Let it be known from the outset that this discourse is not an attempt to fully elucidate the origins and subsequent evolution of Nigeria’s health system. Such a comprehensive undertaking is beyond the limit of this post. This chronicle of events is intended to rouse that idling quest for improved health outcomes especially as it relates to primary healthcare development, first in Nigeria, and then, in the rest of the developing world.
Nigeria was colonized by Britain. Nigeria had no formalized planned health services until the end of the Second World War. Before the war, provision of health services was by the British Army Medical Services. The subsequent integration of the British Army and the colonial government gave birth to the Colonial Medical Service. The Colonial Medical Service provided free health services only to the British Army and the colonial service officers. Nigerians at that time only benefited incidentally. Nigerians were served primarily by a handful of mission and private hospitals sparsely scattered throughout the country.
In 1946, the colonial government promulgated a ten-year National Development and Welfare Plan. There was no separate national health policy at that time but the ten-year plan integrated all aspects of government endeavors, including health activities. The euphoria of independence, the devastation of the Nigerian civil war and the nuances of neocolonialism distracted Nigerian leaders after the expiration of the First National Development Plan. It was not until 1970 and 1975 respectively that the Second and Third National Development Plans were birthed. Although these subsequent development plans did not address the specific issue of a national health policy, the Basic Health Service Scheme evolved as part of the Third National Development Plan. The scheme attempted to put the semblance of a primary healthcare service in place. The scheme had the following objectives:
1. To increase coverage from 25 to 60 percent of the population receiving healthcare;
2. To correct the imbalance between preventive and curative medicine and in the distribution and location of health institutions;
3. To provide the infrastructures for all preventive health programs such as family health, environmental health, nutrition and control of communicable diseases; and
4. To establish a healthcare system best adapted to the local conditions and to the level of health technology.
The first national health policy was promulgated in 1988. The health policy content of the Fourth National Development Plan was in harmony with the first national health policy. At that time, the feverish agitation for Health for All by 2000 was at its peak worldwide. It was not surprising that the first national health policy set out to achieve health for all by 2000 through emphasis on primary health care.
At the moment, Nigeria has a three tier system of government comprising of local, state and federal governments. The Federal government at the center oversees the 36 State governments (and the Federal Capital Territory) and 776 Local Government Areas. The Local Government Areas are equivalents of districts in other countries. Each tier of government has its responsibility thus: the Federal Government oversees all health activities in addition to taking care of tertiary level healthcare at the Teaching Hospitals and Federal Medical Centers; the State Governments supervise health activities at the Local Government level and is solely responsible for secondary healthcare at the General Hospitals; and the implementation of primary healthcare has been devolved to Local Governments. The primary healthcare system is the first point of contact with the healthcare grid. The primary healthcare system in Nigeria is meant to ensure the:
1. Provision and maintenance of health infrastructure;
2. Planning and implementation of strategies to meet community health needs;
3. Provision of the ten primary healthcare components to the community;
4. Training of personnel and logistic support for community mobilization and participation; and
5. Management of health information system.
It should suffice to state that the Local Governments are presently ill-equipped to dispense the much needed primary health care to millions of Nigerians. In other developing countries, this bottom-up primary healthcare approach has successfully improved health outcomes.
Is it out of place to suggest that the government at the center should pay more attention to primary healthcare? Is it not true that the Federal Government has the most resources? Has it not been proven that improved primary healthcare delivery equates improved national health indices? Did Paul Farmer and colleagues not establish that sustainable quality healthcare delivery is possible even in resource-poor settings? Is it not true that most African governments scorn the promise to commit 15% of their budgets to health as contained in the Abuja Declaration? Have wealthy countries complied with the United Nations target of raising overseas official development assistance to 0.7% of their gross national product? Are the patents on medicines by developed economies not adversely affecting primary healthcare development in resource-poor settings? And is it not true that certain policy prescriptions by world bodies such as the World Bank and the IMF deter increased investments in primary healthcare?
These questions beg for answers.
Monday, August 11, 2008
Friday, March 07, 2008
Resolutions of the 51st National Coucil on Health Meeting: Further Responses
As I write this post, the United Nations Economic Commission for Africa in conjunction with the African Union is holding a conference dubbed "Science with Africa" in Addis Ababa, Ethiopia. This conference aims to bring to the forefront the indispensable link between science, innovation, research and sustainable growth in Africa. Asclepius, responding to an earlier discourse about the efficacy of Nicosan in sickle cell anemia sends an abstract of a clinical trial presented at this conference. I reproduce this below.
Evaluation of Niprisan (Herbal Medicine) for the Management of Sickle Cell
Anaemia
Charles Wambebe and Hadiza Khamofu, International Biomedical Research in Africa, Abuja, Nigeria, wambebe@yahoo.com, Joseph Okogun, Nathan Nasipuri and Karynius Gamaniel, National Institute for Pharmaceutical Research and Development, Abuja, Nigeria.
About 70% of all sickle cell anemia (SCA) subjects reside in Africa, estimated at over 12 million. The prevalence of SCA is estimated at over 2% while infant mortality is about 8% and survival rate of SCA babies in rural areas by five years of age is about 20%. These statistics indicate that SCA is probably the most neglected (and sometimes forgotten by health authorities) serious public health disorder with serious mortality and morbidity rates in Africa. The objective was to undertake pre-clinical and clinical assessments of a herbal extract vis-à-vis management of sickle cell anemia using Good Laboratory Practice and Good Clinical Practice principles respectively. In Africa, there is no standard treatment for sickle cell anemia, only palliative management is generally available. In view of this situation, most SCA subjects use herbal medicines. NIPRISAN is a standardized extract from four medicinal/food plants: Piper guineenses seeds, Pterocarpus osun stem, Eugenia caryophyllum fruit and Sorghum bicolor leaves. Short term toxicity study indicated that NIPRISAN was safe in laboratory animals. Bio-activity guided fractionation show that vanillin and aromatic aldehydes may be the bioactive moieties. NIPRISAN reversed sickled red blood cells and protected them from being sickled when exposed to low oxygen tension. NIPRISAN dose- dependently delayed polymer formation of haemoglobin S. NIPRISAN induced 85% increased solubility of deoxy haemoglobin S. The in vivo efficacy study was undertaken at Children Hospital of Philadelphia, USA. Histological examination of lungs of control Tg transgenic mice carrying human sickle haemoglobin showed entrapment of massive numbers
of sickled cells in alveolar capillaries. NIPRISAN significantly cleared the lungs of sickled cells. Furthermore, NIPRISAN induced profound effect on the survival time of Tg mice under hypoxic conditions (p<0.0001). The phase II clinical data indicated that all the subjects benefited from NIPRISAN with no serious adverse effect. About 80% of the subjects did not experience any crisis during the study (12 months). The subjects experienced significant reduction in hospital admission while attendance at school profoundly increased. Furthermore, there was no evidence of kidney or liver damage. NIPRISAN has been patented, licensed to an American company, registered and being manufactured at Abuja for global market.
Evaluation of Niprisan (Herbal Medicine) for the Management of Sickle Cell
Anaemia
Charles Wambebe and Hadiza Khamofu, International Biomedical Research in Africa, Abuja, Nigeria, wambebe@yahoo.com, Joseph Okogun, Nathan Nasipuri and Karynius Gamaniel, National Institute for Pharmaceutical Research and Development, Abuja, Nigeria.
About 70% of all sickle cell anemia (SCA) subjects reside in Africa, estimated at over 12 million. The prevalence of SCA is estimated at over 2% while infant mortality is about 8% and survival rate of SCA babies in rural areas by five years of age is about 20%. These statistics indicate that SCA is probably the most neglected (and sometimes forgotten by health authorities) serious public health disorder with serious mortality and morbidity rates in Africa. The objective was to undertake pre-clinical and clinical assessments of a herbal extract vis-à-vis management of sickle cell anemia using Good Laboratory Practice and Good Clinical Practice principles respectively. In Africa, there is no standard treatment for sickle cell anemia, only palliative management is generally available. In view of this situation, most SCA subjects use herbal medicines. NIPRISAN is a standardized extract from four medicinal/food plants: Piper guineenses seeds, Pterocarpus osun stem, Eugenia caryophyllum fruit and Sorghum bicolor leaves. Short term toxicity study indicated that NIPRISAN was safe in laboratory animals. Bio-activity guided fractionation show that vanillin and aromatic aldehydes may be the bioactive moieties. NIPRISAN reversed sickled red blood cells and protected them from being sickled when exposed to low oxygen tension. NIPRISAN dose- dependently delayed polymer formation of haemoglobin S. NIPRISAN induced 85% increased solubility of deoxy haemoglobin S. The in vivo efficacy study was undertaken at Children Hospital of Philadelphia, USA. Histological examination of lungs of control Tg transgenic mice carrying human sickle haemoglobin showed entrapment of massive numbers
of sickled cells in alveolar capillaries. NIPRISAN significantly cleared the lungs of sickled cells. Furthermore, NIPRISAN induced profound effect on the survival time of Tg mice under hypoxic conditions (p<0.0001). The phase II clinical data indicated that all the subjects benefited from NIPRISAN with no serious adverse effect. About 80% of the subjects did not experience any crisis during the study (12 months). The subjects experienced significant reduction in hospital admission while attendance at school profoundly increased. Furthermore, there was no evidence of kidney or liver damage. NIPRISAN has been patented, licensed to an American company, registered and being manufactured at Abuja for global market.
Friday, February 08, 2008
Resolutions of the 51st National Council on Health Meeting: Responses
I have had a number of responses since I published the last post. The response below is from one aggrieved anonymous writer. Please read.
Dear Doctor,
why do you think it is at a conference so vital to the health of Nigeria that the development and use of Nicosan for sickle cell anemia is not even mentioned at this meeting?Here we have a drug that was developed by the Nigerian government and approved by NAFDAC but absolutely no urgency about getting it to the people who need it.The single mention of sickle cell comes with the only focus being the need for vaccinations in those people afflicted for influenza. Granted those people are at risk due to their physical state but that would not be the case if they were being treated with Nicosan.If Nicosan can return 50% of sickled cells to normal, improve the patient's health and end sickle cell crises would it not stand to reason that their health would be improved enough that they would not be at high risk for influenza?Why is the government not focusing on the distribution of a drug the Nigerian people have paid to develop and is good enough to be granted orphan drug status by the FDA and EU?What is wrong with Nigeria that almost 20 months after the approval of the drug that the government has yet to do anything about making this treatment available to the more than 4 million Nigerians who need it?The vast majority of deaths in childern under the age of 5 years born with sickle cell is not from influenza but from the genetic disease process itself. Focusing on influenza vaccines brought in from foreign countries vs treating the disease state itself with the indigenous drug Nicosan just doesn't make sense. If this is the approach Nigeria plans to take to meet it's Millinium goals of 2012 I am fairly confident they will fail. One of the most effective ways for Nigeria to reduce it's infant/maternal death rate would be to subsidize Nicosan distribution. So what's the government really doing when it chooses to support initiatives that preclude utilizing treatments that public monies have been spent to develop in favor of tertiary prophylactics like vaccinations? Vaccinations are not substitute for health. Prevention of infection does not come close to the benefits of treating the root cause of ill health. The Nigerian people should rise up and ask the government where the drug their tax dollars created is for them!
Posted by Anonymous to AdvocateHealth! at 4:47 AM
Dear Doctor,
why do you think it is at a conference so vital to the health of Nigeria that the development and use of Nicosan for sickle cell anemia is not even mentioned at this meeting?Here we have a drug that was developed by the Nigerian government and approved by NAFDAC but absolutely no urgency about getting it to the people who need it.The single mention of sickle cell comes with the only focus being the need for vaccinations in those people afflicted for influenza. Granted those people are at risk due to their physical state but that would not be the case if they were being treated with Nicosan.If Nicosan can return 50% of sickled cells to normal, improve the patient's health and end sickle cell crises would it not stand to reason that their health would be improved enough that they would not be at high risk for influenza?Why is the government not focusing on the distribution of a drug the Nigerian people have paid to develop and is good enough to be granted orphan drug status by the FDA and EU?What is wrong with Nigeria that almost 20 months after the approval of the drug that the government has yet to do anything about making this treatment available to the more than 4 million Nigerians who need it?The vast majority of deaths in childern under the age of 5 years born with sickle cell is not from influenza but from the genetic disease process itself. Focusing on influenza vaccines brought in from foreign countries vs treating the disease state itself with the indigenous drug Nicosan just doesn't make sense. If this is the approach Nigeria plans to take to meet it's Millinium goals of 2012 I am fairly confident they will fail. One of the most effective ways for Nigeria to reduce it's infant/maternal death rate would be to subsidize Nicosan distribution. So what's the government really doing when it chooses to support initiatives that preclude utilizing treatments that public monies have been spent to develop in favor of tertiary prophylactics like vaccinations? Vaccinations are not substitute for health. Prevention of infection does not come close to the benefits of treating the root cause of ill health. The Nigerian people should rise up and ask the government where the drug their tax dollars created is for them!
Posted by Anonymous to AdvocateHealth! at 4:47 AM
Tuesday, February 05, 2008
Resolutions of the 51st Nigerian National Council on Health Meeting
The 51st Nigerian National Council on Health Meeting held recently in Lagos. Council members came up with important resolutions which will guide health activities in 2008. Since this is an all important 10-page document, this post is devoted to making it available to all.
51st National Council on Health Meeting
Held at Planet One Entertainment Centre, Mobolaji Bank Anthony Way,
Ikeja, Lagos State, 21 – 23 November 2007
COUNCIL RESOLUTIONS
The 51st regular National Council on Health (NCH) meeting was held at the Planet One Entertainment Centre, Mobolaji Bank Anthony Way, Ikeja, Lagos State, 21 – 23 November 2007. A total of 732 delegates participated, from the Federal Ministry of Health and its Parastatals, State Ministries of Health and the Health & Human Services Secretariat of the Federal Capital Territory Administration(FCTA); and Development Partner Agencies which included WHO, UNICEF, DFID, the World Bank, AfDB, the Carter Centre. Delegates from the Health Regulatory Bodies, Military and Para-Military organizations also participated. The delegations from the Federal Ministry of Health, State Ministries of Health and the Health & Human Services Secretariat of the FCTA were led by the Honourable Ministers of Health, the Commissioners for Health and the Secretary, Health & Human Services Secretariat of the FCTA respectively.
2. The Council meeting was preceded by a two-day Technical Session held at the Aquatic Hall, Water Parks, Ikeja, Lagos State. It was chaired by the Coordinator, National Tertiary Hospitals Commission- Dr. Shehu Sule mni, who represented the Permanent Secretary, Federal Ministry of Health. The Technical Session was declared open by the Honourable Commissioner for Health, Lagos State.
3. The 51st meeting of the National Council on Health was declared open by His Excellency, the Executive Governor of Lagos State, Mr. Babatunde Raji Fasola SAN, who was ably represented by the Deputy Governor, Her Excellency Princess Sarah Adebisi Sosan. The Governor welcomed the Honourable Ministers, the Honourable Commissioners and the entire delegations to the NCH and expressed his appreciation, on behalf of the good people of Lagos State, for the opportunity given the State to host this most important meeting. He emphasized the importance of the National Council on Health Meeting to health development in Nigeria and restated the commitment of the Lagos State government to the attainment of the MDGs.
4. The Council meeting was presided over by the Honourable Minister of Health (HMH), Professor Adenike Grange. She welcomed the Council members and other delegates to the 51st National Council on Health meeting and expressed her pleasure at chairing the first meeting of the Council since assuming office. The Honourable Minister’s address focused on intimating Council with the vision and mission of her administration as well as obtaining the inputs and commitments of the Council members towards achieving the goal of “creating wealth through health” in line with the 7- point agenda of President Umaru Musa Yar’Adua that places a high premium on using Health and Education as the twin engine that drives national development by developing human capital.
5. The HMH in her address restated the strong commitment of the present administration to making Nigeria one of the top 20 economies in the world by 2020. This potential commitment has been buttressed by Goldman Sach’s team of global economists who identified Nigeria as having the potential to become one of the top eleven (11) economies in the world by 2020. She stated that although this goal was a laudable one, the poor health status of the people by whom the transformation would take place could impede its attainment.
6. The address also highlighted the fact that despite the existence of several effective and affordable technologies and interventions, gaps in health outcomes continue to widen due to a defective national health system. This situation continues to serve as an impediment to the achievement of the Millennium Development Goals (MDGs). Therefore, it is imperative to reposition and strengthen the weak and fragile health system to be able to deliver the services and high quality of care to those who need them in a timely manner, thus meeting the expectations of both the populace and healthcare workers.
7. The HMH recalled various reform programmes that had been commenced in the past leading to the development of several policies and strategic frameworks for various projects and programmes. However, these programmes have frequently not met their stated objectives due to inadequate emphasis on implementation, monitoring and evaluation. Hence the resolve of her administration to focus on the implementation of the developed policies and institutionalisation of mechanisms for monitoring and evaluation.
8. Other problems identified by the HMH include the loss of confidence in the primary health care sub-system and indeed the entire public health care system; obsolete or absent equipment and infrastructure; inadequate capacity of healthcare staff and training institutions; lack of a coordinated procurement and logistics system; lack of quality assurance or regulatory mechanisms for quality control; weak health information management systems; poor integration of health service delivery; and an almost non-existent referral system. She also reiterated the poor health and human development indices in the country and the threat these posed to the attainment of the MDGs.
9. The HMH solicited for the commitment of the Council members in the implementation of the National Health Investment Plan (NHIP) as a strategic approach to building consensus at all levels for the actualization of the Ministry’s vision. The NHIP will be implemented through six independent but related investment strategies which are: ensuring adequacy of policy instruments; resource mobilization and management; integrated disease management programmes; referral system and tertiary care development; increased surveillance; and full implementation of health insurance schemes.
10. She concluded her address by positing that greater investment in the health sector and more efficient and equitable use of resources are essential for national development. She appealed for greater collaboration between all tiers of government in the delivery of quality health services; and between policy-makers and technocrats in order to sustain the reforms while also suggesting to States to establish Primary Health Care Development Agencies to improve the delivery of primary health care.
11. The Honourable Minister of State for Health (HMSH), Arc. Gabriel Yakubu Aduku OON welcomed delegates to the 51st NCH meeting. He lamented the poor health indices of the country and opined that most of the causes of morbidity and mortality in the country could be effectively addressed at the primary health care level. The HMSH also seized the opportunity to once again buttress the seven (7) point development agenda of the present administration and especially Mr. President’s commitment to accelerating the achievement of the MDGs and improving the performance of the National Health System to one that is more adequately responsive to the health care needs of the people thereby enabling Nigerians live more economically productive lives.
12. HMSH therefore solicited for the support of the States in the translation of policies into actions and appealed for stronger commitment and a renewed synergy/partnership among stakeholders in the attainment of the MDGs. He concluded his address by charging all stakeholders in the health sector to join in the fight to eradicate malaria which has continued to be the leading cause of deaths among under-5 children as it is preventable and curable. He wished the Council fruitful deliberations.
13. In his address, the Honourable Commissioner for Health, Lagos State, Dr. Jide Idris, welcomed the Honourable Ministers, the Hon. Commissioners and all delegates to Lagos. He expressed his pleasure and that of the State for the opportunity granted them to host the 51st meeting of the National Council on Health. He emphasized the importance of effective health care to better health and the general development goals of a nation and hence the importance of the Council meeting where decisions at the Technical Committee meeting are analyzed for their merit before balanced policy decisions are arrived at for implementation.
14. The Honourable Commissioner went on to assert that due to the enormous resources required for the provision of effective health services, it was necessary for all tiers of government to be committed to investing heavily in health. He continued his speech by restating the commitment of the Lagos State Government led by His Excellency Mr. Babatunde Raji Fasola SAN the Executive Governor of Lagos State, to invest in infrastructure, human resources for health, provide adequate funding for the health sector, create systems, urgently address the issue of Maternal and Child Health as well as educate the public adequately. Lastly, on behalf of the State, he thanked all those present at the meeting and encouraged delegates to feel free to move around the State to see the different places of interest.
15. At the end of the opening ceremony, the vote of thanks was delivered by the Coordinator, National Tertiary Hospitals Commission, Dr. Shehu Sule mni, on behalf of the Permanent Secretary of the Federal Ministry of Health. He thanked the State Government and the people of Lagos State for the warm welcome and hospitality accorded all the delegates since their arrival in the State. This has no doubt encouraged the high quality of participation of the delegates in the meeting and would lead to the achievement of the purpose and objectives of the meeting.
16. After the opening ceremony, there were presentations on:
· Sector-wide, System-wide Implementation of PHC in Nigeria
By Dr. Kwame Adogboba
· The National Health Investment Plan and the role of States and LGAs in its implementation by Professor Adenike Grange, Honourable Minister of Health/Dr. Kenneth Ojo/Dr. Anthony Seddoh/Professor Wilfred Iyiegbuniwe
· Final Onslaught on Malaria in Nigeria by Dr. Yemi Sofola/Professor Kio Don-Pedro
· The Role of States Global Fund for AIDS, Tuberculosis & Malaria (GFATM) Activities by Professor Babatunde, DG,NACA
· Policy and Programme Implementation, Monitoring & Evaluation at Federal, State and LGA levels by Dr. Dan Onyeje; and
· Sector-wide Quick Wins and Indicators by Dr. Margaret Mafe
The presentation on Sector-wide, System-wide Implementation of PHC was followed by group discussions on various issues in the implementation of PHC. The following decisions were arrived at following the discussions:
· The need for the establishment of an agency in the health sector of the states that would be responsible for coordinating and facilitating the implementation of PHC;
· Integration of primary and secondary health care services with emphasis on decentralization of management;
· There should be pooling of funds from Federal, State and LGAs into “State Health Fund” for enhancing the management of health systems;
· The need to define and clarify the roles and responsibilities of governments and other stakeholders in the implementation of PHC;
· Promoting the implementation of the existing Public Private Partnership policy in health in Nigeria; and
· The establishment of a better and effective monitoring and evaluation system to monitor the performance of the health system at the state level
Council session was conducted in Plenary to deal mainly with the following:
i. Consideration and adoption of the Proceedings of the 50th National Council on Health (NCH/51/001) as amended.
ii. Report on the Implementation of Resolutions of the 50th NCH Meeting (NCH/51/002). Council noted the various stages of implementation of the 50th NCH meeting resolutions at the Federal and State levels and encouraged States to show more commitment by ensuring greater implementation of resolutions adopted at Council meetings. This could offer an opportunity for peer review and experience sharing.
iii. The recommendations of the Technical Committee which had earlier met on 19-20 November were reviewed.
17. After extensive and interactive deliberations, the National Council on Health approved the following resolutions:
PUBLIC/PRIVATE PARTNERSHIP FOR HEALTH
18. Council, noting the various efforts made by States in the implementation of Public-Private Partnership initiatives in the health sector as contained in the related Memoranda, commended the States that have started and encouraged all States to continue to explore the comparative advantage of PPP in health care delivery within the context of the National Policy on Public Private Partnership in Health.
STRENGTHENING PRIMARY HEALTH CARE SERVICES
19. Council, noting the critical importance of the PHC system in delivering quality health care to a large majority of Nigerians and the possibility of treating many of the leading causes of death at this level, appealed to States to establish State Primary Health Care Development Agencies as a strategy for enhancing the implementation of the PHC programme in their domains. The State PHCDAs could also serve as units for promoting, organizing and managing Public-Private Partnership initiatives in health in the States.
20. Council, noting the consistently poor health indices in the country, in particular, maternal, newborn and child health indices; and the inadequate human resource for health especially at the Primary Health Care level, approved the establishment of a Midwifery Corp Scheme for both basic and post-basic midwives to serve a compulsory one (1) year national youth service in the rural areas. Similarly, Council approved the compulsory posting of NYSC doctors to primary health care centres in the rural areas as a means of providing the necessary human resources for health at the primary health care level. Appropriate ancillary training in Life Saving Skills and Extended Life Saving Skills will be provided. The Council agreed on shared responsibilities between the three (3) tiers of government.
21. Council also approved the provision by the Federal Government of Midwifery Kits in Primary Health Care Centres for use by the midwives.
22. Noting the need to increase access to health care universally, Council approved the adoption of the Ward Minimum Health Care Package as a basis for the prioritization of health interventions, strategic and operational planning, budgeting, advocacy and resource mobilization by all stakeholders.
23. While noting the status of implementation of the construction and utilisation of model primary health care centres across the country Council appealed for better consultation with States, LGAs and Communities when siting PHCs.
STRENGTHENING SECONDARY HEALTH CARE SERVICES
24. Noting the poor quality of health care in the country, Council approved that a complete audit of the health care delivery system in all the States of the Federation should be undertaken with a view to identifying any weaknesses in the quality of care and implementing changes that may be required to assure high quality health delivery.
25. Council also approved the setting up of appropriate machinery for monitoring the provision of quality health care for Nigerians and encouraged States to develop friendly guidelines enshrining patients’ preference for the various outcomes with adequate budgetary provision for the implementation of these programmes.
26. Council noted and commended the construction of new and refurbishment of existing General Hospitals in Anambra State and the subsequent accreditation of these facilities for internship training by the relevant professional regulatory bodies.
FOOD AND DRUG ISSUES
27. Aware of the importance of availability of safe, qualitative and efficacious medicines for the effective functioning of any modern healthcare system; recognizing that lack of access to safe quality and affordable medicines is a major constraint to quality health care; realizing that lack of access to safe and affordable drugs has resulted in complications and even deaths; and considering that this situation cannot be allowed to continue if we are to achieve the MDGs:
28. Council considered a draft resolution which stated that “Council reviewed the drug distribution system in the country and noted that the system is still largely poorly coordinated leading to the proliferation of fake, sub-standard and unregistered drugs with its associated risks and therefore approved the establishment of legal drug distribution centres in all States and the FCT. Council further approved the government financing of the proposed nationwide assessment of government warehouses for lease or rent to the private sector for drug distribution.”. After deliberations, it was decided that the issues entailed required more consultations before consensual decisions could be reached. The draft resolution was thus stepped down.
29. While noting that one of the goals of the National Drug Policy is to stimulate increased local production of essential drugs as well as ARVs and ACTs and the target to produce 70% of national drug needs by 2008, Council approved government’s financing of the proposed nationwide assessment of the capacities of local drug manufacturing industries in order to derive current data on local drug production.
30. Also, in a bid to boost local drug production, Council made a commitment to resist pressure to lift the ban on drugs listed on the 2005 import prohibition list and to upgrade the list based on data that would be generated from the nationwide drug production assessment exercise. Council would also revisit the issue of high tariffs on imported pharmaceutical raw materials while considering other incentives for local drug manufacturing companies.
31. Council noted the benefits of an effective drug revolving fund scheme and commended States in which such schemes have been functioning and sustained while encouraging other States to replicate the schemes.
MATERNAL, NEONATAL AND CHILD HEALTH
32. Council noted with concern the rather slow progress made towards reducing maternal, newborn and child mortality midway to the target year for the attainment of the MDGs, due to poor access to high impact, evidence-based, cost effective interventions and approved the adoption of the Integrated, Maternal, Newborn and Child Health (IMNCH) Strategy developed by the Federal Ministry of Health and partners as a strategy to promote a more holistic, comprehensive, integrated approach to maternal, newborn and child health issues and services as well as the accelerated scaling-up of programmes to reach the target groups.
33. Noting the issues and programmes affecting the health of the mother and child and all the efforts made by the federal and state authorities as contained in the related memoranda, Council commended states for their efforts to improve the health status of women and children and to reduce morbidity and mortality indices among them; however, Council encouraged them to integrate these services in order to maximize the utilization of available resources and achieve the greatest possible impact on the health of the people.
34. Taking cognizance of the proven benefits of Misoprostol in the control of post partum haemorrhage; its ease of administration and relatively few dose-dependent side effects, Council approved the inclusion of Misoprostol in the essential drugs list as part of efforts to reduce maternal morbidity and mortality.
35. Council reviewed and adopted the final draft of “Gender-Based Violence in Nigeria: National Guidelines on Prevention and Response” and encouraged all States and the FCT to approve, adopt and implement the recommended strategies.
36. Re-emphasizing the benefits of exclusive breast-feeding for newborns and taking cognizance of the challenges posed to working mothers in implementing the strategy, Council encouraged all workplaces in Nigeria to provide well equipped and staffed crèches for their female employees as these could also be very important catchment sites for routine immunization. Council also encouraged the Ministries of Health, Women Affairs and Labour & Productivity to work together to plan and implement reproductive health education and counseling programmes for women workers.
DISEASE CONTROL
40. Concerned about the increasing magnitude and public health importance of noncommunicable diseases(NCDs) and their risk factors; the absence of programmes focusing on NCD control in the states, and the need to scale up NCD prevention and lifestyle and behavior change campaigns to check the increasing burden of NCDs; Council resolved that all states should as matter of priority, establish or strengthen and fund appropriately an integrated NCD prevention and control programme in the state and LGAs, coupled with the designation of a state focal point for NCD control. The FMOH will provide technical support to improve state capacities in the development, implementation, monitoring and evaluation of NCD programmes.
41. Acknowledging that blindness is a major cause of unnecessary human suffering, often leading to poverty, social exclusion and early death; and aware of the poor coordination of the commendable work undertaken by voluntary/ non governmental Organizations (NGOs) in the control of blindness in Nigeria, Council resolved and approved that the National Vision 2020 Strategic Plan be adopted as a policy document for implementation at the tertiary, secondary and primary levels of health care services, for elimination of the main causes of avoidable blindness by the year 2020. All the Governments should develop 5 year action plans for Eye Care Services within the context of the National Vision 2020 framework and strengthen inter-sectoral collaboration in the implementation of these plans.
42. Committed to the plan to eradicate Guineaworm by December 2008; noting the need for improved budgetary allocation and timely disbursement of funds required at the LGA, State and Federal levels and the need to intensify surveillance activities for the successful implementation of the last phase of guineaworm eradication; Council resolved that action should be accelerated by all tiers of government and all relevant agencies in the provision of safe water especially in the rural communities; recommended the intensification of Community Participatory Surveillance Strategy; and integration of guineaworm surveillance activities with other grassroot health programmes
43. Concerned about the plight of sickle cell patients and Nigerian children who are both plagued by Pneumococcal and Hib infections; noting that safe effective Haemophilus Influenza type B (Hib) and Pneumococcal Vaccines are available and already being used effectively in our neighboring countries, Council approved that the Federal Ministry of Health works out ways to provide the vaccines for use in the country starting with sickle cell patients who need them most.
HIV/AIDS
44. Council noted the, and commended the National HIV/AIDS and STI Control Programme, for the successes achieved in previous sentinel surveys and the States for their efforts in the control of HIV/AIDS.
45. Further noting the importance of HIV/AIDS sentinel surveys in the determination of prevalence and distribution of HIV infection, sensitization of stakeholders to take appropriate action in prevention and control of the epidemic, planning, implementation and monitoring of HIV/AIDS programme and also for assessing the overall impact of the interventions by stakeholders in the control of HIV infection; Council recommended that the Federal Ministry of Health should facilitate easier access to World Bank’s credit funds and states should make available sufficient budgetary provisions to ensure that they can play agreed roles in the conduct of 2007 survey and future surveys.
MALARIA
46. Recognizing that malaria still remains a major cause of morbidity and mortality especially amongst children and pregnant mothers; considering the limitations of our past efforts towards the elimination of malaria; and realizing the need to accelerate the elimination/eradication of malaria in Nigeria through the implementation of an integrated approach which should include Integrated Vector Management (IVM) strategy; Council resolved that all governments should embrace the new approach for malaria control/elimination/eradication which is the integration of the RBM (Roll Back Malaria) and IVM interventions, and adopt year 2015 as the target year for the total elimination of malaria from Nigeria
HUMAN RESOURCE MANAGEMENT
47. Council noted the dynamic nature of medical knowledge and practice and thus the need for every medical officer to be exposed to new knowledge and discoveries in his/her area of specialization in order to assure the quality of healthcare delivery; and recommended that all Governments should support continuous professional development of all healthcare workers; and MDCN should promote and make efforts to institutionalize continuous professional development (CPD) as a pre-requisite for registration and licensing.
48. Council deliberated extensively and agreed on the effect of variations in salaries paid to health workers across the country on their motivation and efficiency of the healthcare delivery system. Council resolved that a forum should be set up by the FMoH and States to deliberate and agree on a harmonised salary scale for health workers in order to address this problem.
49. Council appreciated the proposed National Health Investment Plan and recommended that the Federal Ministry of Health plays the leading role in its development while states and all other relevant stakeholders would participate and cooperate as appropriate . Some of the expected outcomes of the implementation of the National Health Investment Plan will be to: increase political support for increased budgetary allocation to health and other health investments; enhance coordination and efficiency in the use of donor assistance; develop and implement comprehensive strategies for achieving effectiveness, efficiency and equity of the health sector; provide a basis for better result-oriented budgeting in the health sector; ensure the efficient and equitable utilisation of available health resources; provide an objective framework for monitoring and evaluating the health sector; and improve the overall functioning of the health system for national development.
INFORMATION MEMORANDA
50. A total of seventeen information memoranda were considered by Council. Further to receiving and deliberating on them, Council commended and noted all the memoranda. The information memoranda are:
· Development of National Health Investment Plan
· Establishment of the National Tertiary Hospitals Commission (NTHC)
· Establishment of the National Centre for Disease Control (NCDC)
· International Health Regulations (IHR) 2005
· The Establishment of Field Epidemiology and Laboratory Training Programme (FELTP) in Nigeria
· Traditional Medicine Development
· Presidential Committee on Pharmaceutical Sector Reform
· National Chemical Safety Management in the Health Sector
· National Drug Fomulary/Essential Drugs List (NDF/EDL) Review Committee/Secretariat-DFDS
· Progress Report on National Food Risk Analysis Centre in NAFDAC
· Baseline Study carried out by NAFDAC on the quality of Medicine in circulation in Nigeria
· Progress Report on the Health Systems Development Project II
· NHIS the Journey so far as at October, 2007
· Establishment of Functional Traditional Medicine Boards
· Anambra State Community Health System and Health Financing Scheme
· Dutch Government-assisted Community Health Insurance Scheme in Kwara State SHONGA, BACITA, PILOT STUDY/SCHEME
· The Lagos State Health Facilities Monitoring & Accreditation, Journey so far
· Avian Influenza Control and Human Pandemic Preparedness and Response in Nigeria
51. The 52nd National Council on Health meeting is scheduled to hold in Kano State in May, 2008.
52. The 51st National Council on Health meeting was declared closed by the Honourable Minister of Health, Professor Adenike Grange at 2.17 p.m. on Friday 23 November 2007.
51st National Council on Health Meeting
Held at Planet One Entertainment Centre, Mobolaji Bank Anthony Way,
Ikeja, Lagos State, 21 – 23 November 2007
COUNCIL RESOLUTIONS
The 51st regular National Council on Health (NCH) meeting was held at the Planet One Entertainment Centre, Mobolaji Bank Anthony Way, Ikeja, Lagos State, 21 – 23 November 2007. A total of 732 delegates participated, from the Federal Ministry of Health and its Parastatals, State Ministries of Health and the Health & Human Services Secretariat of the Federal Capital Territory Administration(FCTA); and Development Partner Agencies which included WHO, UNICEF, DFID, the World Bank, AfDB, the Carter Centre. Delegates from the Health Regulatory Bodies, Military and Para-Military organizations also participated. The delegations from the Federal Ministry of Health, State Ministries of Health and the Health & Human Services Secretariat of the FCTA were led by the Honourable Ministers of Health, the Commissioners for Health and the Secretary, Health & Human Services Secretariat of the FCTA respectively.
2. The Council meeting was preceded by a two-day Technical Session held at the Aquatic Hall, Water Parks, Ikeja, Lagos State. It was chaired by the Coordinator, National Tertiary Hospitals Commission- Dr. Shehu Sule mni, who represented the Permanent Secretary, Federal Ministry of Health. The Technical Session was declared open by the Honourable Commissioner for Health, Lagos State.
3. The 51st meeting of the National Council on Health was declared open by His Excellency, the Executive Governor of Lagos State, Mr. Babatunde Raji Fasola SAN, who was ably represented by the Deputy Governor, Her Excellency Princess Sarah Adebisi Sosan. The Governor welcomed the Honourable Ministers, the Honourable Commissioners and the entire delegations to the NCH and expressed his appreciation, on behalf of the good people of Lagos State, for the opportunity given the State to host this most important meeting. He emphasized the importance of the National Council on Health Meeting to health development in Nigeria and restated the commitment of the Lagos State government to the attainment of the MDGs.
4. The Council meeting was presided over by the Honourable Minister of Health (HMH), Professor Adenike Grange. She welcomed the Council members and other delegates to the 51st National Council on Health meeting and expressed her pleasure at chairing the first meeting of the Council since assuming office. The Honourable Minister’s address focused on intimating Council with the vision and mission of her administration as well as obtaining the inputs and commitments of the Council members towards achieving the goal of “creating wealth through health” in line with the 7- point agenda of President Umaru Musa Yar’Adua that places a high premium on using Health and Education as the twin engine that drives national development by developing human capital.
5. The HMH in her address restated the strong commitment of the present administration to making Nigeria one of the top 20 economies in the world by 2020. This potential commitment has been buttressed by Goldman Sach’s team of global economists who identified Nigeria as having the potential to become one of the top eleven (11) economies in the world by 2020. She stated that although this goal was a laudable one, the poor health status of the people by whom the transformation would take place could impede its attainment.
6. The address also highlighted the fact that despite the existence of several effective and affordable technologies and interventions, gaps in health outcomes continue to widen due to a defective national health system. This situation continues to serve as an impediment to the achievement of the Millennium Development Goals (MDGs). Therefore, it is imperative to reposition and strengthen the weak and fragile health system to be able to deliver the services and high quality of care to those who need them in a timely manner, thus meeting the expectations of both the populace and healthcare workers.
7. The HMH recalled various reform programmes that had been commenced in the past leading to the development of several policies and strategic frameworks for various projects and programmes. However, these programmes have frequently not met their stated objectives due to inadequate emphasis on implementation, monitoring and evaluation. Hence the resolve of her administration to focus on the implementation of the developed policies and institutionalisation of mechanisms for monitoring and evaluation.
8. Other problems identified by the HMH include the loss of confidence in the primary health care sub-system and indeed the entire public health care system; obsolete or absent equipment and infrastructure; inadequate capacity of healthcare staff and training institutions; lack of a coordinated procurement and logistics system; lack of quality assurance or regulatory mechanisms for quality control; weak health information management systems; poor integration of health service delivery; and an almost non-existent referral system. She also reiterated the poor health and human development indices in the country and the threat these posed to the attainment of the MDGs.
9. The HMH solicited for the commitment of the Council members in the implementation of the National Health Investment Plan (NHIP) as a strategic approach to building consensus at all levels for the actualization of the Ministry’s vision. The NHIP will be implemented through six independent but related investment strategies which are: ensuring adequacy of policy instruments; resource mobilization and management; integrated disease management programmes; referral system and tertiary care development; increased surveillance; and full implementation of health insurance schemes.
10. She concluded her address by positing that greater investment in the health sector and more efficient and equitable use of resources are essential for national development. She appealed for greater collaboration between all tiers of government in the delivery of quality health services; and between policy-makers and technocrats in order to sustain the reforms while also suggesting to States to establish Primary Health Care Development Agencies to improve the delivery of primary health care.
11. The Honourable Minister of State for Health (HMSH), Arc. Gabriel Yakubu Aduku OON welcomed delegates to the 51st NCH meeting. He lamented the poor health indices of the country and opined that most of the causes of morbidity and mortality in the country could be effectively addressed at the primary health care level. The HMSH also seized the opportunity to once again buttress the seven (7) point development agenda of the present administration and especially Mr. President’s commitment to accelerating the achievement of the MDGs and improving the performance of the National Health System to one that is more adequately responsive to the health care needs of the people thereby enabling Nigerians live more economically productive lives.
12. HMSH therefore solicited for the support of the States in the translation of policies into actions and appealed for stronger commitment and a renewed synergy/partnership among stakeholders in the attainment of the MDGs. He concluded his address by charging all stakeholders in the health sector to join in the fight to eradicate malaria which has continued to be the leading cause of deaths among under-5 children as it is preventable and curable. He wished the Council fruitful deliberations.
13. In his address, the Honourable Commissioner for Health, Lagos State, Dr. Jide Idris, welcomed the Honourable Ministers, the Hon. Commissioners and all delegates to Lagos. He expressed his pleasure and that of the State for the opportunity granted them to host the 51st meeting of the National Council on Health. He emphasized the importance of effective health care to better health and the general development goals of a nation and hence the importance of the Council meeting where decisions at the Technical Committee meeting are analyzed for their merit before balanced policy decisions are arrived at for implementation.
14. The Honourable Commissioner went on to assert that due to the enormous resources required for the provision of effective health services, it was necessary for all tiers of government to be committed to investing heavily in health. He continued his speech by restating the commitment of the Lagos State Government led by His Excellency Mr. Babatunde Raji Fasola SAN the Executive Governor of Lagos State, to invest in infrastructure, human resources for health, provide adequate funding for the health sector, create systems, urgently address the issue of Maternal and Child Health as well as educate the public adequately. Lastly, on behalf of the State, he thanked all those present at the meeting and encouraged delegates to feel free to move around the State to see the different places of interest.
15. At the end of the opening ceremony, the vote of thanks was delivered by the Coordinator, National Tertiary Hospitals Commission, Dr. Shehu Sule mni, on behalf of the Permanent Secretary of the Federal Ministry of Health. He thanked the State Government and the people of Lagos State for the warm welcome and hospitality accorded all the delegates since their arrival in the State. This has no doubt encouraged the high quality of participation of the delegates in the meeting and would lead to the achievement of the purpose and objectives of the meeting.
16. After the opening ceremony, there were presentations on:
· Sector-wide, System-wide Implementation of PHC in Nigeria
By Dr. Kwame Adogboba
· The National Health Investment Plan and the role of States and LGAs in its implementation by Professor Adenike Grange, Honourable Minister of Health/Dr. Kenneth Ojo/Dr. Anthony Seddoh/Professor Wilfred Iyiegbuniwe
· Final Onslaught on Malaria in Nigeria by Dr. Yemi Sofola/Professor Kio Don-Pedro
· The Role of States Global Fund for AIDS, Tuberculosis & Malaria (GFATM) Activities by Professor Babatunde, DG,NACA
· Policy and Programme Implementation, Monitoring & Evaluation at Federal, State and LGA levels by Dr. Dan Onyeje; and
· Sector-wide Quick Wins and Indicators by Dr. Margaret Mafe
The presentation on Sector-wide, System-wide Implementation of PHC was followed by group discussions on various issues in the implementation of PHC. The following decisions were arrived at following the discussions:
· The need for the establishment of an agency in the health sector of the states that would be responsible for coordinating and facilitating the implementation of PHC;
· Integration of primary and secondary health care services with emphasis on decentralization of management;
· There should be pooling of funds from Federal, State and LGAs into “State Health Fund” for enhancing the management of health systems;
· The need to define and clarify the roles and responsibilities of governments and other stakeholders in the implementation of PHC;
· Promoting the implementation of the existing Public Private Partnership policy in health in Nigeria; and
· The establishment of a better and effective monitoring and evaluation system to monitor the performance of the health system at the state level
Council session was conducted in Plenary to deal mainly with the following:
i. Consideration and adoption of the Proceedings of the 50th National Council on Health (NCH/51/001) as amended.
ii. Report on the Implementation of Resolutions of the 50th NCH Meeting (NCH/51/002). Council noted the various stages of implementation of the 50th NCH meeting resolutions at the Federal and State levels and encouraged States to show more commitment by ensuring greater implementation of resolutions adopted at Council meetings. This could offer an opportunity for peer review and experience sharing.
iii. The recommendations of the Technical Committee which had earlier met on 19-20 November were reviewed.
17. After extensive and interactive deliberations, the National Council on Health approved the following resolutions:
PUBLIC/PRIVATE PARTNERSHIP FOR HEALTH
18. Council, noting the various efforts made by States in the implementation of Public-Private Partnership initiatives in the health sector as contained in the related Memoranda, commended the States that have started and encouraged all States to continue to explore the comparative advantage of PPP in health care delivery within the context of the National Policy on Public Private Partnership in Health.
STRENGTHENING PRIMARY HEALTH CARE SERVICES
19. Council, noting the critical importance of the PHC system in delivering quality health care to a large majority of Nigerians and the possibility of treating many of the leading causes of death at this level, appealed to States to establish State Primary Health Care Development Agencies as a strategy for enhancing the implementation of the PHC programme in their domains. The State PHCDAs could also serve as units for promoting, organizing and managing Public-Private Partnership initiatives in health in the States.
20. Council, noting the consistently poor health indices in the country, in particular, maternal, newborn and child health indices; and the inadequate human resource for health especially at the Primary Health Care level, approved the establishment of a Midwifery Corp Scheme for both basic and post-basic midwives to serve a compulsory one (1) year national youth service in the rural areas. Similarly, Council approved the compulsory posting of NYSC doctors to primary health care centres in the rural areas as a means of providing the necessary human resources for health at the primary health care level. Appropriate ancillary training in Life Saving Skills and Extended Life Saving Skills will be provided. The Council agreed on shared responsibilities between the three (3) tiers of government.
21. Council also approved the provision by the Federal Government of Midwifery Kits in Primary Health Care Centres for use by the midwives.
22. Noting the need to increase access to health care universally, Council approved the adoption of the Ward Minimum Health Care Package as a basis for the prioritization of health interventions, strategic and operational planning, budgeting, advocacy and resource mobilization by all stakeholders.
23. While noting the status of implementation of the construction and utilisation of model primary health care centres across the country Council appealed for better consultation with States, LGAs and Communities when siting PHCs.
STRENGTHENING SECONDARY HEALTH CARE SERVICES
24. Noting the poor quality of health care in the country, Council approved that a complete audit of the health care delivery system in all the States of the Federation should be undertaken with a view to identifying any weaknesses in the quality of care and implementing changes that may be required to assure high quality health delivery.
25. Council also approved the setting up of appropriate machinery for monitoring the provision of quality health care for Nigerians and encouraged States to develop friendly guidelines enshrining patients’ preference for the various outcomes with adequate budgetary provision for the implementation of these programmes.
26. Council noted and commended the construction of new and refurbishment of existing General Hospitals in Anambra State and the subsequent accreditation of these facilities for internship training by the relevant professional regulatory bodies.
FOOD AND DRUG ISSUES
27. Aware of the importance of availability of safe, qualitative and efficacious medicines for the effective functioning of any modern healthcare system; recognizing that lack of access to safe quality and affordable medicines is a major constraint to quality health care; realizing that lack of access to safe and affordable drugs has resulted in complications and even deaths; and considering that this situation cannot be allowed to continue if we are to achieve the MDGs:
28. Council considered a draft resolution which stated that “Council reviewed the drug distribution system in the country and noted that the system is still largely poorly coordinated leading to the proliferation of fake, sub-standard and unregistered drugs with its associated risks and therefore approved the establishment of legal drug distribution centres in all States and the FCT. Council further approved the government financing of the proposed nationwide assessment of government warehouses for lease or rent to the private sector for drug distribution.”. After deliberations, it was decided that the issues entailed required more consultations before consensual decisions could be reached. The draft resolution was thus stepped down.
29. While noting that one of the goals of the National Drug Policy is to stimulate increased local production of essential drugs as well as ARVs and ACTs and the target to produce 70% of national drug needs by 2008, Council approved government’s financing of the proposed nationwide assessment of the capacities of local drug manufacturing industries in order to derive current data on local drug production.
30. Also, in a bid to boost local drug production, Council made a commitment to resist pressure to lift the ban on drugs listed on the 2005 import prohibition list and to upgrade the list based on data that would be generated from the nationwide drug production assessment exercise. Council would also revisit the issue of high tariffs on imported pharmaceutical raw materials while considering other incentives for local drug manufacturing companies.
31. Council noted the benefits of an effective drug revolving fund scheme and commended States in which such schemes have been functioning and sustained while encouraging other States to replicate the schemes.
MATERNAL, NEONATAL AND CHILD HEALTH
32. Council noted with concern the rather slow progress made towards reducing maternal, newborn and child mortality midway to the target year for the attainment of the MDGs, due to poor access to high impact, evidence-based, cost effective interventions and approved the adoption of the Integrated, Maternal, Newborn and Child Health (IMNCH) Strategy developed by the Federal Ministry of Health and partners as a strategy to promote a more holistic, comprehensive, integrated approach to maternal, newborn and child health issues and services as well as the accelerated scaling-up of programmes to reach the target groups.
33. Noting the issues and programmes affecting the health of the mother and child and all the efforts made by the federal and state authorities as contained in the related memoranda, Council commended states for their efforts to improve the health status of women and children and to reduce morbidity and mortality indices among them; however, Council encouraged them to integrate these services in order to maximize the utilization of available resources and achieve the greatest possible impact on the health of the people.
34. Taking cognizance of the proven benefits of Misoprostol in the control of post partum haemorrhage; its ease of administration and relatively few dose-dependent side effects, Council approved the inclusion of Misoprostol in the essential drugs list as part of efforts to reduce maternal morbidity and mortality.
35. Council reviewed and adopted the final draft of “Gender-Based Violence in Nigeria: National Guidelines on Prevention and Response” and encouraged all States and the FCT to approve, adopt and implement the recommended strategies.
36. Re-emphasizing the benefits of exclusive breast-feeding for newborns and taking cognizance of the challenges posed to working mothers in implementing the strategy, Council encouraged all workplaces in Nigeria to provide well equipped and staffed crèches for their female employees as these could also be very important catchment sites for routine immunization. Council also encouraged the Ministries of Health, Women Affairs and Labour & Productivity to work together to plan and implement reproductive health education and counseling programmes for women workers.
DISEASE CONTROL
40. Concerned about the increasing magnitude and public health importance of noncommunicable diseases(NCDs) and their risk factors; the absence of programmes focusing on NCD control in the states, and the need to scale up NCD prevention and lifestyle and behavior change campaigns to check the increasing burden of NCDs; Council resolved that all states should as matter of priority, establish or strengthen and fund appropriately an integrated NCD prevention and control programme in the state and LGAs, coupled with the designation of a state focal point for NCD control. The FMOH will provide technical support to improve state capacities in the development, implementation, monitoring and evaluation of NCD programmes.
41. Acknowledging that blindness is a major cause of unnecessary human suffering, often leading to poverty, social exclusion and early death; and aware of the poor coordination of the commendable work undertaken by voluntary/ non governmental Organizations (NGOs) in the control of blindness in Nigeria, Council resolved and approved that the National Vision 2020 Strategic Plan be adopted as a policy document for implementation at the tertiary, secondary and primary levels of health care services, for elimination of the main causes of avoidable blindness by the year 2020. All the Governments should develop 5 year action plans for Eye Care Services within the context of the National Vision 2020 framework and strengthen inter-sectoral collaboration in the implementation of these plans.
42. Committed to the plan to eradicate Guineaworm by December 2008; noting the need for improved budgetary allocation and timely disbursement of funds required at the LGA, State and Federal levels and the need to intensify surveillance activities for the successful implementation of the last phase of guineaworm eradication; Council resolved that action should be accelerated by all tiers of government and all relevant agencies in the provision of safe water especially in the rural communities; recommended the intensification of Community Participatory Surveillance Strategy; and integration of guineaworm surveillance activities with other grassroot health programmes
43. Concerned about the plight of sickle cell patients and Nigerian children who are both plagued by Pneumococcal and Hib infections; noting that safe effective Haemophilus Influenza type B (Hib) and Pneumococcal Vaccines are available and already being used effectively in our neighboring countries, Council approved that the Federal Ministry of Health works out ways to provide the vaccines for use in the country starting with sickle cell patients who need them most.
HIV/AIDS
44. Council noted the, and commended the National HIV/AIDS and STI Control Programme, for the successes achieved in previous sentinel surveys and the States for their efforts in the control of HIV/AIDS.
45. Further noting the importance of HIV/AIDS sentinel surveys in the determination of prevalence and distribution of HIV infection, sensitization of stakeholders to take appropriate action in prevention and control of the epidemic, planning, implementation and monitoring of HIV/AIDS programme and also for assessing the overall impact of the interventions by stakeholders in the control of HIV infection; Council recommended that the Federal Ministry of Health should facilitate easier access to World Bank’s credit funds and states should make available sufficient budgetary provisions to ensure that they can play agreed roles in the conduct of 2007 survey and future surveys.
MALARIA
46. Recognizing that malaria still remains a major cause of morbidity and mortality especially amongst children and pregnant mothers; considering the limitations of our past efforts towards the elimination of malaria; and realizing the need to accelerate the elimination/eradication of malaria in Nigeria through the implementation of an integrated approach which should include Integrated Vector Management (IVM) strategy; Council resolved that all governments should embrace the new approach for malaria control/elimination/eradication which is the integration of the RBM (Roll Back Malaria) and IVM interventions, and adopt year 2015 as the target year for the total elimination of malaria from Nigeria
HUMAN RESOURCE MANAGEMENT
47. Council noted the dynamic nature of medical knowledge and practice and thus the need for every medical officer to be exposed to new knowledge and discoveries in his/her area of specialization in order to assure the quality of healthcare delivery; and recommended that all Governments should support continuous professional development of all healthcare workers; and MDCN should promote and make efforts to institutionalize continuous professional development (CPD) as a pre-requisite for registration and licensing.
48. Council deliberated extensively and agreed on the effect of variations in salaries paid to health workers across the country on their motivation and efficiency of the healthcare delivery system. Council resolved that a forum should be set up by the FMoH and States to deliberate and agree on a harmonised salary scale for health workers in order to address this problem.
49. Council appreciated the proposed National Health Investment Plan and recommended that the Federal Ministry of Health plays the leading role in its development while states and all other relevant stakeholders would participate and cooperate as appropriate . Some of the expected outcomes of the implementation of the National Health Investment Plan will be to: increase political support for increased budgetary allocation to health and other health investments; enhance coordination and efficiency in the use of donor assistance; develop and implement comprehensive strategies for achieving effectiveness, efficiency and equity of the health sector; provide a basis for better result-oriented budgeting in the health sector; ensure the efficient and equitable utilisation of available health resources; provide an objective framework for monitoring and evaluating the health sector; and improve the overall functioning of the health system for national development.
INFORMATION MEMORANDA
50. A total of seventeen information memoranda were considered by Council. Further to receiving and deliberating on them, Council commended and noted all the memoranda. The information memoranda are:
· Development of National Health Investment Plan
· Establishment of the National Tertiary Hospitals Commission (NTHC)
· Establishment of the National Centre for Disease Control (NCDC)
· International Health Regulations (IHR) 2005
· The Establishment of Field Epidemiology and Laboratory Training Programme (FELTP) in Nigeria
· Traditional Medicine Development
· Presidential Committee on Pharmaceutical Sector Reform
· National Chemical Safety Management in the Health Sector
· National Drug Fomulary/Essential Drugs List (NDF/EDL) Review Committee/Secretariat-DFDS
· Progress Report on National Food Risk Analysis Centre in NAFDAC
· Baseline Study carried out by NAFDAC on the quality of Medicine in circulation in Nigeria
· Progress Report on the Health Systems Development Project II
· NHIS the Journey so far as at October, 2007
· Establishment of Functional Traditional Medicine Boards
· Anambra State Community Health System and Health Financing Scheme
· Dutch Government-assisted Community Health Insurance Scheme in Kwara State SHONGA, BACITA, PILOT STUDY/SCHEME
· The Lagos State Health Facilities Monitoring & Accreditation, Journey so far
· Avian Influenza Control and Human Pandemic Preparedness and Response in Nigeria
51. The 52nd National Council on Health meeting is scheduled to hold in Kano State in May, 2008.
52. The 51st National Council on Health meeting was declared closed by the Honourable Minister of Health, Professor Adenike Grange at 2.17 p.m. on Friday 23 November 2007.
Subscribe to:
Posts (Atom)