Wednesday, June 28, 2006

Revisiting Nigerian Health Indicators: Lessons Learnt from the Swedish Example

I am in Lagos at the moment. I traveled by road from Jos-a 12-hour journey. It was quite exhausting but it allowed me some time off my daily routine. I am not here entirely on vacation. My place of work cannot afford for me to do that. To the contrary, I am here to attend a workshop on reproductive health organized by the Faculty of Family Medicine of the National Postgraduate Medical College of Nigeria. It has been quite revealing, quite riveting!
We discussed several issues that bordered on the ways and means by which we can reduce maternal mortality and morbidity. Chairmen of Local Government Councils, officials of the Faculty of Family Medicine, among others, were present. Renowned, experienced university professors from Nigeria’s premier university were some of the facilitators. The workshop was participatory in approach. Issues such as the following were appraised:
Community obstetrics-its relevance in reducing maternal mortality in poorly urbanized settings,
Maternal mortality-its cause, effects and needed intervention,
High risk pregnancy
Puerperal sepsis
Breastfeeding
HIV issues in pregnancy
Hypertensive disorders in pregnancy
Contraception
During one of the sessions, one of the facilitators decried the state of medical record keeping in Nigeria as we could not agree on what the maternal mortality in Nigeria is.
The workshop, for me, has re-echoed the intrigue I wrote about in my last post (see below). By the way, I kept on coming back to that post to compare those figures. I am still amazed by the fact that Sweden, with a population of about 9 million people, spends more than 50 times what Nigeria spends on the health of about 130 million people. Perhaps it is more accurate to say that Sweden’s Total Health Expenditure as % of GDP is twice that of Nigeria. Here lies the difference-responsible governance. And the rest of the Swedish data speak for themselves.
Some may consider it cruel to compare Nigeria with Sweden. But there is no wisdom in doing otherwise. I would rather compare myself with those who are better than me. After all, Nigeria’s Fitch Rating is now BB minus, comparable to some countries that are doing well. The fact that Nigeria is rich in resources, the fact that Nigeria has paid off its debts to her creditors, the fact that Nigerians have got the resolve, among other things, is enough impetus. Jeffery Sachs, the acclaimed global economist and advisor to the United Nations’ Secretary-General is strongly of the opinion that resource-challenged countries have the capacity to initiate the process of change successfully even before the often needed support comes from donor countries. While canvassing for prudence and responsible governance by resource-limited communities, he encourages “big” countries to quickly help so as to achieve the MDGs as scheduled.
Developing countries should take a cue from the foregoing.

Friday, June 16, 2006

Nigerian Health Indicators: Intriguing!

I found the following Nigerian health indicators on the WHO’s website recently. I consider these very intriguing, very distressing. Take a look. You may leave a comment-perhaps you have a nostrum for Nigeria’s (and other resource-constrained countries) health problems.

Total population: 131,530,000
GDP per capita (Intl $, 2004): 1,085
Life expectancy at birth m/f (years): 45.0/46.0
Healthy life expectancy at birth m/f (years, 2002): 41.3/41.8
Child mortality m/f (per 1000): 198/195
Adult mortality m/f (per 1000): 513/478
Total health expenditure per capita (Intl $, 2003): 51
Total health expenditure as % of GDP (2003): 5.0
Figures are for 2004 unless indicated. Source: The world health report 2006

Compare these with Swedish statistics:

Total population: 9,041,000
GDP per capita (Intl $, 2004): 30,336
Life expectancy at birth m/f (years): 78.0/83.0
Healthy life expectancy at birth m/f (years, 2002): 71.9/74.8
Child mortality m/f (per 1000): 4/3
Adult mortality m/f (per 1000): 82/51
Total health expenditure per capita (Intl $, 2003): 2,704
Total health expenditure as % of GDP (2003): 9.4
Figures are for 2004 unless indicated. Source: The world health report 2006

What do you think?

Tuesday, June 13, 2006

As regards Nigerian Health Reforms

The Nigerian Government has finally decided to do something about the crisis in the healthcare system. I am sure they are haunted by the fact that the private sector provides 65.7% of healthcare delivery which in most part is unregulated, inaccessible and not affordable to the predominantly poor Nigerian populace.
Although there were a number of white papers on health policy reforms during the protracted, mediocre military era, there was total disconnect between policy formulation and implementation.
This present regime’s effort at revitalizing the Nigerian health system anchors its foundation on a certain health policy (the National Policy and Strategy to achieve health for all Nigerians) promulgated in 1988. This policy was revised by the present administration in 2004 and forms the platform for collaboration with several agencies for healthcare development, including the WHO.
There has been a number of consultations with several stakeholders with the ultimate aim of implementing the health strategies of the New Partnership for Africa Development (NEPAD), National Economic Empowerment and Development Strategy (NEEDS) and the Millennium Development Goals (MDGs) allowing primary healthcare to remain the fulcrum of sustained, equitable development by encouraging and strengthening Village Health Committees (VHCs) to mobilize community. The following are some of the policy thrusts of the reform agenda:
-National Health System and its Management
-National Healthcare’s Resources Management
-National Health Interventions and Services delivery
-National Health Information Systems
-Partnerships for Health Development
-Health Research and Healthcare Laws.
I do not want to appear pessimistic but there is need for total resolve by all concerned to translate all the above to improved health outcomes for the ordinary Nigerian.
I work as a physician in Nigeria and I experience firsthand the difficulties people face here when trying to obtain quality healthcare or any healthcare at all. Perhaps those experiences are for another post. But it can be very frustrating working in here because of inadequate capacity, among other limitations. You can not help many as you would want to. You cannot even help yourself! We simply toil on.

Wednesday, June 07, 2006

Of Poverty, Millenium Development Goals (MDGs) and Equity

There has been so much talk about the nexus between extreme poverty (as if poverty in 'mild' form is permissible) and health. It is a vicious cycle of poverty birthing ill health and vice-versa. Prior to the report of the WHO's Commission on Coordination of Macroeconomics and Health(CMH), it was popularly believed that wealth was the driver of health. It is now known that the reverse is the case-health drives poverty reduction.
The WHO's Coordination of Macroeconomics and Health Program aims to support countries to achieve the millenium development goals (MDGs) by encouraging National Ministries of Health focus on the poor by identifying cross sectoral strategies and cost effective options that will sustain improved health outcomes;
strengthen commitments to increased financial investment in health; and
minimize non financial constraints to the absorption of greater investments by increasing efficiency and effectiveness.
I am saddened by the fact that we have become so proficent in drafting policies and neologisms-for instance, Health for All by 2000, Vision 2010, (the list is endless)-without realizing these goals. There is no advantage in finger-pointing. These policies can work if all resolve to contribute to development.
Compare the 2 pictures. Both were taken in Nigeria, my country. There is so much disparity in the socioeconomic status of people here. Ofcourse, most live in conditions you find in the second picture. And it is true that Nigeria is rich in mineral resources.
It is not uncommon to find poverty and so much wealth existing side by side. Did you see Oprah's coverage of Katrina and CNN's coverage of living conditions of some in France?
Many do not crave for stupendous wealth: many simply desire basic, equitable means by which they can lead 'normal' lives.

Saturday, June 03, 2006

The Whole Systems View

It is absolutely imperative to approach healthcare development from the Whole Systems perspective: it is impossible to achieve sustainable development without this. Health systems do not exist in isolation. All other systems must work harmoniously, in synergy to ultimately improve our existence. We all want the better, brighter life. We cringe from human misery.
And we deserve to live well-in the best of health, in abundance, in a sustainable environment.
A lot of effort, no doubt, is needed to create an equitable society. But it is doable!
This picture of a malnourished child on her mother's lap was taken at the Yiriba Feeding Center in Awasa, 300km south of Addis Ababa,Ethiopia. This Center's initiative may not be considered an epic in the quest to undo humanity's misery but it is a step in the right direction. We stand guilty of negligence if we stand aloof, fold our arms and do nothing.