, to mention a few.”
According to him, the aforementioned cause of treatment failure contributes to drug resistance, as it exposes the malaria parasite to sub-optimal drug levels. “Across-the-shelf purchase of anti-malaria drugs and advertisement of various types of anti-malaria drugs in the media, have led people to indulge in self-medication without undergoing medical tests to ascertain whether malaria really is the cause of fever. As a result, inappropriate medication leads to development of resistant strains of the malaria parasite. One should also be aware that cross-resistance is common, which means a parasite developing resistance to one drug will show resistance to any other drug within that drug family. However, as all fever is not malaria, diagnosis for malaria must be done and treated within 24 hours of the onset of symptoms in line with WHO stipulation,” he said.
To Wellington Oyibo, consultant medical parasitologist, college of medicine, University of Lagos, Idi-araba, Lagos, tolerance to ACT, which was reported in Thailand and Cambodia late 2008, showed that when ACT was administered, early stages of the parasite in blood was not cleared but tolerated.
Oyibo disclosed that though the older stages of the malaria parasite were cleared at the tolerance stage, it took a longer time for both parasites and clinical symptoms to be cleared, which became an early warning sign of the onset of resistance.
“There was full resistance reported in 2009 in the Thailand/Cambodia boarder, i.e. ACT resistance. However, in Nigeria, there has been no scientific evidence of resistance ACT resistance though some individual observations have been shared among health workers,” said the parasitologist.
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 the ACT resistance gene, as is the case with prophylactic drugs like chloroquine and Fansidar.
It is noteworthy to state that due to poverty, Nigerians still purchase drugs across the counter –like Chloroquine and Fansidar which are already known to be resistant to the malaria parasite. Global Fund through the FMOH is making ACT drugs free in some private and government health institutions and at a subsidised price in private institutions. In this manner, Nigerians would be able to access drugs easily without much difficulty.
For Oyibo, “The government should scale up the supply of ACT drugs by global fund to ensure that Nigerians have access to it. With access to ACTs, the continued use of chloroquine and Fansidar should be stopped forthwith so as to reduce the continued spread of malaria parasite resistance genes in the population. However, for clinical managers, good diagnosis and data management must be in place to manage issues relating to malaria prevention. Caregivers and Nigerians should desist from using Chloroquine and Fansidar for the treatment of malaria ….”
The reason is simple: if ACT fails in the treatment of malaria, where are Nigerians going to take succour from? That is why all hands should be on deck. The well considered policy on malaria diagnosis and treatment which requires the confirmation of malaria through rapid diagnosis or microscopy is expected to curtail the overuse of anti-malaria drugs and thus reduce drug pressure.
..By Alexander Chiejina
Malaria prevention is one issue that has spurred researchers across the globe to effectively combat the parasite Plasmodium species, which is transmitted via infected mosquito bites. However, despite the use of prophylactic drugs like Fansidar, Quinine, Chloroquine, etc. in areas where mosquitoes are common, little has been achieved, even as issues of partial immunity development in individuals infected with the parasite have arisen.
Interestingly, research by the World Health Organisation (WHO) suggests that the best available treatment is a combination of drugs known as artemisinin-based combination therapies (ACT). Nonetheless, the discovery of low quality supplies of the drugs in some countries has given real cause for concern, besides dampening Nigerians confidence since evidence shows malaria is unrelenting in the level of devastation it causes.
Figures from National Malaria Control Programme (NMCP) show that 50 percent of the population will have at least one attack in a year, with malaria currently accounting for about 130 million clinically diagnosed cases and about 60 percent of all clinic attendance and 30 percent hospital admissions.
Furthermore, some Nigerians have complained of the inability of drugs regimens, including some Artemisinin based Combination Therapies (ACTs), to cure their malaria, prompting concerns from the Federal Ministry of Health.
Only recently, a survey of anti-malaria drugs in three African countries found that the drugs were of poor quality. The joint US and World Health Organisation (WHO) study discovered that up to 40 percent of artemisinin-based drugs in Senegal, Madagascar, and Uganda, failed quality tests. Also, researchers found out that between 26 and 44 percent of the malaria pills tested was of low quality, as some of the the drugs had included impurities or pills not containing enough active ingredients.
Although an inquest to authenticate these claims has been commissioned in Nigeria, medical experts opine that several things could account for the poor quality of the drugs.
Shilaj Chakravorty, consultant pathologist, BT health and Diagnostic centre, Lagos State University Teaching Hospital, (LASUTH), Ikeja, noted that what can cause treatment failure of malaria include incorrect drug dosage, poor drug quality, non-compliance of drug regimen and consumption of substandard anti-malaria drugs, as insufficient active ingredients could hinder the effectiveness of the ACT drug, to mention a few.”
According to him, the aforementioned cause of treatment failure contributes to drug resistance, as it exposes the malaria parasite to sub-optimal drug levels. “Across-the-shelf purchase of anti-malaria drugs and advertisement of various types of anti-malaria drugs in the media, have led people to indulge in self-medication without undergoing medical tests to ascertain whether malaria really is the cause of fever. As a result, inappropriate medication leads to development of resistant strains of the malaria parasite. One should also be aware that cross-resistance is common, which means a parasite developing resistance to one drug will show resistance to any other drug within that drug family. However, as all fever is not malaria, diagnosis for malaria must be done and treated within 24 hours of the onset of symptoms in line with WHO stipulation,” he said.
To Wellington Oyibo, consultant medical parasitologist, college of medicine, University of Lagos, Idi-araba, Lagos, tolerance to ACT, which was reported in Thailand and Cambodia late 2008, showed that when ACT was administered, early stages of the parasite in blood was not cleared but tolerated.
Oyibo disclosed that though the older stages of the malaria parasite were cleared at the tolerance stage, it took a longer time for both parasites and clinical symptoms to be cleared, which became an early warning sign of the onset of resistance.
“There was full resistance reported in 2009 in the Thailand/Cambodia boarder, i.e. ACT resistance. However, in Nigeria, there has been no scientific evidence of resistance ACT resistance though some individual observations have been shared among health workers,” said the parasitologist.
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 the ACT resistance gene, as is the case with prophylactic drugs like chloroquine and Fansidar.
It is noteworthy to state that due to poverty, Nigerians still purchase drugs across the counter –like Chloroquine and Fansidar which are already known to be resistant to the malaria parasite. Global Fund through the FMOH is making ACT drugs free in some private and government health institutions and at a subsidised price in private institutions. In this manner, Nigerians would be able to access drugs easily without much difficulty.
For Oyibo, “The government should scale up the supply of ACT drugs by global fund to ensure that Nigerians have access to it. With access to ACTs, the continued use of chloroquine and Fansidar should be stopped forthwith so as to reduce the continued spread of malaria parasite resistance genes in the population. However, for clinical managers, good diagnosis and data management must be in place to manage issues relating to malaria prevention. Caregivers and Nigerians should desist from using Chloroquine and Fansidar for the treatment of malaria ….”
The reason is simple: if ACT fails in the treatment of malaria, where are Nigerians going to take succour from? That is why all hands should be on deck. The well considered policy on malaria diagnosis and treatment which requires the confirmation of malaria through rapid diagnosis or microscopy is expected to curtail the overuse of anti-malaria drugs and thus reduce drug pressure.
..By Alexander Chiejina
Saturday, September 4, 2010
Taking traditional medicine to the next level in NIgeria
…as experts call for the establishment of Traditional Medicine Board
There is no gain saying that over 60 percent of Nigerians patronise different forms of traditional medicine (TM) practice and the trade accruing from traditional medicine only is estimated to be over USD1billion.
However, what is worrisome is that while countries like China and India have developed their TM such as acupuncture to become globally accepted and are reaping billions of dollars in foreign exchange, Nigeria is still grappling with giving legislative backing to a practice which is sustaining millions of Nigerians that cannot afford orthodox treatment.
In an interview with BusinessDay with Tamuno Okujagu, Director-General/Chief Executive Officer, Nigeria Natural Medicine Development Agency (NNMDA), said that traditional medicine has been with mankind al binito and has contributed immensely the World Health Organisation (WHO) acknowledges the growing need and potentials of TM and continues to encourage and support its promotion, documentation and research with a view of further developing its potentials and use.
He stated that as Nigeria joins the African continent to celebrate a decade of African Traditional medicine (ATM) with the theme “Universal access and Human Rights”, there is the need for stakeholders in the country to take stock of activities during the decade, the achievements, challenges, lessons learnt from the promotion of TM medicine with a view of chartering a way forward for its integration into the nation’s healthcare system.
Okujagu disclosed that the Federal Government through the Agency produced the first draft policy and legal instrument for Intellectual Property Right (IPR) regime for Traditional Medicine Knowledge and Practice (TMKP) with the draft policy titled: “Traditional knowledge and biological resources protection Act.
In his words “The draft policy is the basis for a proposed draft bill, which builds on an international consensus that traditional knowledge and genetic resources should not be misappropriated, and that some form of protection is required to achieve this. The rights of holders to the effective protection of their knowledge against misappropriation should be recognised and respected. Although the draft policy is the first working document on mechanism for IPR for traditional medicine knowledge and practice, it has not been sent to the National Assembly.”
The Director General added that more needs to be done to further achieve the outcomes of issues of policy, legal framework, institutionalizing TM, inauguration of National Board to regulate traditional medicine, establishment of centers of excellence, promotion of laboratory and clinical evaluation, development of local production, to mention but a few.
Lending his view at a one day symposium to commemorate African Traditional Medicine day in Lagos recently, Mukhtar Abdurahman, Vice Chancellor, Kaduna State University, revealed that disregard for the role of traditional medicine in primary healthcare system by policy makers, lack of sufficient scientific data on safety, efficacy, and quality of TM, absence of regulatory policies as well as problems arising from activities of traditional practitioners are the major challenges facing the sector.
Abdurahman stated that the main objective of the plan of action as agreed by African union head of states and governments at a summit held in Lusaka, Zambia in July 2001 was the recognition, acceptance, development and integration of TM into the public healthcare system of the region.
“Priority areas were developed; sensitization of the society on TM, legislation of TM, institutional arrangement, resource mobilization, research and training, cultivation and conservation of medicinal plants, local production of standardization ATM, partnerships, to mention but a few. Taking a cursory look at the current situation, Nigeria hasn’t fared so well hence the Federal Ministry of Health, Federal Ministry of Science and Technology and other relevant agencies need to pursue the mandate for developing safe and high quality traditional medicine for all,” Abdurahman concluded.
With the launch of WHO’s comprehensive traditional medicine strategy in 2002, which was designed to assist countries develop national policies on the evaluation and regulation for TM practices, promote therapeutically sound use of TM by providers and consumers, a lot needs to be done to the government towards creating the enabling environment to facilitate the development of TM.
For Bunmi Omoseyindemi, Chairman, Lagos state Traditional medicine board, the integration of traditional medicine into the nation’s healthcare system will go a long way in improving the current poor health index.
Omoseyindemi disclosed that “Unlike Nigeria, Ghana and other neighbouring country have centers of excellence where research on traditional medicine is done and training and degrees awarded. In this way, adequate science evidence base is developed and appropriate information to the public is made.”
It is important to state that the bill seeking the establishment of Traditional Medicine Council still before the national assembly waiting its passage into law. It will be recalled that the Federal Executive Council (FEC) had on August 16, 2006, approved a draft policy and a bill on the regulation and practice of traditional medicine in the country. The bill is titled: “Establishment of the Nigerian Traditional Medicine Policy and the Bill to Establish the Traditional Medical Council of Nigeria.”
So, traditional medicine has much to offer global health, especially as new drugs have never been more urgently needed. No doubt, with joined research capacities in equitable collaborations, new scientific techniques could spark a revival in global health research and development. At least, Artemisinin, which is extracted from Artemisia annua or Chinese sweet wormwood, is the basis for the most effective malaria drugs the world has ever seen till date.
by Alexander Chiejina
There is no gain saying that over 60 percent of Nigerians patronise different forms of traditional medicine (TM) practice and the trade accruing from traditional medicine only is estimated to be over USD1billion.
However, what is worrisome is that while countries like China and India have developed their TM such as acupuncture to become globally accepted and are reaping billions of dollars in foreign exchange, Nigeria is still grappling with giving legislative backing to a practice which is sustaining millions of Nigerians that cannot afford orthodox treatment.
In an interview with BusinessDay with Tamuno Okujagu, Director-General/Chief Executive Officer, Nigeria Natural Medicine Development Agency (NNMDA), said that traditional medicine has been with mankind al binito and has contributed immensely the World Health Organisation (WHO) acknowledges the growing need and potentials of TM and continues to encourage and support its promotion, documentation and research with a view of further developing its potentials and use.
He stated that as Nigeria joins the African continent to celebrate a decade of African Traditional medicine (ATM) with the theme “Universal access and Human Rights”, there is the need for stakeholders in the country to take stock of activities during the decade, the achievements, challenges, lessons learnt from the promotion of TM medicine with a view of chartering a way forward for its integration into the nation’s healthcare system.
Okujagu disclosed that the Federal Government through the Agency produced the first draft policy and legal instrument for Intellectual Property Right (IPR) regime for Traditional Medicine Knowledge and Practice (TMKP) with the draft policy titled: “Traditional knowledge and biological resources protection Act.
In his words “The draft policy is the basis for a proposed draft bill, which builds on an international consensus that traditional knowledge and genetic resources should not be misappropriated, and that some form of protection is required to achieve this. The rights of holders to the effective protection of their knowledge against misappropriation should be recognised and respected. Although the draft policy is the first working document on mechanism for IPR for traditional medicine knowledge and practice, it has not been sent to the National Assembly.”
The Director General added that more needs to be done to further achieve the outcomes of issues of policy, legal framework, institutionalizing TM, inauguration of National Board to regulate traditional medicine, establishment of centers of excellence, promotion of laboratory and clinical evaluation, development of local production, to mention but a few.
Lending his view at a one day symposium to commemorate African Traditional Medicine day in Lagos recently, Mukhtar Abdurahman, Vice Chancellor, Kaduna State University, revealed that disregard for the role of traditional medicine in primary healthcare system by policy makers, lack of sufficient scientific data on safety, efficacy, and quality of TM, absence of regulatory policies as well as problems arising from activities of traditional practitioners are the major challenges facing the sector.
Abdurahman stated that the main objective of the plan of action as agreed by African union head of states and governments at a summit held in Lusaka, Zambia in July 2001 was the recognition, acceptance, development and integration of TM into the public healthcare system of the region.
“Priority areas were developed; sensitization of the society on TM, legislation of TM, institutional arrangement, resource mobilization, research and training, cultivation and conservation of medicinal plants, local production of standardization ATM, partnerships, to mention but a few. Taking a cursory look at the current situation, Nigeria hasn’t fared so well hence the Federal Ministry of Health, Federal Ministry of Science and Technology and other relevant agencies need to pursue the mandate for developing safe and high quality traditional medicine for all,” Abdurahman concluded.
With the launch of WHO’s comprehensive traditional medicine strategy in 2002, which was designed to assist countries develop national policies on the evaluation and regulation for TM practices, promote therapeutically sound use of TM by providers and consumers, a lot needs to be done to the government towards creating the enabling environment to facilitate the development of TM.
For Bunmi Omoseyindemi, Chairman, Lagos state Traditional medicine board, the integration of traditional medicine into the nation’s healthcare system will go a long way in improving the current poor health index.
Omoseyindemi disclosed that “Unlike Nigeria, Ghana and other neighbouring country have centers of excellence where research on traditional medicine is done and training and degrees awarded. In this way, adequate science evidence base is developed and appropriate information to the public is made.”
It is important to state that the bill seeking the establishment of Traditional Medicine Council still before the national assembly waiting its passage into law. It will be recalled that the Federal Executive Council (FEC) had on August 16, 2006, approved a draft policy and a bill on the regulation and practice of traditional medicine in the country. The bill is titled: “Establishment of the Nigerian Traditional Medicine Policy and the Bill to Establish the Traditional Medical Council of Nigeria.”
So, traditional medicine has much to offer global health, especially as new drugs have never been more urgently needed. No doubt, with joined research capacities in equitable collaborations, new scientific techniques could spark a revival in global health research and development. At least, Artemisinin, which is extracted from Artemisia annua or Chinese sweet wormwood, is the basis for the most effective malaria drugs the world has ever seen till date.
by Alexander Chiejina
A nation on the brink of cholera outbreak
With over 517 deaths in eight weeks, resulting from 10, 134 cases of cholera attacks in over 10 states in the country, mostly in the North-west and North-east zones, the current outbreak is one of great concern to public health experts in the country given recent epidemiological survey which suggest that the entire country may be at risk of infection.
This warning no doubt should rally unaffected states to act fast against any possible spread that might likely increase the country’s health woes. This is as a total of about ten states have recorded cases of cholera outbreak- Bauchi, and Borno, recording high incidence of the epidemic followed by states like Gombe, Jigawa, Yobe, Taraba, Kaduna, Cross-River, Rivers and of course Adamawa.
In an interview with Innocent Ujah, Director General, Nigerian Institute of Medical Research (NIMR), Ujah regretted the unfortunate deaths of Nigerians in the states being ravaged by cholera outbreak. He stated that cholera is a disease of poverty and ignorance which can be prevented easily through simple hygiene and low technology. He hinted that many lives are needlessly lost largely due to intellectual poverty.
In the words of the Director General; “In response to the devastating pathology caused by outbreak of cholera in 11 states of the Federation, NIMR has dispatched a team of microbiologists to the affected states to work with other health team. In the meantime, the Institute has embarked on research component of the intervention with the sole aim of characterising the disease among others which should assist various governments to develop policies and strategies that will prevent or reduce the avoidable tragedy.”
Explaining the disease in its entity, Shilaj Chakravorty, Consultant Pathologist, BT Health & Diagnostic Complex, Lagos State University Teaching Hospital (LASUTH) Ikeja, Lagos, disclosed that cholera is an infection of the small intestine by which the bacterium Vibrio cholera releases toxin that causes increased release of water in the intestines, which produces severe diarrhea.
Chakravorty noted that though cholera occurs in places with poor sanitation, crowding, risk factors that predisposes people to get infected with the bacteria include exposure to contaminated/untreated drinking water, living in or travelling to areas where there is cholera. He hinted that symptoms associated with cholera include serious diarrhoea, vomiting, leading to dehydration as within a short incubation period, it can be fatal if not treated in time.
The consultant pathologist disclosed that “In India where infectious disease centers/hospitals exist, people who come down with such diseases like cholera are rushed to such centers. There, clinical examinations are done to ascertain the actual cause of the outbreak. In addition, people affected with the disease are isolated for proper observation so that they don’t infect others within the community.
“The objective of treating people with cholera is to replace fluid and electrolytes lost through diarrhea. The World Health Organization (WHO) has developed an oral rehydration solution that is cheaper and easier to use than the typical intravenous fluid. This solution of sugar and electrolytes is now being used internationally. Given adequate fluids, people can make a full recovery,” Chakravorty concluded.
Taking a cursory look at the cholera episode in the country, it will be recalled that Bauchi State Health commissioner Mohammed Jalem blamed the cholera outbreak on poor sanitation and contamination of open wells - the major sources of water in the rural communities. So far, Bauchi state has recorded the highest casualty figures. Going further, tales of prompt medication forced affected victims to resort to self-medication. Recent floods in parts of the North compounded the situation further as houses were destroyed; sewage bursting forth and merging with blocked drainages in the affected areas thus worsening water supply channel.
This current outbreak says a lot about the seriousness of health authorities that a disease whose cause is so well-known should be allowed to occur. It is obvious at this point that government should lay more emphasis on preventive health, than curative as a first step to stopping cholera scourge.
No doubt, if our leaders hold with high esteem the lives of the people they profess to serve, a multi-pronged approach to curbing incessant cholera outbreaks is needed. New strategies are required. Primary health care must improve; this level of healthcare and disease prevention must be strengthened. States may have to work closely with the National Primary Health Care Development Agency and seek the technical support of international agencies. The relevant departments in the states should also be proactive.
Since drinking of contaminated water is a known cause of cholera, state governments must commit themselves to the provision of potable drinking water for people both in rural and urban areas. Going further, sanitation must also be given top priority, with state governments not just naming one Saturday in a month as environmental sanitation day but actually enforcing the clean up exercise by making sure residents came out to clean their surroundings.
More importantly, a lot can be done in the area of public enlightenment and education, with special emphasis on basic hygiene practices. Local government councils must live up to their responsibility of clearing rubbish heaps that are gradually taking over most streets and roads in our towns and cities, by providing standard refuse disposal facilities and ensuring that these too are regularly emptied with refuse disposal trucks to a designated dump site.
Even as the country is already lagging behind in the implementation of the Millennium Development Goals (MDGs) with global target year of 2015, it is instructive that access to potable water is an integral part of the MDGs, a task in which the country must immediately address.
By Alexander Chiejina
This warning no doubt should rally unaffected states to act fast against any possible spread that might likely increase the country’s health woes. This is as a total of about ten states have recorded cases of cholera outbreak- Bauchi, and Borno, recording high incidence of the epidemic followed by states like Gombe, Jigawa, Yobe, Taraba, Kaduna, Cross-River, Rivers and of course Adamawa.
In an interview with Innocent Ujah, Director General, Nigerian Institute of Medical Research (NIMR), Ujah regretted the unfortunate deaths of Nigerians in the states being ravaged by cholera outbreak. He stated that cholera is a disease of poverty and ignorance which can be prevented easily through simple hygiene and low technology. He hinted that many lives are needlessly lost largely due to intellectual poverty.
In the words of the Director General; “In response to the devastating pathology caused by outbreak of cholera in 11 states of the Federation, NIMR has dispatched a team of microbiologists to the affected states to work with other health team. In the meantime, the Institute has embarked on research component of the intervention with the sole aim of characterising the disease among others which should assist various governments to develop policies and strategies that will prevent or reduce the avoidable tragedy.”
Explaining the disease in its entity, Shilaj Chakravorty, Consultant Pathologist, BT Health & Diagnostic Complex, Lagos State University Teaching Hospital (LASUTH) Ikeja, Lagos, disclosed that cholera is an infection of the small intestine by which the bacterium Vibrio cholera releases toxin that causes increased release of water in the intestines, which produces severe diarrhea.
Chakravorty noted that though cholera occurs in places with poor sanitation, crowding, risk factors that predisposes people to get infected with the bacteria include exposure to contaminated/untreated drinking water, living in or travelling to areas where there is cholera. He hinted that symptoms associated with cholera include serious diarrhoea, vomiting, leading to dehydration as within a short incubation period, it can be fatal if not treated in time.
The consultant pathologist disclosed that “In India where infectious disease centers/hospitals exist, people who come down with such diseases like cholera are rushed to such centers. There, clinical examinations are done to ascertain the actual cause of the outbreak. In addition, people affected with the disease are isolated for proper observation so that they don’t infect others within the community.
“The objective of treating people with cholera is to replace fluid and electrolytes lost through diarrhea. The World Health Organization (WHO) has developed an oral rehydration solution that is cheaper and easier to use than the typical intravenous fluid. This solution of sugar and electrolytes is now being used internationally. Given adequate fluids, people can make a full recovery,” Chakravorty concluded.
Taking a cursory look at the cholera episode in the country, it will be recalled that Bauchi State Health commissioner Mohammed Jalem blamed the cholera outbreak on poor sanitation and contamination of open wells - the major sources of water in the rural communities. So far, Bauchi state has recorded the highest casualty figures. Going further, tales of prompt medication forced affected victims to resort to self-medication. Recent floods in parts of the North compounded the situation further as houses were destroyed; sewage bursting forth and merging with blocked drainages in the affected areas thus worsening water supply channel.
This current outbreak says a lot about the seriousness of health authorities that a disease whose cause is so well-known should be allowed to occur. It is obvious at this point that government should lay more emphasis on preventive health, than curative as a first step to stopping cholera scourge.
No doubt, if our leaders hold with high esteem the lives of the people they profess to serve, a multi-pronged approach to curbing incessant cholera outbreaks is needed. New strategies are required. Primary health care must improve; this level of healthcare and disease prevention must be strengthened. States may have to work closely with the National Primary Health Care Development Agency and seek the technical support of international agencies. The relevant departments in the states should also be proactive.
Since drinking of contaminated water is a known cause of cholera, state governments must commit themselves to the provision of potable drinking water for people both in rural and urban areas. Going further, sanitation must also be given top priority, with state governments not just naming one Saturday in a month as environmental sanitation day but actually enforcing the clean up exercise by making sure residents came out to clean their surroundings.
More importantly, a lot can be done in the area of public enlightenment and education, with special emphasis on basic hygiene practices. Local government councils must live up to their responsibility of clearing rubbish heaps that are gradually taking over most streets and roads in our towns and cities, by providing standard refuse disposal facilities and ensuring that these too are regularly emptied with refuse disposal trucks to a designated dump site.
Even as the country is already lagging behind in the implementation of the Millennium Development Goals (MDGs) with global target year of 2015, it is instructive that access to potable water is an integral part of the MDGs, a task in which the country must immediately address.
By Alexander Chiejina
Friday, August 27, 2010
Primary Healthcare system, still in need of upgrade…...... 32 years after
There is no gainsaying the fact that the sustainability of any country’s economic and social growth largely depends on a vibrant healthcare sector. Perhaps in recognition of that fact, preventive medicine which formed the bedrock of the nation’s Primary Healthcare (PHC) system in 1978 was aimed at providing health services, improving the efficiency and effectiveness of service delivery and ensuring widespread coverage and access to basic care, particularly among the rural populace. But 32 years on, its implementation still generates mixed reactions among Nigerians.
A quick review of the nation’s health indices indicates that the infant mortality rate is put at 75 per 1000 deaths, and under-five mortality rates at 157 per 1000 deaths. Needless to say, the majority of these deaths stem from common ailments like malaria, respiratory tract infection, diarrhoea, etc, which could be prevented if all facets of the health sector deliver quality primary care services at optimal capacity. While critics believe that the government has been remiss in providing this all-important service over the years, others maintain that there is a need to revamp the system, which will definitely improve healthcare delivery in the country.
In a recent interview, Mohammed Pate, executive director, National Primary Healthcare Development Agency (NPHDA), said the poor state of healthcare at the PHC level is due to non-utilisation of the PHC platform for effective integration of services, inequality in the distribution of available health workforce staff, financial barriers to health, particularly at the community level, and the absence of an enabling act to guide the PHC implementation, culminating in poor to outright non-utilisation of PHC facilities, among others.
According to Pate, the sector-wide capacity constraints had steadily increased following the provision of PHC into the LGAs, and “it might be argued that the poor performance is associated with low levels of financial resources.” For Adepoju Olusegun, a public affairs analyst, the frequent sojourn of Nigerians abroad in search of quality treatment for minor ailments connotes the state of affairs in the health sector. Olusegun stated that if government officials were satisfied with and could boast of the quality of healthcare at the various health institutions, they should be confident enough to fall asleep under the influence of anesthesia in hospitals without any doubt on their minds.
“Nowadays, local government chairmen are enthralled by the pictures of established health centres which would be used for canvassing for votes at the polls, and not actually meeting the health needs of the host communities. The health services, based on primary healthcare, include education regarding prevailing health problems and the methods of preventing and controlling them, promotion of food supply, proper nutrition material and child care, as well as family planning immunisation against the major infectious diseases,” he said. Doubtless, the importance of the PHC system cannot be over-emphasised given the fact that PHC services which fall under the jurisdiction of the Local Government Areas cover approximately 60 percent of Nigerians living within the rural areas.
Proffering a solution to the problem, Onyebuchi Chukwu, minister for health, remarked that the passage of the National Health Bill would go a long way in addressing healthcare delivery in the country. According to the minister, the National Health Bill which has sailed through the Senate and gone through the first reading in the House of Representatives will ensure that responsibilities are assigned to all the tiers of government.
“Looking at the nation’s healthcare system, the bill is an all-encompassing document aimed at turning around the sector for good because our health indices are poor in relative spending. But there is lot more that can be done in terms of improving maternal mortality and other childhood diseases. The health bill will address these constraints. It will define roles and responsibilities of the three tiers of government as it relates to health. With this in place, Nigerians will know whom to hold responsible if a particular arm is not working,” Chukwu assured.
For Pate, aligning incentives for the implementation of PHC, improving accountability, strengthening inter governmental relations, effective expenditure management, among others, will go a long way in revamping the ailing system.
“What we need is a strong political commitment, increased investment in the health sector and clear policy and administrative guidelines that ensure health programmes are delivered through the Primary Health Systems at LGA levels in a horizontal and vertical manner,” said Pate.
By Alexander Chiejina
A quick review of the nation’s health indices indicates that the infant mortality rate is put at 75 per 1000 deaths, and under-five mortality rates at 157 per 1000 deaths. Needless to say, the majority of these deaths stem from common ailments like malaria, respiratory tract infection, diarrhoea, etc, which could be prevented if all facets of the health sector deliver quality primary care services at optimal capacity. While critics believe that the government has been remiss in providing this all-important service over the years, others maintain that there is a need to revamp the system, which will definitely improve healthcare delivery in the country.
In a recent interview, Mohammed Pate, executive director, National Primary Healthcare Development Agency (NPHDA), said the poor state of healthcare at the PHC level is due to non-utilisation of the PHC platform for effective integration of services, inequality in the distribution of available health workforce staff, financial barriers to health, particularly at the community level, and the absence of an enabling act to guide the PHC implementation, culminating in poor to outright non-utilisation of PHC facilities, among others.
According to Pate, the sector-wide capacity constraints had steadily increased following the provision of PHC into the LGAs, and “it might be argued that the poor performance is associated with low levels of financial resources.” For Adepoju Olusegun, a public affairs analyst, the frequent sojourn of Nigerians abroad in search of quality treatment for minor ailments connotes the state of affairs in the health sector. Olusegun stated that if government officials were satisfied with and could boast of the quality of healthcare at the various health institutions, they should be confident enough to fall asleep under the influence of anesthesia in hospitals without any doubt on their minds.
“Nowadays, local government chairmen are enthralled by the pictures of established health centres which would be used for canvassing for votes at the polls, and not actually meeting the health needs of the host communities. The health services, based on primary healthcare, include education regarding prevailing health problems and the methods of preventing and controlling them, promotion of food supply, proper nutrition material and child care, as well as family planning immunisation against the major infectious diseases,” he said. Doubtless, the importance of the PHC system cannot be over-emphasised given the fact that PHC services which fall under the jurisdiction of the Local Government Areas cover approximately 60 percent of Nigerians living within the rural areas.
Proffering a solution to the problem, Onyebuchi Chukwu, minister for health, remarked that the passage of the National Health Bill would go a long way in addressing healthcare delivery in the country. According to the minister, the National Health Bill which has sailed through the Senate and gone through the first reading in the House of Representatives will ensure that responsibilities are assigned to all the tiers of government.
“Looking at the nation’s healthcare system, the bill is an all-encompassing document aimed at turning around the sector for good because our health indices are poor in relative spending. But there is lot more that can be done in terms of improving maternal mortality and other childhood diseases. The health bill will address these constraints. It will define roles and responsibilities of the three tiers of government as it relates to health. With this in place, Nigerians will know whom to hold responsible if a particular arm is not working,” Chukwu assured.
For Pate, aligning incentives for the implementation of PHC, improving accountability, strengthening inter governmental relations, effective expenditure management, among others, will go a long way in revamping the ailing system.
“What we need is a strong political commitment, increased investment in the health sector and clear policy and administrative guidelines that ensure health programmes are delivered through the Primary Health Systems at LGA levels in a horizontal and vertical manner,” said Pate.
By Alexander Chiejina
Monday, August 23, 2010
Is Nigeria on course to meet MDG target?
As the countdown to 2015 begins, reports reveal that the country is unlikely to meet the Millennium Development Goal (MDG) deadline for poverty eradication, as five out of every 10 Nigerians is adjudged to still live in poverty. Alexander Chiejina examines Nigeria's chances in this regard.
At the start of this millennium, world leaders were concerned about the poverty burden, particularly in developing nations across the globe. This concern was born out of poverty and the dearth of productive resources to ensure sustainable livelihoods in that category of nations. In a bid to address these challenges, the United Nations established the MDGs to help underdeveloped countries overcome the problems of illiteracy, poverty, poor health and quality of life.
Much emphasis was placed on the attainment of MDG targets in education because of its pivotal role in national development. The targets include education for all through 100 percent gross enrolment rate by 2015, gender equality in access to education opportunities, eradication of adult illiteracy, and improvement of the quality of education.
Other goals are: promoting gender equality and empowering women, reducing under-five mortality by two-thirds, improving maternal health, combating HIV/AIDS, malaria and other diseases, ensuring environmental sustainability and developing a global partnership for development. However, five years before 2015 rolls by, and in view of the next month's United Nations General Assembly meeting, during which countries will be assessed on their MDG achievements, calls have made on the Office of the Millennium Development Goals (MDGs) in the country to strengthen critical areas of development projects so as to actualise set targets.
While receiving the report of the Presidential Committee on the Assessment and Monitoring of the MDGs recently, Ima Niboro, senior special assistant to the President on Media and Publicity, advised that the committee should ensure that funds budgeted for various projects were adequately used to meet the yearnings and aspirations of Nigerians, especially in the health and education sectors.
"President Goodluck Jonathan identified the need for the committee to do more in the health sector to further reduce the maternal mortality rate. Also, the harmonisation and generation of a baseline data that will assist in proper monitoring and evaluation of all MDG-related projects is essential," remarked Niboro.
For Femi Akinwumi, public affairs analyst and medical expert at the University College Hospital (UCH), Ibadan, while MDGs 4, 5 and 6 seek to reduce child mortality rate, improve maternal health, combat HIV/AIDS, malaria, and other diseases, the non-effective Primary Health Care (PHC) system in the country which should cater for about 70 percent of the population's health needs has instead put good healthcare delivery in jeopardy.
According to him, "Very few Local governments (LGs) in the country have more than five medical doctors on their payroll managing the PHCs for the provision of basic but effective healthcare to the people in their domains. These LGs share up to 30 percent of monthly allocation from the federation account running into scores of millions of naira into the coffer of each LG. In view of this, we as a nation cannot realise the targets of MDGs without an adequately structured, properly managed and well-equipped PHC system."
In the meantime, evidence from the 2006 MDG report shows there is the likelihood of achieving three of the eight goals in Nigeria: achieving universal basic education, ensuring environmental sustainability and developing global partnership for development; while the health MDGs remain daunting challenges for Nigeria. However, a critical barrier to achieving the MDGS remains the unavailability of up-to-date data on most of the indicators. This is compounded by the limited funding available for data generation and management, as expressed by the report.
It would be recalled that while making a presentation at a three-day public hearing to assess the implementation of MDGs in Nigeria between 2007 and 2010, organised by the House of Representatives Committee on MDGs, Hajiya Amina Az-Zubair, senior special assistant to the president on MDGs, disclosed that the MDG project had gulped N1.04trillion since 2006.
Amina Az-Zubair explained that since 2006, $1 billion (about N150 billion) had been gathered from the Paris Club debt relief, out of which the Federal Government takes $750million (N112.50billion) and state governments $250million (about N375 billion). The SSA therefore emphasised the need to be on guard so that funds appropriated for the attainment of the MDGs, about $1 billion per annum were not misappropriated. "N20 billion was appropriated for her office in 2007, out of which N18.4 billion was allocated to the states under the Conditional Grant Scheme [CGS], and thatN300 million was returned to the treasury as unspent fund. In 2008, her office got N59.3 billion and gave N2.3 billion to states as CGS; while N15.5 billion was returned. In 2009, the office received N32.6 billion, spent N27.04 billion given to states under the CGS, while in 2010, it was appropriated N35.02 billion but was yet to make the CGS disbursements," she said, adding that 90 percent of Nigerian children under school age had been registered and attend school, which was a significant achievement as it translated to nine out of 10 children.
"11.6 million Nigerian school children benefit from better quality education from over 200,000 teachers retained through MDGs. Through the work we are doing, many remote communities across the country, some of which have never experienced any form of real development, now have access to primary healthcare centres, boreholes, classrooms and so on," she concluded.
Meanwhile, reports during a workshop on the validation of the 2010 MDGs report and five-year countdown strategy for Nigeria held in Abuja at the weekend state that MDGs implementation in the country over the past few years is a mixed-bag of modest and steady progress on many goals and slow progress on a few others.
The report further notes that out of the eight goals, Nigeria has recorded an average performance on five MDGs, with less satisfactory performance on three others. Listed under the less satisfactory performance are goals one, five and seven.
Goal 1 which is to eradicate extreme poverty and hunger by 2015; the report noted "although poverty has reduced since 2000, the reality is that among every ten Nigerians, five still live in poverty. Growth has not been sufficiently equitable or generated employment," adding however that nutrition has improved significantly. On goal five, improved maternal health, the report noted that there is sizeable reduction of maternal mortality ratio from 800/100,000 (2003) to 157/100,000 (2008). Proportion of births attended by skilled health personnel increased slightly from 36 percent (2003) to 39 percent (2008). The report also noted increase in contraceptive prevalence rate from 8.0 percent (2003) to 10.0 percent (2008).
One salient point is the fact that the timeline for the achievement of the MDGs is 2015, not 2020; hence the goals of the MDGs are a lot more modest and geared towards salvaging the less privileged. However, constitutional responsibility for implementation on almost all the goals rests with the states and local governments in Nigeria's federal structure. But despite remarkable strides at the federal level, appreciation of the requirements for meeting these goals, as well as institutional capacity remain relatively low at the other levels of government.
For Otive Igbuzor, new representative, Centre for Development and Population Activities country office in Nigeria, "there is the need to formulate and implement policies that will promote transparency and accountability, overcome institutional constraints, promote pro-poor growth, bring about structural change, enhance distributive equity, engender social and cultural re-orientation, engineer political transformation, promote human development, practise inclusive urban development, generate employment and transform power relations," Igbuzor concluded.
By Alexander Chiejina
At the start of this millennium, world leaders were concerned about the poverty burden, particularly in developing nations across the globe. This concern was born out of poverty and the dearth of productive resources to ensure sustainable livelihoods in that category of nations. In a bid to address these challenges, the United Nations established the MDGs to help underdeveloped countries overcome the problems of illiteracy, poverty, poor health and quality of life.
Much emphasis was placed on the attainment of MDG targets in education because of its pivotal role in national development. The targets include education for all through 100 percent gross enrolment rate by 2015, gender equality in access to education opportunities, eradication of adult illiteracy, and improvement of the quality of education.
Other goals are: promoting gender equality and empowering women, reducing under-five mortality by two-thirds, improving maternal health, combating HIV/AIDS, malaria and other diseases, ensuring environmental sustainability and developing a global partnership for development. However, five years before 2015 rolls by, and in view of the next month's United Nations General Assembly meeting, during which countries will be assessed on their MDG achievements, calls have made on the Office of the Millennium Development Goals (MDGs) in the country to strengthen critical areas of development projects so as to actualise set targets.
While receiving the report of the Presidential Committee on the Assessment and Monitoring of the MDGs recently, Ima Niboro, senior special assistant to the President on Media and Publicity, advised that the committee should ensure that funds budgeted for various projects were adequately used to meet the yearnings and aspirations of Nigerians, especially in the health and education sectors.
"President Goodluck Jonathan identified the need for the committee to do more in the health sector to further reduce the maternal mortality rate. Also, the harmonisation and generation of a baseline data that will assist in proper monitoring and evaluation of all MDG-related projects is essential," remarked Niboro.
For Femi Akinwumi, public affairs analyst and medical expert at the University College Hospital (UCH), Ibadan, while MDGs 4, 5 and 6 seek to reduce child mortality rate, improve maternal health, combat HIV/AIDS, malaria, and other diseases, the non-effective Primary Health Care (PHC) system in the country which should cater for about 70 percent of the population's health needs has instead put good healthcare delivery in jeopardy.
According to him, "Very few Local governments (LGs) in the country have more than five medical doctors on their payroll managing the PHCs for the provision of basic but effective healthcare to the people in their domains. These LGs share up to 30 percent of monthly allocation from the federation account running into scores of millions of naira into the coffer of each LG. In view of this, we as a nation cannot realise the targets of MDGs without an adequately structured, properly managed and well-equipped PHC system."
In the meantime, evidence from the 2006 MDG report shows there is the likelihood of achieving three of the eight goals in Nigeria: achieving universal basic education, ensuring environmental sustainability and developing global partnership for development; while the health MDGs remain daunting challenges for Nigeria. However, a critical barrier to achieving the MDGS remains the unavailability of up-to-date data on most of the indicators. This is compounded by the limited funding available for data generation and management, as expressed by the report.
It would be recalled that while making a presentation at a three-day public hearing to assess the implementation of MDGs in Nigeria between 2007 and 2010, organised by the House of Representatives Committee on MDGs, Hajiya Amina Az-Zubair, senior special assistant to the president on MDGs, disclosed that the MDG project had gulped N1.04trillion since 2006.
Amina Az-Zubair explained that since 2006, $1 billion (about N150 billion) had been gathered from the Paris Club debt relief, out of which the Federal Government takes $750million (N112.50billion) and state governments $250million (about N375 billion). The SSA therefore emphasised the need to be on guard so that funds appropriated for the attainment of the MDGs, about $1 billion per annum were not misappropriated. "N20 billion was appropriated for her office in 2007, out of which N18.4 billion was allocated to the states under the Conditional Grant Scheme [CGS], and thatN300 million was returned to the treasury as unspent fund. In 2008, her office got N59.3 billion and gave N2.3 billion to states as CGS; while N15.5 billion was returned. In 2009, the office received N32.6 billion, spent N27.04 billion given to states under the CGS, while in 2010, it was appropriated N35.02 billion but was yet to make the CGS disbursements," she said, adding that 90 percent of Nigerian children under school age had been registered and attend school, which was a significant achievement as it translated to nine out of 10 children.
"11.6 million Nigerian school children benefit from better quality education from over 200,000 teachers retained through MDGs. Through the work we are doing, many remote communities across the country, some of which have never experienced any form of real development, now have access to primary healthcare centres, boreholes, classrooms and so on," she concluded.
Meanwhile, reports during a workshop on the validation of the 2010 MDGs report and five-year countdown strategy for Nigeria held in Abuja at the weekend state that MDGs implementation in the country over the past few years is a mixed-bag of modest and steady progress on many goals and slow progress on a few others.
The report further notes that out of the eight goals, Nigeria has recorded an average performance on five MDGs, with less satisfactory performance on three others. Listed under the less satisfactory performance are goals one, five and seven.
Goal 1 which is to eradicate extreme poverty and hunger by 2015; the report noted "although poverty has reduced since 2000, the reality is that among every ten Nigerians, five still live in poverty. Growth has not been sufficiently equitable or generated employment," adding however that nutrition has improved significantly. On goal five, improved maternal health, the report noted that there is sizeable reduction of maternal mortality ratio from 800/100,000 (2003) to 157/100,000 (2008). Proportion of births attended by skilled health personnel increased slightly from 36 percent (2003) to 39 percent (2008). The report also noted increase in contraceptive prevalence rate from 8.0 percent (2003) to 10.0 percent (2008).
One salient point is the fact that the timeline for the achievement of the MDGs is 2015, not 2020; hence the goals of the MDGs are a lot more modest and geared towards salvaging the less privileged. However, constitutional responsibility for implementation on almost all the goals rests with the states and local governments in Nigeria's federal structure. But despite remarkable strides at the federal level, appreciation of the requirements for meeting these goals, as well as institutional capacity remain relatively low at the other levels of government.
For Otive Igbuzor, new representative, Centre for Development and Population Activities country office in Nigeria, "there is the need to formulate and implement policies that will promote transparency and accountability, overcome institutional constraints, promote pro-poor growth, bring about structural change, enhance distributive equity, engender social and cultural re-orientation, engineer political transformation, promote human development, practise inclusive urban development, generate employment and transform power relations," Igbuzor concluded.
By Alexander Chiejina
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