Lagos State - continues to set the pace

Sometimes..out of the quagmire of the Nigerian political space....a leader emerges that is head and shoulders above his peers.

When he shes does, we really do not care if that person is Igbo, Yoruba, or Hausa. We do not care if he/she is from the east, west, north or south. We do not care if he she is Christain or Muslim.

This is why almost all Nigerians in my generation will continue to celebrate Nasir El Rufai, Nuhu Ribadu, Ngozi Okonjo Iweala, Oby Ezekwesili. We saw ourselves in them.

If a leader emerges that provides security to Nigerians, peace in the Niger Delta and Electricity across the country...most of us will honestly not care that the Minister of Finance, Minister of National Planning, and the Governor of the Central Bank of Nigeria are all from Kano. We will not care less!

So today...Ill celebrate with you the one Nigerian leader putting the rest to shame. Showing that you do not need years to plan. A leader that has shown that being a SAN does not make you any less sensitive to the needs of the guy hawking at Ojuelegba. Managing the city fastest growing city in Sub Saharan Africa and making it work. We have blogged on it before and we will continue to....

It is slow....but it is happening in our life time. LAGOS is beginning to work again, thanks to inspirational leadership of Raji Fashola

Read the following developments in the health sector:

1. Daily Trust: No fewer than 11,000 people resident in five local government areas of Lagos State have benefited from the free ambulance boat services, designed to improve health care services in rural areas...

2. Vanguard: Newly procured Field Hospital into the Lagos State Eko Free Health Mission is yielding fruits for less privileged Nigerians...

3. BusinessDay: Lagos - Battle against fake drugs

4. Vanguard: Lagos to establish immunisation posts for children


Now to really understand the contrast in governance in Nigeria - read this article in Leadership; one of our favourite Governors - Isa Yuguda of Bauchi State, a former Aviation Minister, former Managing Director of Inland Bank and brother in-law to our President. He has concluded that the best way to address the health sector's challenges in his state is to import doctors from Egypt!


I rest my case!

Eko O ni Baje!

Reporting health in the Nigerian Press....

Recently I was involved in a conversation with a colleague who writes on health issues in South Africa. We discussed about the healty and vibrant debate that went on in the South African press during the tenure of the erstwile Minister of Health in South Africa. Dr. Mantombazana 'Manto' Edmie Tshabalala-Msimang will be remebered for her emphasis on treating South Africa's AIDS epidemic with vegetables such as garlic and beetroot, rather than with western antiretroviral medicines. We talked about the debates about acces to anti retrovirals and to Mbeki's stubborn stance on HIV/AIDS. I felt her pride in the role of the South African press in shaping the discourse.

She asked me...how the press reported health in Nigeria.

...mmmh....well...sadly Apart from Chukwumah Muanya who writes for the Guardian, I cannot point to any other journalist in the Nigerian press who has consistently reported health stories and put the often difficult issues into pespective.


So for all its worth, I looked for the stories that have appeared over the past few weeks. Sadly ...at least 95% of press stories in the Nigerian press report what our public officers say. No critical analysis, no context, no perspective....just what the Minister says!

Find below a small fraction of what the Minister of Health has said...courtesy of the Nigerian press:

1. Vanguard: Osotimehin Enjoins Nigerians to Donate Blood Voluntarily

2. The Sun: Health minister declares war on tobacco

3. World news: Osotimehin - Sustained Funding Will Hasten Elimination of Malaria

4. Thisday: Osotimehin - Nigeria's Battle Ready for Malaria

5. Vanguard: Oshotimehin advocates for community participation in health

6. Vanguard: Professor Babatunde Osotimehin has tasked the media to sustain the high level of awareness about the A(H1N1) Influenza among the citizenry of the country.

....if the the purpose of a free press in a democracy is to guarantee free and open debate and discussion...it is not happening in Nigeria....and it is NOT the Minister's fault!

I am Hungry, Please Re-brand me

New voice out of our troubled country...If you have not...bookmark this blog - Suleiman's Blog

Now read this excerpt...

I am Nigerian...I have millions of acres of arable land and billions of cubic litres of water, but I cannot feed myself. So I spend $1 billion to import rice and another $2 billion to import milk. I produce rice, but don’t eat it. I have 60 million cattle but no milk. I am hungry, please re-brand me.


....Malaria, typhoid and many other preventable diseases send me to hospitals which have no doctors, no medicines and no power. So my wife gives birth with candle light and surgery is performed by quacks. All the nurses have gone abroad and the rest are waiting to go also. I have the highest maternal and infant mortality rates in the world and future generations are dying before me. I am hopeless, hapless and helpless, please re-brand me.

More here....

If you like it, read When the Ivory Towers Came Crashing Down...

Have a good weekend!

A visit to the Nigerian High Commission

In a recent posting about the annual MANSAG dinner, I promised to share with you the promise made by the High Commissioner of our Federal Republic, His Excellency Dr. Dalhatu Sarki Tafida, OFR, MBBS, MRCP, FNMCP, FWACP, former Honourable Senator of the Federal Republic of Nigeria.

In his usual calm, collected and eloquent nature Dr Tafida spoke passionately about how he tracked down the producers of a film that aired on Channel 4 in the UK "Saving Africa's Witch Children". He described his initial skepticism of this film, set in Nigeria, it evolved as he met the producers and understood that their motivation was nothing other than the best interests of our children. (viewing this movie is not for the faint hearted!)


To end his address, he offered his colleagues the opportunity to phone him whenever we needed the services of the consular section of the Nigerian High Commission in order to ease the process for us.

I had an appointment with my family at the Nigerian Consular section a few days later so I thought hard about the High Commisioner's offer. But in the end....I remembered the words in Achebe's book, "The Trouble with Nigeria", which I had coincidentally re-read recently-

"...that precisely is the view which Nigerian elite groups foster in their private and public behaviour. The queue is for the little man, the big man has no use for it"


So...no...I will not take advantage of the privilege of being acquainted to His Excellency, I gathered courage, packed my family and we headed to 9 Northumberland Avenue.

But before that we went to the website - http://www.nigeriahc.org.uk/ - Now... this website is a complete disgrace. There is no politically correct way to put it. There are more flying objects on it than you will find airplanes over the skies of Heathrow. Compare this to the excellent website of the Nigerian Immigration Service. Now if you really want to weep, look up the website of the Ghanain High Commision in London. What does it take to put up a decent website in 2009?

When I did manage to navigate my way through the site, and hit the usual stumbling blocks, I decided to call the High Commission on their advertised number of 0207 839 8746. Try it yourself...and enjoy the soothing voice of a prerecorded message giving directions to the High Commission, and opening times. Nothing else. Nothing. What does it take to answer a phone in 2009?


So..off to # 9 Northumberland Avenue. On the previous day, I had gone physically to the High Commission to find out what documentation I needed before I packed my family for the journey. Then we arrived the next day, bright and early and joined the long queue that forms from 6 am every morning. Not of tourists,businessmen etc, but of Nigerians...Nigerians of all manners, and walks of life looking sad at the prospects of a day of pain.

In the High Commission itself, we were faced with officials, completely out of their depths on how to manage the crowd. Confusion prevailed. "Officials" shouting at the top of their voices. People wondering what queue to join. Toddlers crying, children running around. A TV blaring in the corner, showing a Nigerian production with its volume set at the loudest. We look at each other and seek mutual support. Nobody is smiling. Every single person in the room is looking upset. Upset at a country that treats it citizens like they were irrelevant. Upset that there is apparently nothing we can do about it. We collect our emotions, endure the pain and hang in there. The pictures below tell the story.










Having said all this, it is obvious that those at the embassy are actually working hard to serve to the best of their capacity. BUT the world has moved on, and Nigerians expect that its High Commission moves on too.

Until the new generation banks came on the scene in Nigeria, we thought that getting your money normally required a full day at the bank. Until MTN came to Nigeria, we planned a full day to visit NITEL. We need someone/group with the competence on managing processes to support our High Commission. We also need a few Nigerians that understand what customer service is. It is a pity that the High Commission has a monopoly on the issuance of visas and passports...else we would long have moved on.

Having said this too, I know that Dr Tafida means well. I know he wants the High Commission to work. But he really needs to focus on this issue. Nigerians' deserve better in the one place they can call home in the UK. For now...all I can think about, are the mothers and their children that struggled up and down the stairs, with their prams and children as they moved from one queue to the next. As I finally got out of the embassy at 3 pm on the day with my family, we made the sign of the cross and thanked God things money can't buy....the Green Kpale!

But for the website and phone...there is no excuse!

We can do better! We definitely can. Accepting the status quo is accepting that there is something inherently wrong with us. I thought back to my recent experience at the Embassy of Tanzania and how efficiently I was served...

So this is obviously not a resource issue. So if we cannot get our High Commission in London to work, then how can we get our health sector in Nigeria to work. The general feeling at the High Commission amongst the various visa and passport applicants was that there was nothing anyone could do, well this is mirrored in people's attitudes to the various failures our health sector...........WE CAN DO BETTER....Yes...we can do better Dr Tafida.

Dr Nasidi speaks on Swine Flu in Nigeria

Director in the Federal Ministry of Health: Dr Nasidi speaks on Swine Flu...(at the beginning of the outbreak)


Nigeria Osotimehin Mobilises Against Swine Flu - More related videos from Asterpix

Road safety: the new immunization?

by ndubuisi edeoga

The jury is out; with the World Health Organizations (WHO) recent, first ever report on worldwide road safety shows that low and middle income countries like Nigeria account for more than 90% of traffic fatalities worldwide. The breakdown of the report shows that about 1.3millon people die each year on our roads and between 20 and 50 million people sustain non-fatal injuries.

Do you know that traffic injuries cost about $518 billion dollars a year, not counting the lives lost for which we may not have a dollar value for? Have we been barking up the wrong tree?


The WHO goes on to tell us what we already know, but have refused to implement.

• Strictly enforce speed limits
• reduce drunk driving
• tighter seat-belt laws
• helmet laws
• more research on road planning and design

Road design is important since the report goes on to show that vulnerable road users listed as pedestrians, cyclists and motorcyclists popularly known as okada men, account for 46% of all traffic deaths. The road safety chief; Corps marshall and Chief executive of the FRSC Mr. Osita Chiduka has not been sleeping, see his vision 2020 plan here. But this new call by the WHO merits his undivided attention. (sadly...again the FSC website is "down" http://www.frscnigeria.org/)

WHO recommends that road safety laws need to be made more comprehensive, and that enforcement of road safety rules needs to be strengthened. The Global status report on road safety is a call to action for all stakeholders, most importantly us.

Looking at the WHO fact site... Nigeria has a seat-belt law, motorcycle helmet law, drink-driving law amongst others but no Child restraint law. I’m Nigeria and I love my kids so much and I know most other Nigerians do love their kids. Not making enabling laws to protect our children by the Nigerian government leaves a lot to be desired. It looks like we don’t love our children enough to immunize them, now they make seat-belt laws and forget our kids, what next?

Now...lets us shall take the law into our hands. Spread the message to your friends and family, next time you are going home plan to buy some car seats for your friend and family, next time you are driving make sure you have your seat-belt on and ask everyone in your car to put their belt on too, next time you have to drink and drive, remember that it could be you, and that you are not immortal as we all believe, next time your speedometer gets above 100kph make a detour to the race course who knows you might be the next Michel Schumacher, and make some money while you are there. If we all make these little adjustments we will not have to wait for the Nigerian government to save us from ourselves.

Next time you are taking that new baby home from the hospital make sure you have the survival kit viz: mosquito net, car seat, immunization schedule in hand, and pray that the guy driving past you in car lot just read this blog.

We learn the hard way...

When in 2003, the Polio crisis first broke in Kano and threatend the Global Polio Eradication efforts, the public health community around the world were dumbstruck. First we ignored the situation, but then as the outbreak spread across Africa and beyond we reacted with anger. But finally we realised that neither silence nor anger was going to solve this one.

We needed to go back to those ancient public health tools of community engagement and social mobilisation. So a process of slowly regaining the support of the population in Northern Nigeria started.

Thisday reports that on the 6th of May foremost traditional leaders from Northern Nigeria met in Kaduna and expressed their commitment to ensuring that polio is totally eradicated from the region. What a turn of events!

The Sultan of Sokoto, His Eminence, Alhaji Sa'ad Muhammad Abubakar III, tasked the traditional rulers to be personally involved in polio eradication initiatives. He is the head of the Nigerian National Supreme Council for Islamic Affairs and is considered the spiritual leader of Nigeria's muslims. On November 2, 2006, Sa'adu Abubakar succeeded his brother, Mohammadu Maccido, who died on ADC Airlines Flight 53.

The Sultan has been a relevation since his emergence in the Nigerian polity.

Now we have learnt that to win the hearts and minds of the people ...we have to speak to them. Our leaders have to engage. See if you recognise any of these...




You will probably be wondering where the president of the country with the most case of Polio in the world is...but thats an isue for another day. Today, let us celebrate The Sultan.

But talking is not enough. Polio vaccination too is not enough. With routine vaccine coverage remaining persistently below 40% since 1997, measles has remained hyperendemic in many parts of the country, especially the north...which we have frequently blogged about.

Improving routine immunisation (as opposed to campaigns) can prevent many deaths, yet we do not seem to be able to muster the required resolve to pursue this goal without disease specific targets. A window of opportunity exists to broaden the benefits of these vertical programmes beyond the specific disease, in this case poliomyelitis. Active efforts should be made to plan for the diversification of these skills. This can only be achieved if the donor that supports these programmes actively demands integration.

Sustained vaccine coverage for measles of below 40%, as in Nigeria, in an era of regular national immunisation days for polio eradication is a modern tragedy.

These are the issues we expect the Sultan to challenge the Government on, indeed these are issues we should all challenge our government about. With the renewed energy in the National Primary Health Care Development Agency...Nigerians are hopeful.....we deserve more.

MANSAG - Still going strong!

Organising Nigerian doctors will never been an easy task. The Medical Association of Nigerian Specialists and General Practitioners have been doing this in the UK since 1997. As is tradition every year it recently held its annual charity ball. This was a ball with a difference as it had the ebullient Nigerian (rather than Nigerian-born) comedian Gina Yashere, who held the audience spell bound with her jokes....(would love to see her on stage with BasketMouth)



But it was a night of serious affairs too. MANSAG has been very active in supporting specific charities every year. This year the chosen charity was "Stepping Stones" Stepping stones works in Nigeria with the Child Rights and Rehabilitation Network (CRARN) and our sister NGO - Stepping Stones Nigeria to protect, save and transform the lives of children who have been stigmatised as being 'witches'.

No doubt, MANSAG has matured as an organisation. Guided by the able leadership of Professor Stanley Okolo and his team. It has done its bit in defending the interests of Nigerian doctors in the UK. Speaking to Stanley at his last Ball as president, he says that one achievement he is proud of in the engagement of the next generation Nigerian doctors in the UK in MANSAG's activities. As the new executive comes in...they will have to carry on with this challenge. Of the literarily thousands of Nigerian doctors in the UK, at best, less than 200 are active in the activities of MANSAG.

At the dinner was Nigeria's High Commissioner to the UK, Senator Dalhatu Tafida, a former Honourable Minister of our Federal Republic and a colleague. Watch out for what Dr. Tafida said at the dinner and why it matters in subsequent posts.




But for now, on save the date of the next 20th MANSAG conference and AGM in October 2009 Plymouth (Weekend: 30 October - 1 November 2009).

Between July 14 - 19 MANSAG is collaborating with the Association of Nigerian Physicians in the Americas and the Nigerian Medical Association to organise a conference in Abuja. Find the programme here.


So...if you are in the UK and a doctor, don't sit on the fence, engage with MANSAG. Check out their website at http://www.mansag.org/ (...and yes...they are working on a better website :))

The good news, the bad news…and some hope

Last week I was at the annual conference of the European Society of Pediatric Infectious Disease in Brussels.

There was a buzz in the room as the new tools available in our arsenal to do battle with our microbial competitors in our ecosystem were discussed. In addition to cutting edge new drugs, there were some papers that were amazing not for their science but for their implementation. One of particular interest was by Dr Pettit of the University of Geneva Hospital who showed how through several “simple” but meticulously implemented measures as like hand-washing,are able to push down the rate of hospital acquired infections, saving lives and saving money. I thought back to my time working at the University of Nigeria Teaching Hospital Enugu and our struggle to get running water. I think of the efforts of students pouring water over the surgeons hands from a bucket as he prepared for surgery, to then imagine that this is the premier tertiary health facility in Eastern Nigeria…goose pimples emerge at the thought of what the effects are. Health care associated infections is an area we have not even scratched in Nigeria...so Ill not bore you.

So...guess what are the two biggest vaccine-preventable diseases which together account for more than 35% of all child deaths every year, the majority of which are in the developing world.

....no ...not measles, meningitis, diptheria....

....no not TB

The two are "diarrhoeal disease" and "pneumonia"

The good news - What I will share with you is the availability of two “new” vaccines. They are not really new, but their impact on the lives of children is just becoming obvious.

1. A vaccine has been included in the routine vaccination schedule against 10 subtypes of the bacteria – pneumococcus, the most common cause of pneumonia in children, but also a cause of meningitis and sepsis in many developed countries. A 7-valent vaccine has been available for some years now. WHO has issued a recommendation for the introduction of pneumococcal vaccines into immunization programs in developing countries to save millions of lives, starting with the currently available 7-valent pneumococcal conjugate vaccine.

One African country has added the pneumococcal vaccine to its schedule: Rwanda. Several others have plans in advanced stages...for details look here....and sorry Nigeria is NOT one of them!

2. A new vaccine against the rotavirus, already widely used in many parts of the world, including most of Latin America has now been shown to work effectively in African settings too following studies conducted in Malawi and South Africa. On the 5th of June during the ESPID conference last week in Brussels, the World Health Organisation recommended the global use of the rota virus vaccine.

These new vaccines bring real hope to millions of children in Africa, sadly not yet ours. The agency responsible for delivering on immunisation in Nigeria as been in the wilderness for years, with neither the will nor the leadership to deliver on its mandate. We have barely been able to deliver the primary vaccines that have been on our schedule for years.

But now with new leadership (more on this in future posts) at National Primary Health Care Development Agency, the agency responsible for immunisation in Nigeria there is renewed hope. The agency is working towards to re-defining itself and to restore some of the legacies of Professor Kuti and protect the lives of the most vulnerable. For now, these kids will continue to die from pneumococcal disease...just because they were born in Nigeria and not Rwanda! What a turn of events!

Meanwhile...see here my means of transport in Brussels....lovely city!

How we hurt ourselves...

For a few years I have reviewed abstracts for the International AIDS conferences. Nigerians have often met in these conferences. While we remain proud of our increasing contribution to the knowledge base....many ...many of the abstracts submitted leave a lot to be desired.

Plagiarism is considered one of the worst offences in academia. This is defined as "the use or close imitation of the language and thoughts of another author and the representation of them as one's own original work"

Find below and email I have just received from the conference organisers:

Dear IAS 2009 Abstract Reviewer,

We are writing to inform you that it has been discovered that one of the abstracts that were part of your IAS 2009 reviewing assignment in March was in fact plagiarized. The title of the abstract was the following:

Using information & communication technology (ICT) products to reduce stigmatization of HIV+ female sex-trafficked deportees as a measure of increasing access to antiretroviral treatment (ART) and Care in Edo-State, Nigeria

The conference secretariat is informing all reviewers who scored abstracts that have been found to be plagiarized to ensure that the record and reputation of the original author(s) stands protected. It is particularly critical in the event that you or the other reviewers would have identified a study/research as previously presented elsewhere.

Please do not hesitate to contact me if you should have questions or need further information.

...our problems are deep....but together we will continue to hold ourselves to account...

A Minister's promise - "You can count on us"

A few weeks ago I got a message from the PA of the Honourable Minister of Health of our Federal Republic. He was passing through London enroute Nigeria from the World Health Assembly in Geneva. He asked to meet me. It was short notice and I was in the middle of managing a major infectious disease incident. I was worried of being berated for articles on this blog that might be considered critical. But at the end of the day, I rescheduled a few meetings and hopped into a cab to meet Professor Osotimehin at a London tube station. It always feels a bit strange when you meet an important Nigerian politician looking very ordinary, without the entourage and the hangers on. But there he was, standing beside the "Boots" shop as arranged. We looked for a quiet restaurant to talk. Thanks to the small bundles of technology we carry around these days, I quickly found a quiet place. "Its a 10 minutes walk, Sir". "No problem" he said....


We found somewhere, and sat facing each other, removed jackets, and ordered water (I could have done with some brandy :))

First he said...he wanted to listen. I had structured my thoughts a bit and did my best to share my views (shared with many of you that read this blogs). He listened patiently
....then he spoke; passionately, articulately, in extemporaneous detail, very much aware of the small window he has bring the change we seek.

I thought hard about the appropriateness of reproducing his words on this blog. I have not had the time to go back to ask, now I do not have to. Professor Osotimehin has written a letter to the Nigerian people, published in THISDAY on 05/06/09. He says all the things he said to me...but most importantly...he says it to the Nigerian people, and us to "COUNT ON HIM".

Find the entire letter re-produced below. It is an important read, as it discusses many of the issues we have been highlighting here.

We are grateful for his promises, we will keep the letter and hold him to account in 2 years time.

For now...lets work together ...for the best interest of the people who it is all about!

Our Health System: Matters Arising

By Babatunde Osotimehin, 06.05.2009


Our health situation has lately invited us to ponder on steps to take in initiating immediate and long term solution. Without sounding immodest, the leadership of the Health Ministry understands the urgency of our situation and is responding with its entire zeal, within the broader spirit of President Umaru Musa Yar’Adua administration’s promise of efficient service delivery. We understand the recent threat of swine flu, and the subsisting presence of Lassa fever, cerebrospinal meningitis, and polio situation, amongst others. Overall, we are saying, it is important to improve our health care delivery system. In fact, our Primary Health Care system does need rejuvenation. We have been working at this, as it is important to focus on nearly every area of our health care system, not least so is maternal and child health. To bring about this improvement, I have said it elsewhere; it will need an alert from all tiers of government, particularly the state and the local. Resources would then have to be adequately provided, while human resources should not be lacking. Then the management of drugs and consumables have to be better than it is, apart from the institution of a good referral system. What should stop us from achieving these? Absolutely nothing really.
I say nothing if we are determined as a people. There is absolutely nothing that a collective will cannot make us achieve. By encouraging our health workers who labour across the length and breadth of the country, without being celebrated, we should have taken a significant step forward. Human resources galvanize. It drives processes to the desired level, and may be undermined only at our own peril. This cannot happen at a time we are even striving to accomplish a significant programme, which is the 7-point agenda of President Yar’Adua. We understand that the Nigerian health system and the health status of the citizens are experiencing a low rating from the estimation of the World Health Organisation. But like I have been saying, we can collectively increase our ranking.
On the part of the government, we are already providing the required energy in the system, through a repositioning of the environment and the leadership to enable the right contribution from all. Then we are seeking to improve our health service delivery not only via a holistic change in our Primary Health Care, but by strengthening referrals with secondary and tertiary institutions to reduce the disease burden that would then shore up the countries’ health status.
Besides, we are enhancing the financial resource mobilization through the expansion of the NHIS and other Public Private Partnership (PPP) arrangement. Then again, we are enhancing the coordinating role of the ministry and its interface with states and local governments, while also providing the much needed improvement in its overall performance. This is because the requisite human resources must be ready in all its right combination, just as the skewed distribution of workforce need to be dealt with. More than this, because one of the key weaknesses in the Nigeria’s health system is the lack of data to guide planning, a strengthened Health Management system is necessary to provide this needed data. Rest assured that the ministry is working on urgent steps to strengthen HMIS.
In the area of communication and public relations management, we are mobilizing and galvanizing public support for increased personal responsibility for health through utilization of preventive and health promotive services. The media is crucial in this role, which is why we are utilizing several media to ensure that timely and comprehensive evidence-based information about its activities are made available to build broad-based understanding of and foster acceptance and support for the new strategic agenda of the ministry and government.
Without any doubt, the above elements of our stewardship over the next 24 months or so are also being worked into the much broader and long term national strategic health development plan. Importantly, we started the process of developing a costed National Health Investment Plan. At the same time, we were embarking on a parallel initiative, a follow-on programme to the Health Sector Reform Programme (2003-2007), as the health sector contribution to NEEDS2. This was just before NEEDS was re-christened by government as the National Development Plan (NDP). The two initiatives: Health Investment Plan; and the Health Sector/NEEDS2 initiatives have now been harmonized into the preparation of a National Strategic Health Development Framework and Plan (NHSDP) process that is being led by the Federal Ministry of Health working with all the states, development partners, and non-state actors, amongst others. This process is currently being managed via the Health System Forum, and has attracted participation from many.
The NSHDP is aimed at a single country health plan, a single results framework, a single policy matrix and a costed plan that will be the basis for funding. There are also one single policy matrix; one costed plan that will be the basis for funding; one single mutual monitoring and reporting process; one single country-based appraisal and validation process for country health plan; one single fiduciary framework; benchmarks for government performance, benchmarks for development partner performance; agreement on aid modalities; and process for resolution of non-performance and disputes. These are the cross cutting principles of the IHP+ built on the Paris Declaration on Aids Effectiveness.
We recognize that domestic funding should make a significant contribution in meeting the challenges for Health-MDGs. Thus, the government has steadily improved on its funding support for Health-MDGs in recent years: N15 billion in 2008; and N22.5 billion proposed for 2009. We are internally challenged by issues of efficiency and in spending wisely and we are thus looking for technical assistance in this regards, especially in building capacity for power costing for Health-MDGs, and in innovative mechanisms that offer tremendous potential to save lives through new and creative solutions. Domestic funding alone is unlikely to meet all the challenges of funding Health-MDGs. We also remain concerned on whether or not we are making real progress in terms of the indicators.
Arguably, the greatest burden of disease in Nigeria is attributable to the index diseases of HIV/AIDS, malaria, and tuberculoses (ATM), and the diseases are at the heart the Health-MDGs Global compact. As mentioned above, the level of resources, both from within and external, to fight these diseases has increased steadily. However, the national response remains complex and confusing with multiple overlaps and poor coordination. Progress has been very slow. We certainly can do far more and we intend to do so. For this reason, a task force on ATM has been established, under my direct supervision, as part of a renewed spirited effort to ensure visible progress on Health-MDGs.
Membership of the task force are drawn from the Federal Ministry of Health, other Federal Ministries (National Planning, Ministry of Finance/Budget Office), and representative of state MOHs, members from cooperating partners active in ATM, representatives from civil society, and representatives from private sector bodies. The committee has focal point persons from the Federal Ministry of Health to assist in both technical and administrative work of the committee. I shall be the Chairman, with the Honourable Minister of State for Health serving as Alternate Chairman and member of the committee. Importantly, we have since moved forward, and we are continuing in this trend. Constant review and determination as exemplified in the President Yar’Adua’s directive remain our top priority and we shall not shirk our responsibility in this respect.

You can count on us.
• Prof. Osotimehin is Minister of Health.

The health of our prisoners - who cares?

Have you ever wondered...with the state of health care facilities in Nigeria, what the health services available to prisoners would be like?

While in medical school at the University of Nigeria Teaching Hospital, Enugu...it was a regular feature of our days to see a prisoner being brought to the hospital in a wheel barrow.

I remember one particular young man. He was brought to our unit with "crusted scabies", a severe form of scabies that would usually only occur in imunocompromised patients. Despite the usual challenges of raising the funds to pay...he was slowly managed to better health. We spoke a lot during his time at the hospital. Together with other medical students on our team, we bought him the odd bottle of coca cola and groundnuts. Despite his illness he was happy for the 1-week in hospital. He tried to explain the situations under which prisoners live in Nigeria. For us young medical students, about to dedicate the rest of our professional lives to the concept of "saving lives" ...it was difficult to come to terms with. Probably why I cannot forget this guy....

It is easy to forget that prisoners have just as much a right to health as the rest of us. I have not yet head of a prison sentence that includes the removal of the right to health.

It is also easy to forget that most prisoners currently in prison are going to come out soon and return to society, our society, so that the diseases/conditions they potentially acquire in prison...will soon become part of our society's burden, and potentially transmitted to the rest of us...the "good ones" (who might ourselves be ending up in prison soon!). This is to illustrate that "prisoners" are not a separate breed...they are us!

In preparing this blog, I was happy to find that the Nigerian Prison Service does have a website!...and has a Directorate of Health and Social Welfare charged with the physical, psychological and developmental well-being of the inmates and staff. They, for the most part try to provide for the health care of prisoners themselves by directly employing doctors and other health care professionals. How well this is done....you tell me!

....then I looked up Pubmed to search for any articles on the health of prisoners in Nigeria. I barely found a handful, a few on HIV/AIDS...a few on psychiatric consequences.

....then I searched the web for an NGO that worked for the health of prisoners in Nigeria....and I found one (Prison Rehabilitation Mission International (PREMI) (if you know of any other, pls holla)

....then I looked out for politicians speeches talking about the health of prisoners...and you can guess what I found.

There is a general ignorance about prisons and prisoners, there are no votes in them, so politicians ignore them. The rest of us feel embarrassed to be associated with "them" so we pretended they do not exist.

I contend that we do need to know what goes on in prisons, and what happens to the health of prisoners. Even if it is for selfish reasons as "they" will return to our communities. "Their" physical and mental health when they return does matter....it should matter to us!

...do you know that:

• Most of the total prison population have not been convicted!

• Many are locked up 24 hours a day because there are not enough warders to prevent escapes.

• Cells are dirty, hot and hold scores of people.

Read more on the BBC

- Over 150 inmates have broken out of an overcrowded prison in Nigeria's south-east during a midnight escape bid.

- Andrew Walker visits a prison in the south-eastern city of Enugu where some people who have not committed any crime are locked up for years on end.

Who takes care of our doctors?

by ndubuisi edeoga

We are happy about all the positive posturing by the new minister of Health. We are happy about his utterances so far. We await the outcomes....

While we wait for him to walk the walk, we would continue to add to his "to do" list, with our growing list of health related problems and concerns.

Let’s leave the sphere of physician kidnappings, the much talked about issues of physician assisted death or deaths due to negligence, the ever present polio cases, the perennial malaria, the lack of roadside assistance for accident victims and for once talk about these species on the extinction list in Nigeria.

The doctor-patient ratio stands at 28/100,000, which breaks down to one doctor to 3,572 Nigerians.

I got off the phone with a physician friend of mine practicing in Nigeria. He was watching the champion’s league semi-finals and suddenly started bleeding from the nose. He finally had to go to the Emergency Room when he could not stop the bleed. Final diagnosis was high blood pressure, really high systolic of about 230/ and diastolic of about 110 and yes mmHg! (230/110mmHg). If you are a physician and you are reading this article please take a moment and go get your blood pressure checked and come back and finish.

Apparently he had not checked his blood pressure for the past 10-15years, even though he has a family history of high blood pressure in both parents.

When a doctor does not have time to care for himself, how can he have the time to care for his patients adequately. Some people might say that the doctors as so engrossed in caring for their patients that they do not have time to care for themselves, well same thing.

It gets even worse for the Nigerian doctor, If he is not worried about his next salary because of strike, he is worried about being kidnapped, if he has his own personal protection, then he might be worried that there would be no light to effectively use the equipments supplied by VAMED to care for his patients.

What is the state of post exposure prophylaxis, what existing laws and protocols exist for our doctors. Especially for areas with high prevalence of HIV infection.

What rules and provisions are made for continuing medical education (CME) for our doctors?

What is the role of the Nigeria Medical and Dental council (NMDC), apart from collecting annual practicing dues, in making sure our doctors are regularly updating their knowledge base? Do you require CME credits or some extra knowledge or education before you can renew your license or is practicing medicine enough to keep practicing medicine? (Pardon my tautology).

With the high cell phone usage and increasing tele-density in Nigeria, my grandmother in the village even have a cell phone (actually 2 cell phones MTN and Glo). Is it time to start looking at the e-medicine/tele-medicine model that has worked in some other countries? When one doctor has to take care of 3,572 patients, I guess he needs all the help he can get....but ...but ...how do we thinkk of e medicine without electricity???


Where do we start?...where?

Malaria Matters

If you follow this blog, you should also follow .... this most important blog "Malaria Matters". It is maintained by Bill Brieger, a Professor in the Health Systems Program of the Department of International Health at Johns Hopkins University...and a long term friend of Nigeria. From 1976 to 2002 he was Professor in Health Education at the African Regional Health Education Centre, University of Ibadan, Nigeria. Many of his posts relate directly to Nigeria.

If you are interested in health in Nigeria....follow this blog!







I wished we could give you the stats....but you probably do not need them.

Malaria matters! It matters to Nigeria!

For many years....we have accepted malaria as an inevitable part of our reality in Nigeria. Little progress was made in scaling up any of the available public health interventions to have an impact on the populations level....

April 2009 - The World Bank is "investing" US$300 million in International Development Association (IDA) funding to expand Nigeria's efforts to control malaria. Combined with Nigeria's initial 'Malaria Plus' package of US$180 million (approved in 2006), the bank's support to Nigeria is expected to approach US$500 million, which would make it the largest single-country malaria control investment in the bank's history.


May 2009 - Nigeria's National Malaria Control Program (NMCP) and the Kano State Government launches the first wave of a national bed net distribution campaign designed to reduce by half the number of malaria deaths in the country over the next few years. Nigeria’s Minister of Health, Babatunde Osotimehin, tells a recent malaria summit in Washington, DC. “By the end of 2010, over 60 million treated bed nets will blanket the country,”.

Together with Malaria Matters, we will keep you informed as mush as possible on progress. But for now...we invite you to read these posts all related to Malaria in Nigeria.

Universal Coverage of LLINs Kicks off in Kano

Malaria Training Trounced by Transfers

Down Syndrome Association of Nigeria

Thanks to GoodNaijaGirl.....we bring you this important post...

about the ...Down syndrome Association of Nigeria is a non-governmental, not-for-profit association of children with Down syndrome as well as their parents, caregivers, and other interested stakeholders.

The association of Nigeria was formed on 4th of December, 2001 by a parent of a child with Down syndrome. Societal attitude toward parents of people with Down syndrome is totally negative in the Nigerian society. Society defines them by what they do not have rather than what they have; what they cannot do rather than what they can do; they are relegated, denigrated and stigmatised on the basis of some retrogressive myth and tradition They are abused physically and sexually with impunity and in extreme cases; even their right to life itself is denied them. It is against this rather harrowing and ugly backdrop that Down Syndrome Association of Nigeria evolved with a vowed commitment to bridge the gap between children/adults with Down syndrome and the rest of the society through a support system that seeks ultimately to integrate them. This commitment is rooted in the firm belief that if given the necessary encouragement and enabling environment to grow like others, people with Down syndrome can and do actualise their potentials and live a fulfilled life. In a vast country like Nigeria, as well as in the entire West African coast, with a combined population of well over 230 million, we are the known non-governmental organization working to provide leadership in all areas of concern as it relates to persons with Down syndrome. It should be noted that charity/volunteer work in our part of the world could be most challenging and frustrating, especially as there is very insignificant, if any, support (both morally/financially) from the Government and corporate concern

Mission Statement

Vision - Our vision is a world where all young people with Down syndrome are offered the opportunities that they need to achieve their individual potential.

Now they need your help!

LIFE SAVING HEART SURGERY FOR 3 DS BABIES

...on behalf of the underlisted babies who have been diagnosed with a serious heart defect:

Ajoke Taofeek (F) – 9 months
Felicia Oyinloye (F) – 12 month
Etim Gabriel (M) – 18 months.

In view of the urgent need for an immediate corrective surgery so as to save the lives of the remaining three babies, the association is making urgent arrangements towards this, but are not financially in a position to bear the total cost hence the appeal for partnership/support in this life-saving venture. It is estimated that the total amount required for the corrective surgery on the three babies in India is approx =N=10.5m. These donations will be used for the sole purpose and benefit of the children
Any donations, no matter how little, will be highly appreciated. Please note that all cheques should be made payable to: DOWN SYNDROME ASSOCIATION OF NIGERIA or paypal payment to info@dsanigeria.org.

For those of you in Nigeria who would like to donate money in person, or volunteer your time, please call or visit the DSAN headquarters. They are located in Lagos, and can be reached by phone at +234 (1) 2704710, +234 (1) 8119718 or +234 (0)8032285545.

Food for thought: Cholera/Zimababwe vs Meningitis/Nigeria

Who remembers

Cholera epidemic in Zimbabwe - The international outcry, consternation at what was happening, at a point....even some suggestion that this might lead to the fall of the Government of Zimbabwe....

Now...who heard about Cerebrospinal Meningitis in Nigeria? Barely a whimper in the press, barely a reaction internationally....not even a public acknowledgement by our president.

Now compare the figures:

Zimbabwe - As of March 2009, 91 164 cases with 4 037 deaths.

Nigeria - As of March 2009, 24 868 cases with 1 513 deaths.

The LANCET reports that it is 47 902 cases 2148 deaths—reporting that the Nigerian Health Ministry has admitted that the outbreak is more serious than was initially suspected. (!?!)

Trying to find out any information about the response in Nigeria is like searching for meet in in my soup bowl while in boarding school....but finally....we did find something....reported ...no not by the Ministry of Health, but by Doctors Without Borders/Médecins Sans Frontières

MSF reports that;

"At the end of the intervention, almost 4.8 million people will have been vaccinated by MSF/Ministry of Health in Nigeria during this epidemic"

....so whats the food for thought;

Where is the public consternation at so many preventable deaths?

Where is the Government's explanation for so many preventable deaths?

Where is the Ministry's explanation for such a slow and fragmented response to an outbreak every one knew was coming for the past 2 years?

How can all of us...our people, our leaders turn and look the other way?

So ...what would have happened without MSF?

Is real reform underway in the health sector?

Professor Babatunde Osotimehin has a tough job.


He was appointed Minister of Health half way through this administration's tenure. An administration that has been criticised as not keeping pace with the yearnings of the Nigerian people for true reform. Snubbed internationally, unable to carry out the simplest of elections and one that has unashamedly declared its inability to meet the millennium development goals as they relate to health.

He was appointed to a Ministry marred by corruption. The previous Minister, Professor Grange openly declared... "As a professional and technocrat, I must admit that the level of decay and corruption within the Ministry is in glaring need to be decisively tackled and purged"....

Now the Minister minister himself is reported by Thisday as saying

"the sector is still in a comatose state"

BUT THE GOOD NEWS is that he also said that...

"we restructuring the sector in such a way that there are not just enough resources but BETTER COORDINATION to ensure that those who work in secondary and tertiary health sectors do interact with those at the primary level for effective healthcare delivery"

Recently....we have been privy to the framework for a new plan for the health sector. A plan that will bring together the Federal, State and Local governments to work together within a single framework for the development of the health sector. Finally, our Government seems to be in the driving seat in defining the agenda and asking our development partners to come and join hands with us in our plan. While still in consultation...we see the beginnings of real reform. The challenge lies not just in getting agreement on the plan by all those engaged in the health sector....but to give Nigerians an opportunity to know and own the plan, engage with its operationalisation and hold accountable those entrusted to deliver on it.

Nigerians are hopeful...as hope is all we can have...

These are the plans of the past as elucidated by Professor Umaru Shehu at a recent conference in London:

• The 2nd Post Independence Economic Development Plan that included the restoration of health services destroyed during the civil war, control of communicable diseases and training of healthcare workers.
  

• The 3rd Post-Independence Economic Development Plan: 1975 – 1980

• The first national health summit organised by the then Minister of Health; Dr Ihechukwu Madubuike.

• The Vision 2010 under General Sani Abacha.

• ...and finally Professor Elitayo Lambo's Health Sector Reform Programme 2004 - 2007
  

No Nigerian needs be told the outcomes of these plans....we feel then in our febrile children, our dead mothers and our "mere consulting clinics" as aptly described by one of our great leaders...

Now is the time to move from strategic planning to strategic action. As tough a job he has, Professor Babatunde Osotimehin has an opportunity to be a hero....a true hero to the ordinary Nigerians that bear the burden when basic health services fail....

As the saying goes....an acre of performance is worth a whole world of promise...

The Business of Health in Africa

While we have focused mostly on the challenges facing the public sector in health care delivery in Nigeria, the private sector is similarly challenged in providing private health care to anywhere near the standards available in India, Brazil, South Africa....and similar countries with whom we would like to rub shoulders ...on our path to being among the 20 largest economies by the year 2020 :) (if only it depended on how often the newscasters reported this on network news!)

Find below a link to thought provoking report on the role of the private sector in health in Africa from the World Bank.

The Business of Health in Africa: Partnering with the Private Sector to Improve People’s Lives.

Specific sectors include:

1. The Role and Likely Evolution of the Private Sector in Health Care in Sub-Saharan Africa
   
   
2. Actions Needed to Mobilize Private Sector Participation in Health Care
   
   
3. The Case for Investing in the Private Health Care Sector in Sub-Saharan Africa

Most importantly find a presentation on Nigeria from 2008


Thanking Timbuktu Chronicles for this link!

The President speaks, but not about health...

Our president hardly ever grants interviews. When The Guardian got him to sit down with them for his most detailed interview to date, they called it Umaru Yar'Ardua: President... on a mission incredible. For 3 hours he spoke to the editorial team from the Guardian...in what they described a voice ... though gentle, had a bell-like jingle to it that seemed to emphasise his authority on the subject of discussion.

And yes...he did speak in detail, with more insight than I have ever heard a Nigerian president speak, about most of the big issues that confront us in Nigeria....all except health.

In all 16,500 words (yes 16,500) ...just 441 were vaguely related to health. Within these 500 words is the most painful admittance of our collective failure as a country "Nigeria cannot meet the MDG target by 2015, on the issue of child maternal mortality and morbidity"

These 441 words are reproduced below. I'll let you draw your own conclusions on the Government's commitment to health, and draw your own conclusions about how much we the people and the press has placed the health sector on the political agenda.


...Talking about the "enablers for development"... you must have the manpower - educated and skilled manpower - to operate within those sectors, especially education and health that determine quality of human capital.



...The same thing we are doing in the health system. We are concentrating on primary health-care. We said all contracts awards from building the clinics, purchase of drugs, we should get out. We should help with the policy, help build capacity, supervise and make sure that those policies are implemented by the state governments. And we concentrate on the tertiary sector. Right now, we have said that the special project fund should concentrate on three teaching hospitals: the University of Ibadan Teaching Hospital, Ahmadu Bello University Teaching Hospital, University of Nigeria, Enugu Campus Teaching Hospital. To bring these teaching hospitals up to the minimum acceptable international standard so that any research hospital, any university hospital you see abroad, you can compare these three teaching hospitals with those teaching hospitals. We believe by doing this, it may take us say, three or four years to accomplish, we may not use this year to complete this. It may take two years, it may take three years.

...on the issue of the Millennium Development Goals. Last week, I was at a quarterly meeting where we received the MDG quarterly report. If you cast your mind back, at the end of that meeting, we said Nigeria cannot meet the MDG target by 2015, on the issue of child maternal mortality and morbidity and on the issue of poverty and hunger. So what I have asked the Senior Special Assistant on the MDGs and other officials to do is to look at what we need to do between now and 2015 to ensure that we increase the pace of investment in these areas and to determine what additional time do we need to realistically be able to say that we will be able to achieve these human development goals. So this is what we are doing now: they are working it out now. We are aware of that and we are being frank to this nation that this is the position and that we have asked officials to look at these two issues. What we need to do is to raise the level of investment in these four areas between now and 2015 and at what time would we be able to say that we have made progress and achieve these goals. Is it by 2018, 2020, at what point? I told them that by the next meeting which will be in three months time, these are the issues we will be deliberating on.

"Where is the local health centre?"

Find attached this excellent piece by my friend; Kalu Aja on his dialogue with a new friend visiting our country. A must read! - posted here unedited, undiluted,... ENJOY!


In the papers today “the lost tribe of Taraba” was the editorial. The story says that a Christian missionary group, the Mission Light House Wukari, “discovered” a community of mountain dwelling people of Jibu. It is said that their condition is worse than the Koma people, they were completely naked, and drank water from a well that their animal drank from. They were “primitive” no less. hmmmm

Last year I had this expat friend whose son, Tom decided to come to Nigeria for a week, he came to explore and had an open mind. So I was detailed, (since we were of the same age) to take him around town. I went to pick up Tom at the house in Lekki. Nice enough chap, he quickly asked me, “where is the local health centre”? I need to get anti malaria shot Tom, I replied “we have none in Lekki, there are private clinics though”, No local clinics? "Well how do the guys who can’t afford private health care survive"? Tom asked, Well I replied “they pray, visit their herbalist or drink Agbo. Wow no health care!

I took him to Silverbird,( I wanted to show off with our mall). On the road were lots of potholes so Tom asked “why so many potholes? “Don’t the guys in this borough pay their taxes”?, suppressing a snigger I replied “Tom, first of; Nigerians don’t pay taxes, second if they even paid the tax, why should the LGA chairman fix a road? He needs to buy his L3 Landover first, then accumulate his re-election war chest, then after that maybe fill a few potholes” wow potholes!

Just as we were about to turn into Silverbird, an Okada rider slammed into our car, the “passenger” was thrown up into the air, “quick” Tom cried, “call 911, tall them to send an ambulance”. Where do I start? “Tom, first there is no 911 call centre, even if there was, I have no credit” , “ok” tom said, “where are the phone booths, there is usually a free emergency number”, sorry no public phone booths. Wow, no phone booths, no 911 emergency!

In the mall Tom said, “Kalu I need to get some D Banji tunes, where is the Apple media store”? Tom, we have no ITunes for Nigeria? Wow no ITunes! So we left Silverbird and I took him to go bowling (yes we have one) suddenly the lights went off, Tom dove under the desk, “Kalu quick, it’s an earthquake, the powers gone”. Dear me, “Tom see in Nigeria, power does tend to go out from time to time”, wow no constant power! Leaving the bowling alley we saw some mai ruwa (Hausa water sales men) pushing 25 liter jerry cans on a cart in Ikoyi. What’s that? Tom asked “well Tom, that water”, “for what?” he asked, Well the resident in Ikoyi buy it, but hang on Kalu Ikoyi is a high brow area yeah, you mean they don’t have running water in their homes? Yep. Wow no running water!

Tom peeped out and saw a sign saying “don’t urinate or defecate here, by Order” “Kalu he asked, is this like candid camera? would people actually “go” on a bridge? Where are the public toilets? Cant they just pull up at a gas station and go?” Well tom, actually there are public toilets for now”, wow no public toilets!

We then got stuck in traffic jam; “Kalu” Tom asked why are those buses on our lane? Tom I sad they are doing “one way” “so where are the traffic cops”? He asked, well they are over there collecting N20 form the okada guys”, “collecting bribes!” tom exclaimed? “Aren’t they scared the CCTV will catch them doing that”? Well there is no CCTV. Wow no Traffic Cops, no CCTV! The traffic jam was too bad, so Tom has a brainwave, “Kalu, park the car, then let’s get on the subway”, emm, “Tom there is no subway”, wow no subway!
I took Tom home, it was pretty late, so the OPC boys (security men) stopped us, Tom nearly has a hearth attack,” kalu they have machetes, hide”, “Tom theses are our security men”, “your security men?” Tom screamed “where are the police”? Well half are in Abuja with the politicians the other half are in Ekiti, I replied. Wow no police men doing beats.

I left tom feeling good about myself, we are developing now, I mean Lagos was wearing a new look, roads have been fixed, street and traffic light working, even BRT, we try jare, Eko o ni baje.Tom left the next day, last month I got a letter from him, reads as below

Dear Kalu,

I cannot thank you enough for being a tour guide to a helpless foreigner like myself. You know I told you I was a student, well I was studying anthropology, and I could not get material to write my thesis till I got to Nigeria.

My classmates went to Egypt to see the pyramids, other went to Rome to see the Coliseum, other to China to see the Great Wall, but providence brought me to Lagos, you see I “discovered” something new and it’s all because of you.
I discover a new type of humans, they have quite a lot of resources, but they can survive without, health care in their local governments, bad roads, no power, and no public transportation, no running water in their homes, no public toilets, no 911 emergency responder, no traffic police, no CCTV, they “go” on the streets without a care, hire private armies for security, worse of all, they have no ITunes. When I told my professor such a people existed he doubted at first but I showed him pictures. He was floored he, said it is impossible for people to live so “primitive”. My school has given me a junior fellowship, next month I am back in Nigeria to further study these unique people, I even hear there are better cities to study than Lagos, like Ekiti, Aba and Jigawa. I am so excited.

If I do this right, I could be in for a job with the Discovery Channel, wish me luck. I remain in your debt.

Your friend Tom


It’s our problem, we can fix it
Kalu