Category: Special Report

  • Tracking worsening blindness crisis

    Shrinking health budget connives with pervasive poverty and poor health-seeking attitudes to worsen blindness and visual impairment burden in the country, reports Moses Emorinken

     

    WITH an estimated population of over 200 million people, Nigeria, which prides itself as the undoubted giant of Africa, sits comfortably among the top ten most populated countries in the world. However, Nigeria has become overburdened and overweight with many health challenges, which brings the writer to the conclusion that an overweight giant becomes a burden to itself. Globally, it is said that 285 million people are visually impaired, and 39 million of these are blind; 90 per cent of which live in low-income countries, and 55 per cent of those blinds are women. However, 80 per cent of blindness is due to avoidable causes.

    In Nigeria, it is estimated that 1.13 million individuals aged 40 years are blind. A further 2.7 million adults aged 40 years are also estimated to have a moderate visual impairment and an additional 400,000 adults are severely visually impaired. Also, 4.25 million adults aged 40 years in Nigeria are visually impaired or blind. The prevalence rate of blindness is about 0.78 per cent in all ages and the major cause of blindness includes – cataract, glaucoma, trachoma, AIDS-related nuclear degeneration, diabetes and hypertension, etc. The estimates were generated by the Nigerian National Blindness and Visual Impaired survey (2005-2007) in close collaboration with key stakeholders in the eye health sector, including the Federal Ministry of Health.

    It also found that the prevalence of blindness among children aged between 10-15 years is about 0.06 per cent, with measles, vitamin A deficiency, and traditional eye medication accounting for about 3 per cent of that figure. Refractive errors, which are easily corrected by eyeglasses, are responsible for about 77.9 per cent of mild visual impairment; 57.1 per cent are moderate visual impairment, and 11.3 per cent of several visual impairments; 1.4 per cent complete blindness in adults. With the staggering statistics from the national survey, the consistent shrinking of budgetary allocation to the health sector and the near neglect of primary eye care, experts are worried the country is at a precipice as far as eye health is concerned.

    Poverty, the catastrophic cost of eye care

    Poverty is a major problem as far as general health is concerned; not to talk of eye health. Because of the poor state of the economy, many have devised unhealthy ways to prioritise other concerns above their health. Even when many consider their health, eye conditions are usually in the back burner of their priorities. The 2018 report by the World Poverty Clock showed that Nigeria has overtaken India as the country with the most extreme poor people in the world.

    With 90.8 million Nigerians living in extreme poverty, this represents about 46.4 per cent of the country’s estimated population. The huge poverty burden also means that it is increasingly becoming more difficult for people to access health services without catastrophic consequences on their finance. According to the programme director for Christoffel Blinden Mission (CBM), Dr. Juliana Nathaniel, poverty is the number culprit for the worsening blindness crisis in the country. “Poverty is a very big issue in Nigeria. When it comes to the issue of eye health conditions, our people would rather attend quickly to some other health conditions like diarrhoea, malaria, etc. People tend to neglect issues of eye health; if they have a preference of the ailment to attend to quickly, most would rather go for other conditions than going for eye health. Because this is happening, most of the situations that would have been attended to early enough to prevent the occurrence of blindness, don’t get that particular kind of attention as at when due,” Nathaniel said.

    Another significant barrier to accessing quality eye services in Nigeria is the perceived and actual out-of-pocket costs of eye care interventions. Due to problems of affordability, people are increasingly pushed into poverty in a system that operates on catastrophic out-of-pocket payment for health care services. Medical experts say efforts need to be targeted at reducing the catastrophic healthcare cost, which is the degree to which people can use health services they need without adverse effects on their livelihood as a consequence of paying for healthcare.

    Ignorance, poor health-seeking attitudes

    While speaking with The Nation, Dr. Nathaniel explained that many people don’t have the necessary knowledge about eye health conditions; they don’t even know what to do when they are confronted with challenges of eye health. “There are some misconceptions and socio-cultural issues that affect the issue of eye health in Nigeria. For instance, it is expected that children should naturally take immunisation. When you take immunisation, issues like measles, are prevented. This way, eye health complications that may come by as a result of measles are taken care of. The immunisation coverage in Nigeria is very low. Also, the issue of diet is very important. People now eat only what is available because they cannot afford foods (that are) rich in Vitamin A.”

    Also fueling the visual impairment problems is poor health-seeking behaviour among the poor, Dr. Ozy Okonokhua, president of the Nigeria Optometric Association, said. Apart from eye health, many Nigerians are equally guilty of not bothering to submit themselves to regular medical checks as it is done in more advanced climes. “This is a big issue that is compounding the situation because Nigerians generally have poor health-seeking behaviour. We don’t routinely walk into a clinic for a health check. Meanwhile, everybody should go for a routine eye check once a year. The average Nigerian will walk into a chemist or patent medicine store and say I have this problem, please provide me with drugs, without undergoing any consultation with any specialist.

    “There is also the traditional high-end medicine that people are trying. They believe that some leaves will help cure the problem in their eyes. So they squeeze the juice into their eyes, thereby compounding their problem. There is also the misunderstanding that a child is too young to start wearing glasses; so we wait till the child gets old. Those mindsets are compounding the already precarious situation we have in the eye care business,” Okonokhua said.

    Closely associated with poor health-seeking culture is widespread ignorance, which makes many people believe and do what is wrong or not true when it comes to eye care. According to Dr. Oluwafunmike Ani, chair of Public Health Ophthalmology Group of Ophthalmology Society of Nigeria (OSN), ignorance has made many people do things that eventually worsen their case. “The health-seeking attitude is affected by ignorance. We believe so many things that are not true about our health, about our eyes. This makes us take wrong decisions to handle problems. The problems must have become worse before they show up to practitioners that can find a solution for them. Our people sometimes go on and do what is called ‘couching,’ which is a traditional way of removing the cataract. But couching is poor because it doesn’t address many things. It creates more problems by pushing it further into a corner inside the eye. By this, it causes inflammation and eventually leads to eye loss,” Ani said.

    The disparity in the spread of eye doctors

    Although Okonokhua believes that the country is blessed with enough manpower as far as eye care is concerned, the problem is that they are not evenly distributed. In Nigeria, eye care professionals are distributed in favour of urban centres to the detriment of the rural areas. “The spread is more towards the South than to the North. We have a dearth of manpower in the North and what appears to be an abundance of manpower in the South. Even those in the South are not evenly distributed. The blame will always be put on the government, but then, the professionals need to be encouraged to the rural areas. Unavailability of facilities in rural areas is a turnoff for professionals.

    “Local government authorities should take up primary eye care as part of the primary health care services they provide and engage qualified personnel to provide eye care services. If this is done, we will have reduced our disease burden considerably. We need to engage an optometrist, at least one in each primary health care centre in each of the local governments in the country. If eye care is not accessible and affordable, then you have not achieved Universal Health Coverage (UHC).

    “As at today, people still travel from the North and South to go to Kano to access eye care from one ECWA Eye Centre run by a religious institution. Meanwhile, if you provide them with services in their locality, they don’t need to travel such long distance. There are so many optometrists in the country that are ready to work. Optometrists are produced annually in the country from different schools. Why don’t we engage them in PHC centres so that they provide services to the rural populace? If you don’t tackle it at the PHC centre or Primary Eye Care (PEC) centres, you escalate the problem to come to the already flooded and overburdened secondary and tertiary health care centres,” Okonokhua said.

    Shrinking health budget versus  ‘no-budget’ for eye health

    One pointer that government is paying lip service to eye care is in the area of budgeting. According to Dr. Okolo Oteri, national coordinator, National Eye Health Programme of the Federal Ministry of Health, “there is no funding for eye health in Nigeria, but it is something that we are working towards addressing; we are working towards including it in health budgeting by 2021.” This claim was corroborated by Juliana. “Recently, we attended the national council on health and one of the things spoken about was the universal health coverage package. Eye health is not included in the package because it is not seen as a priority. There is a need for the government to consider making provision for eye health budget so that we can pursue the issue of blindness among the populace. One per cent consolidated fund and eye health is not part of it,” Juliana said.

    Okonokhua added that the blindness crisis has reached an emergency level, which calls for drastic measures in a way that involves all stakeholders. “The hurdles that you have to go through to get an eye clinic equipped with basic eye equipment are unthinkable. The government does not know that it is very cheap to tackle eye services at the early stages. What we see now by way of interventions is coming primarily from donor agencies and NGOs. Government has not realised that there is a need for an emergency to be declared on the eye care services currently. We are getting to the situation where you will be finding at least one blind man on every street in this country,” Okonokhua said.

     

    The role of health insurance

    The National Health Insurance Scheme (NHIS) offers eye care coverage for about five per cent of the population. This is because the list of what it excludes is long: refractive services, vision training services, and a lot of other services are either underpriced or not covered at all. For example, treatment for glaucoma, which is one of the leading causes of blindness, is not covered in the NHIS. Also, underpricing does not encourage the provider to continue to provide services, thereby excluding a lot of patients.

     

  • Atiku, PDP kick as Buhari, APC celebrate victory

    By Gbade Ogunwale, Augustine Ehikioya and Bolaji Ogundele, Abuja

    It was a different stroke for different folks on Wednesday. For President Muhammadu Buhari and the All Progressives Congress (APC), the Supreme Court judgment dismissing Alhaji Atiku Abubakar and the Peoples Democratic Party (PDP) petition is a victory for the people.

    But, for Atiku and the PDP, the judgment has denied the people the good leadership they deserve.

    Buhari, in a statement, thanked the people of Nigeria for the mandate they gave to him to run the affairs of the country for another four years.

     

    ‘Buhari elected by majority’

     

    A statement by the Senior Special Assistant on Media and Publicity, Malam Garba Shehu, said: “The Government – and people of Nigeria – have been aware that the result of February 23, 2019, the presidential election has been settled now for some eight months. ‘‘President Buhari was re-elected by an absolute majority of 55.6 per cent of the national vote, with Nigerians casting nearly 4 million more votes for President Buhari than his nearest challenger – representing a margin close to 15 per cent of the total vote.

    “The former Vice President and his political party exercised their rights, under the Nigerian Constitution and electoral laws, to petition the courts and dispute this result.

    ‘‘They did so first at the Presidential Election Petition Tribunal which ruled in September 2019 against them. Now – following his appeal to the Supreme Court and its ruling to dismiss their case for “lacking merit” – this matter is now closed.

    “The President and Government of Nigeria do wish to extend our gratitude to former vice-president and his party for undertaking their campaign through protestations to the courts.

    ‘‘In this regard, they have conducted themselves in line with the laws of the country they sought to lead.

    “Now, following this final legal bid before the highest court, it is time the country is afforded the right to move on – in the interest of all Nigerians – regardless of how they voted.

    “The elected President and his Government now must be enabled to focus solely on addressing the issues that concern the country.

    ‘‘From building economic empowerment and opportunities for the nearly 200 million Nigerians, 60 per cent of whom are youths bubbling with energy, to defeating the twin ills of terrorism and corruption, there is much work to do.

    “So too must the opposition be afforded the right to focus directly on their vital role of holding the administration to account for its decisions.

    Read Also: Judgment an affirmation of peoples collective voice, says Tinubu

    ‘‘The governance of democracy only functions as it should when those checks on the executive are in place – and utilised.

    “The opposition, as much as the government, must now move on – and without the need for further distractions,” he said.

     

    APC: Court’s verdict apt

     

    The APC described the Supreme Court’s verdict as apt.

    The APC, in a statement signed by its National Publicity Secretary, Mallam Lanre Issa-Onilu, commended the apex court for dismissing the PDP and Atiku’s petition and for refusing to be blackmailed against its conscience.

    According to the party, the victory won at the Supreme Court would enable the APC-led Federal Government to go ahead and face the task of delivering the Next Level programmes to Nigerians.

    The party, however, encouraged the opposition party and its presidential candidate to abandon other alleged plans to continue antagonising the government, saying democratic politics cannot thrive in chaos.

    “The All Progressives Congress (APC) welcomes the Supreme Court’s dismissal of the appeal filed by the Peoples Democratic Party (PDP) and its presidential candidate, Alhaji Atiku Abubakar against President Muhammadu Buhari’s 2019 election victory.

    “We congratulate Nigerians, the President; Vice President, Prof. Yemi Osinbajo; party leaders, members and supporters on the Supreme Court’s verdict.

    “Following the earlier judgment of the 2019 Presidential Election Petition Tribunal which dismissed in its entirety the PDP and Atiku’s petition, the Apex Court was apt in dismissing the appeal for lacking merit.

    “The Party hails the Judiciary for standing firm in the face of the PDP and Atiku’s subterfuge and for siding with the Nigerian electorate who through their votes decided to do away with PDP’s ignominious past and re-elect the President Buhari-led APC administration which has ushered in a new era of progressive growth for our country.

    “With the ruling of the Supreme Court, which has finally affirmed President Buhari’s election victory, we enjoin the PDP and Atiku to jettison their destructive and disruptive agenda against Nigeria, which they have made up their minds to pursue for the next four years.

    “The PDP and Atiku should not confuse opposition politics for their unpatriotic agenda. Democratic politics cannot be practised in the state of anarchy, confusion which the PDP and Atiku wish to achieve. Such a diabolic plan will definitely fail.

    “Going forward, the President Buhari-led APC government will continue to focus on delivering our Next Level plans for the country,” the party said.

     

    Atiku, PDP shocked

     

    In a statement yesterday by the spokesman for the PDP, Kola Ologbondiyan, the party said the verdict delivered by the apex court was not what majority of Nigerians, who participated and observed the presidential election expected.

    “The PDP notes that it indeed made a solid case, with indisputable evidence, showing that Atiku Abubakar won the presidential election and as such is surprised that the justices of the Supreme Court held otherwise; however, that is the highest court of the land.

    “Notwithstanding, the distinction of our case remains for Nigerians, including generations yet unborn, to appreciate”, the party said.

    The PDP expressed gratitude to millions of Nigerians across the board for voting Atiku in the election as well as for their unflinching support for the party during the election and throughout the duration of court proceedings.

    “Nevertheless, our party, indeed the nation, awaits the justices of the Supreme Court to release their reasons behind their verdict,” the party added.

    Atiku, in a statement, described the judgment as part of the nation’s democratic challenges, saying: “It is said that the Supreme Court is not final because it is infallible, but that it is infallible because it is final.

    “While I believe that only God is infallible everywhere, and only Nigerians are infallible in our democracy, I must accept that the judicial route I chose to take, as a democrat, has come to a conclusion.

    “Whether justice was done, is left to the Nigerian people to decide. As a democrat, I fought a good fight for the Nigerian people. I will keep on fighting for Nigeria and for democracy, and also for justice.

    “I thank all Nigerians who have stayed the course since the commencement of trial in the petition on the February 23 presidential election. The judgement is part of democratic challenges we must face as a nation”.

    According to him, the Nigerian judiciary, just like every estate of the realm, has been sabotaged and undermined by an overreaching and dictatorial cabal, who he said has undone almost all the democratic progress the PDP and its administrations nurtured for sixteen years, up until 2015.”

    Atiku continued: “Can Nigeria continue like this? Recently, former United States Assistant Secretary of State for Africa, Linda Thomas-Greenfield, averred that Nigeria had rolled back the democratic gains she made in 2015.

    “When democracy is rolled back, the economy, the society and the judiciary will not be far behind. Today, the nail has been put on the coffin and the gains we collectively made since 1999 are evaporating, and a requiem is at hand.

    “In a democracy, you need a strong judiciary, a free press and an impartial electoral umpire. Nigeria has none of those three elements as at today.

    “One man, one woman, one youth, one vote, should be the only way to make gains in a democracy. And when that is thwarted, the clock starts to tick.

    “Two and a half millennia ago, Sophocles said ‘If we are to keep our democracy, there must be one commandment: ‘Thou shalt not ration justice’. Nigeria will do well to observe this warning.

    “To those who think they have broken my spirit, I am sorry to disappoint you. I am too focused on Nigeria to think about myself. I gave up that luxury twenty years ago. The question is not if I am broken. The question is if Nigeria is whole?

    “This is not a time for too many words. It will suffice for me to remind Nigeria of this – we are an independent nation and we are the architects of our fate. If we do not build a free Nigeria, we may end up destroying her, and God forbid that that should be the case.

    “I was a democrat, I am a democrat, and I will always continue to be a democrat. May God bless Nigeria.”

     

    Secondus: God is ultimate judge

     

    PDP National Chairman Prince Uche Secondus hailed Nigerians for supporting the party during its travails, adding that final judgment comes from God.

    Secondus, in a statement by his media adviser, Ike Abonyi, said the commitment of Nigerians to democracy and its tenets despite inhibiting factors, is worthy of emulation and highly commendable.

    Secondus said: “We thank you for your support for PDP, for your commitment to democracy. Nigerians know that you voted PDP, even APC knows that you rejected them on February 23, 2019, international community knows you voted for PDP if the Supreme Court of seven justices say otherwise, leave it to God the ultimate Judge”.

    He also commended the media for their commitment to democracy and good governance and urged them not to relent in their roles of holding politicians accountable to the people.

    Secondus enjoined Nigerians to remain resolute in their prayers to God, saying that the country “is in such an untidy state and that only God can bail her out”.

  • Telcos, banks bicker over USSD charge

    Controversy has continued to trail the attempt by telecoms companies to implement a supposed gentleman agreement between them and the commercial banks over Unstructured Supplementary Service Data (USSD) charge, writes LUCAS AJANAKU

     

    “YELLO, as requested by your bank, from October 21, we will start charging you directly for USSD access to banking services.

    “Please, contact your bank for more info.”

    The terse text message above which was sent by Nigeria’s largest carrier, MTN, to its over 60 million subscribers ahead of the implementation of a mutual agreement between the carriers and the banks, has sparked a reaction from stakeholders across every stratum of the country.

    While the telcos say the green light to deduct the charges was given to them by the bank CEOs, acting under the aegis of Body of Bank CEOs, the bank CEOs have pushed back, denying ever agreeing on the issue.

    According to online knowledge bank, Wikipedia, ‘Unstructured Supplementary Service Data (USSD), sometimes referred to as “Quick Codes” or “Feature codes”, is a communications protocol used by GSM (global service for mobile communications) cellular telephones to communicate with the mobile network operator’s computers.

    According to the President, Association of Telecoms Companies of Nigeria (ATCON), Olusola Teniola, the USSD platform was not configured ab initio to accommodate banking transaction but to get free services such as checking airtime balance from service providers.

    He said: “The USSD platform is not meant and wasn’t built to be used extensively for transactions that could take up to two minutes to conclude and may have interoperability problems with other systems, remember, the GSM protocol and system we use in Nigeria is 30 years old. It was not foreseen that there will be a country where the fixed-line does not exist and everyone is using a mobile device to everything. That is the reality. We have a platform that is not the best way we should be using. There are other ways to do this. So when you have every bank publicising shortcode. The mobile app is not effective because it depends on the internet.”

    The USSD services of the lenders include GTB’s *737#; First Bank’s *894#; Fidelity Bank’s *770#; Access Bank’s *901#; and UBA’s *919#. They all run on telecoms infrastructure. While there is an initial charge of N50 by the bank, which will be retained, customers who use the USSD will be made to pay additional N4 which would have automatically translated to double billing.

    Teniola said the banks cannot continue to charge the customers while telcos will do same, arguing that it is the issue that must be resolved urgently.

    Fed Govt intervenes

    The Minister of Communications and Digital Economy, Dr. Isa Pantami, promptly directed the Nigerian Communications Commission (NCC) to suspend the plan.

    In a statement endorsed by his spokesperson, Uwa Suleiman, titled: Discontinuation of Alleged USSD Service Charge by MTN, Pantami said the ministry was not aware of it.

    “The attention of the Federal Ministry of Communications has been drawn to the viral text message allegedly sent by the Mobile Network Operator MTN Nigeria and other mobile operators notifying subscribers of a N4 charge per 20 seconds on USSD access to banking services from the 21st of October 2019.

    “The office of the Minister of Communications, Dr. Isa Ali Ibrahim Pantami, is unaware of this development and has hereby directed the sector regulator, the NCC to ensure the operator suspends such plans until the minister is fully and properly briefed,” the statement read.

    ALTON reacts

    The Chairman, Association of Licensed Telecoms Companies of Nigeria (ATCON), Gbenga Adebayo, who reacted to the minister’s suspension order said the USSD channel has evolved from a telco exclusive channel used for only telco services such as balance inquiry and recharges, to a channel being utilized for the deployment of financial, insurance, agricultural and government services, etc. The USSD channel is delivered using the Standalone Dedicated Control Channel (SDCCH) which is also used for call set-up, SMS set-up, and delivery.

    Similar to the other telco services such as SMS, voice and data, network resources are utilised in the provisions of USSD services and as such there are significant costs associated with deploying and maintaining the service.

    “The banks, however, identifying the convenience of delivering services to its customers over the USSD channel applied to the NCC for USSD codes to deliver these services. USSD Shortcodes were thereafter issued to the banks and as is expected, they became fully responsible for the charges associated with delivering services to their customer through these shortcodes.

    “To accelerate the adoption of financial services on USSD, the banks partnered with our members to zero-rate the USSD access to end-users, while the banks bore the cost for the provision of service. Based on this arrangement, the banks took on the responsibility of billing customers and paid our members for use of the USSD infrastructure from the service fees deducted from the customer’s bank account. These service fees charged by the banks were however far over the costs remitted to our members by the banks for providing the USSD platform and have since remained so.

    “Following the issuance of the USSD Pricing Determination by the N CC which resulted in a price review of USSD service by our members, the banks stated that they would no longer pay for USSD service delivered to their customers and requested our members to charge customers directly for use of the USSD channel. This billing methodology where the Banks customer is directly charged USSD access fees by our members irrespective of the service charges that the bank may subsequently apply to the customers’ bank account is called “End-User Billing” which the banks specifically demanded that all our members implement. The banks, however, provided no assurances to our members that such service fees charged to customers’ bank accounts for access to bank services through the USSD channel will be discontinued post-implementation of end-user billing by our members,” Adebayo said.

    He said the removal of these service fees by the banks would have meant that if bank customers were charged only the USSD costs communicated by our members per USSD session, bank customers will be paying far less than what they are currently being charged by the banks which in some instances are as high as N50.

    “Our members were however concerned that the banks were unlikely to discontinue the USSD service fees charged by the banks when customers utilise the USSD channel thereby resulting in double and overbilling, whereby our members charge consumers for the USSD access from their airtime and the Banks still proceed to charge the same consumers a service charge from their bank accounts. In the interest of the consumers, our members challenged the implementation of end-user billing until a formal request for its implementation was received from the Body of Bankers Chief Executive Officers and several banks specifically demanding that end-user billing be implemented.

    “In view of the opposition to the implementation of end-user billing by customers, our members, as responsible and responsive corporate citizens are committed to safeguarding consumer interests, and in this regard, we are willing to explore mutually beneficial solutions which ensure that costs associated with the provision of USSD services as determined by the NCC are fully recovered by our members and customers are not billed twice for the same service and by different institutions which is what end-user billing advocated by the banks will entail,” Adebayo added.

    CBN steps in

    Central Bank Governor, Godwin Emefiele, kicked against the move too.

    He said: “About five, four months ago, I held a meeting with some telecom companies as well as the leading banks in Nigeria at Central Bank, Lagos.

    “At that time, we concluded that the use of USSD is a sunk cost.

    “What we mean by a sunk cost is that it is not an additional cost on the infrastructure of the telecom company.

    “But the telecom companies disagreed with us. They said it was an additional investment in infrastructure and for that reason, they needed to impose it.

    “I have told the banks that we will not allow this to happen.

    “The banks are the people who give this business to the telecom companies and I leave the banks and the telecom companies to engage.

    “I have told the banks that they have to move their business, move their traffic to a telecom company that is ready to provide it at the lowest possible if not zero cost.

    “And that is where we stand, and we must achieve it,” he said.

     USSD sunk cost controversy

    The telcos have faulted the CBN chief over his assumption that the USSD is a sunk cost.

    Adebayo said: “With the increase in USSD traffic driven by financial services which currently constitutes approximately 90per cent of the entire USSD traffic, our members have continued to incur additional costs to provision additional SDCCH channels to mitigate against the negative impact on the quality of service. It is therefore factually incorrect when allusions are made that USSD costs incurred by our members are sunk costs which are not recoverable.

    Teniola agreed no less with him. According to him, the GSM protocol is well-tuned for voice application which is what we have used it for, the supplementary services were an after-thought.

    “So, there’s is additional infrastructure built around it to extend it and ensure that it is robust enough and secure enough to ensure that if it is being used as a means to get to those communities that cannot afford smartphones using feature phones, then, it is built accordingly but there is no specification out there in the world that USSD should have been used purely for financial services. In Nigeria, we have a peculiarity and it requires a pasty investment, it requires fibre, for the USSD gateway to be enhanced to enable the amount of traffic that will b put on to it. So it doesn’t impact on service where the quality of service will be degraded,” Teniola said.

  • X-raying House of Representatives’ agenda

    Is four years enough time to bring to bear a lofty idea? This is a question-begging for an answer as the House of Representatives roll out its legislative agenda, a document that is supposed to guide its legislative activities in the next four years, writes TONY AKOWE

     

    THE Legislative Agenda is a declaration of the intent of members of the House of Representatives to serve the country with dedication, focusing considerable energies on those issues that most affect the lives of the citizens. The House has indicated its intention to pay close attention to the general welfare of the Nigerian people. There is a wide range of items on the agenda, as contained in a document prepared by an ad hoc committee led by Hon. Julius Ihonvbare. These items deliberated upon and approved by the lawmakers include Reform of the House of Representatives, social justice, sustainable power, environment and climate change. Others are economic growth, development and job creation; gender; education reform; anti-corruption; sustainable agricultural development and food security; security; open governance, transparency and accountability; Internally Displaced Persons; public health; media and national development as well as the national budget.

    Presenting the document to the public, House of Representatives Speaker Femi Gbajabiamila said the legislative agenda was a product of the determination of the House to be the people’s parliament and to take the welfare of the Nigerian people as a top priority.

    Gbajabiamila said: “We have codified in these pages an ambitious agenda that we absolutely intend to achieve. First among these, is to reform the way the House of Representatives manages its affairs in every area, from the administration of our finances to the operations of the committee system and the process of the vote taking and recording in the House. Our goal is accountability and transparency because as we seek to drive reforms across the government, we are obliged to make sure our own House is in the best order. We have collaborated with the private sector to outline a set of objectives and develop a programme of activities that will facilitate increased investment, encourage innovation and drive economic growth. We will act to protect those who are most vulnerable amongst us.”

    He assured the Nigerian people that the House will seek through legislation and oversight, engagement and collaboration, the achievement of a kinder, gentler, more prosperous nation, so that we may leave as our legacy a bequest of love and promise greater than anything else that has come before. He stressed that nothing of substance or consequence is ever achieved by the endeavours of one individual alone, especially in government and public affairs.

    In his statement of purpose, the Speaker lamented that 20 years into the present democratic journey, the promise and benefits of democracy are yet to be fully felt in the lives of many Nigerians.

    A close study of the legislative agenda showed what could be described as an ambitious agenda. The question then will be whether members of the House will be able to actualise these lofty agenda in the overall interest of the Nigerian people. The house pledged to pay special attention to the vexing issues of rape, violence against women and child abuse while promising to work with development partners, human rights organisations, religious leaders, and the Nigerian Bar Association (NBA) to firmly address this malady.

    The document further stated that, “Issues of wealth and job creation, mass housing, access to water, education reforms especially at the basic level, social and food security, prison reforms, the conditions of internally displaced persons, protection of the girl child, environmental protection, and socio-economic and cultural rights will form part of the core of our interest and concern in the 9th Assembly”. The lawmakers noted that for decades, corruption has been the bane of the nation’s development. They also observed that policymaking processes have been distorted and compromised to produce policy outcomes expressly designed to serve the interests of a few, at the expense of the majority whilst resources for development and security, healthcare and education are diverted to enrich the private interests of a few public officials. The House further noted that the private sector has not been spared, as corruption has continued to limit its ability to make the breakthroughs required for industrialisation and growth. “Until we put in place a system that punishes acts of public corruption quickly and decisively. The Nigerian people will never be convinced of our commitment to rid ourselves of corrupt tendencies.

    They are not oblivious of the fact that the fight against corruption has been slowed down by cumbersome legal processes and concluded that the anti-corruption law is not strong enough to bring about great success.

    Conscious of the clamour by Nigerians for a special court to try corruption cases, the lawmakers resolved to examine the possibility of establishing, through legislation, and (or) constitutional amendment, Special Courts for the prosecution of public corruption cases under the proposed Omnibus Corruption and Racketeering in Public Service law in the same way that special tribunals are used for election petition matters. The special courts being considered by the lawmakers will allow for an expedited process of investigation, indictment and prosecution to allow for rapid dispensation of these matters.

    THE agenda also suggested an amendment to the Economic and Financial Crimes Commission (EFCC) Act to allow for appointment of qualified persons from the judiciary, academia, legal practice etc., to lead the Commission, instead of the current practice that allows for only current or former security and law enforcement personnel to be appointed to chair the Commission. It also sought to increase funding for the EFCC and the ICPC for recruitment of lawyers and forensic accountants with expertise in investigation and prosecution of crimes of financial misappropriation and public corruption. “We will further seek, through legislation, to ensure that the two Commissions can engage foreign and local experts and partners to aid in the investigation and prosecution of crimes”, the document said.

    Prison reform is to get commendable attention from the lawmakers within the period. It is of the view that the prisons are overburdened by thousands of inmates who, having never been convicted, are incarcerated while awaiting trial. In some cases, the incarceration lasts for much longer than it would have been had they been convicted by a court of competent jurisdiction. To this end, the House intends to pass the Prisoners’ Rights Bill for an Act for the protection of the rights of prisoners. It also seeks a review of the statutory framework for the establishment, maintenance and control of prisons.

    One major area of special attention in the legislative agenda in the state of power supply in the country. According to the document, constant, cost-effective power supply remained an integral part of the economic development of any nation. They are not happy that Nigeria has not yet begun to generate or distribute sufficient power to meet present needs or provide for future demand, despite the involvement of the private sector in the process through privatisation. They stressed that the paucity in power generation negatively affects productive sectors – from large industry to small and medium scale enterprises resulting in measurable adverse effects on economic productivity, industrial sustainability and general prices of goods and services. The House believes that getting things right with electricity generation, transmission and distribution will drastically improve the nation’s economic outlook and it’s essential to put it on the path of sustained economic development.

    THEY vowed to revisit laws, policies and investments including the roles of the Power Distribution Companies (DISCOs) and Power Generating Companies (GENCOs). In doing this, the House said it will initiate a comprehensive review of all legislation relating to the power sector in Nigeria and engage all stakeholders in the industry and take all necessary steps to guarantee that the views of businesses are considered in the process. The House will also step up its oversight functions to ensure that the funds allocated to the development of the power industry are judiciously and effectively deployed, adding that the mismanagement and misuse of funds are also one of the issues crippling electricity development in Nigeria. All records of legislative proceedings and documents for the energy sector, particularly those relating to misuse of funds would be reviewed for onward legislative deliberations and resolutions. That is, oversight should ensure that there is no diversion of funds meant for electricity.

    Besides, the House intends to use its legislative instrument to mandate allocation of pre-paid meters to all electricity consumers, pointing out that currently, less than 20 per cent of consumers in Nigeria is on a prepaid meter system. This, the Reps noted, is an inefficient arrangement that places an undue burden on end-users of electricity, which must stop. “All electricity consumers in Nigeria must be provided with prepaid meters within a fixed period. We would seek to enforce a comprehensive ban on the practice of estimated billing and make it impossible for distribution companies (DISCOs) to continue to take undue advantage of consumers”. They also want to pass legislation that will provide the right environment for the development of local engineering capacity and encourage technological advancement of Nigerian universities in the area of engineering technology. The envisaged legislation would also enable the Federal Government to actively exercise control over privatised yet inefficient power companies and encourage and assist capable market players and investors to take over ineffective ones. In doing this, they intend to support full commercialisation of the industry to attract new capital and advanced technology and encourage investors in power generation to distribute directly to consumers or where the law insists that they must continue to supply to the national grid alone, then there must be guaranteed payment for power supplies from the federal government.

    ON the economy, the House agenda stressed the fact that sustained economic growth is the key to effectively addressing other national problems of rising inequality, insecurity and conflict.

    The need to comprehensively address the security challenges in the country is also of prime importance to the House. The legislative agenda lamented that the nation has contended with the insurgency in the NorthEast that continues to transform, adapting itself to changing circumstances, yet remains a significant threat to lives and property, and a drain on limited resources. “In the Northwest and North Central regions, banditry, cattle rustling and community clashes between farmers and herders have exacerbated the already existing communal tensions resulting in a steady occurrence of cataclysmic outbreaks that cost lives and property. Further south, miscreants and criminal elements have taken advantage of our overstretched national security capacity to commit crimes of rape, cultism, kidnapping, and armed robbery against citizens. Taken together, all these developments have created an untenable national security environment that is inhospitable to local and foreign investment, that discourages our people from productive pursuits and creates uncertainty and instability that mitigate against economic growth and national advancement. The challenges we face call for a new approach; increased funding for training and equipment, better engagement with local communities for intelligence gathering and community support and accountability in the allocation and disbursement of national security resources”.

    THE health sector and its decay are expected to get prime attention under the legislative period as the House stressed that access to quality healthcare is one of the critical developmental challenges still facing the country. It observed that in too many parts of the country, access to basic healthcare facilities is limited at best and non-existent at worst. Primary healthcare centres, where they exist, are not able to meet the demands of the communities due to a host of problems ranging from lack of equipment to the absence of qualified personnel. Tertiary healthcare institutions are not sufficiently equipped to test for and treat many of the illnesses currently ravaging large segments of the country. In many parts of the country, health care institutions are dilapidated and almost abandoned. In the urban areas, healthcare access is limited not by the unavailability of institutions or personnel, but by the often, exorbitant costs. Every year, thousands of nurses, doctors, lab technicians and other medical professionals leave our shores in search of better opportunities elsewhere. AS a consequence of all these, tens of millions of Nigerians continue to die of preventable diseases and we lose millions of dollars each year to medical tourism. Achieving a healthcare system that works for all is both a humanitarian issue and an economic issue. The House, therefore, resolved to work with all stakeholders to expand access to the National Health Insurance Scheme (NHIS) for all Nigerians, while seeking to identify and address policy issues that have affected a rollout of the scheme across Nigeria, especially in rural communities that need it the most. “Through the relevant house committees, we will review the NHIS Act to bring it up to date with contemporary best practices. This is in addition to an all-inclusive review of the laws relating to the healthcare sector in the country”. They observe that too many citizens, including healthcare providers in the country, are still unwilling to participate in the NHIS for a variety of reasons, including a misconception about how the scheme operates and the cost of participation. The House intends to work with the Nigerian Medical Association (NMA) and other healthcare advocacy groups on awareness campaigns to address these concerns and achieve broader acceptance of the scheme.

    On cases of killer diseases, the Reps pledge to fund efforts to establish Special Hospitals and research centres, and rapid response units for the treatment, study, management and control of serious diseases such as cancer, diabetes, renal disease, HIV/AIDS, ebola, Lassa fever and cardiovascular diseases. Besides, the House said it would ensure adequate funding for the health sector through the improved budgetary provision and effective oversight in general, and particularly with regards to efforts at disease prevention across the country, while all existing healthcare laws will be reviewed for necessary reforms and amendments.

    The agenda expressed concern over the rising cases of fake and substandard drugs being imported or manufactured in the country. “These drugs are sources of serious health hazards and have led to the loss of many lives and the devastation of many families. We will continue to support the activities of the National Food and Drug Administration and Control (NAFDAC), the Nigerian Customs Services, National Drug Law Enforcement Agency (NDLEA), Federal Competition and Consumer Protection Council (FCCPC) and other regulators and stakeholders to stop the purveyors of these drugs from continuing in their deadly trade. We will also support the activities of advocacy groups and non-governmental organisations in building national awareness about the adverse consequences of using these fake drugs”.

    Also on the card is the plan to reform the nation’s budget and budgeting system. According to the agenda, the power of the purse, the right and responsibility to manage government expenditure through the appropriations process is the central power of the legislature. It is this power that makes all else possible. “Our intention to deliver on the promise of infrastructure development, meet the challenges of insecurity, provide our citizens with quality education and reposition our economy for growth, will not be met until we succeed in developing and implementing a budget framework that adheres to the best practices of effective budget policy. As such, reforming the appropriations process to ensure greater accountability, improve budget implementation and achieve an appreciable level of certainty in the process is an important component of the Agenda of the 9th House of Representatives”.

    AMBITIOUS as the legislative agenda is, it is left to be seen whether members will have the political will to confront some of the issues they have resolved to handle in the next four years. A closer study of the document revealed the determination of the House to help move the country forward. But whether the resolve will translate into action is left to be seen. Nigerians and the entire world will be watching to see how the lawmakers translate the ideas contained in the document, which is already in the public domain, into reality. Analysts believe that once the House can push legislative actions in the areas identified, other problems militating against the development of the country would have been addressed, thus leading the nation on the path of development.

  • Southeast’s highways of grief

    Our correspondents who visited major cities in the states they cover, commuting along the major federal roads to ascertain their current conditions, report that the roads have become highways of pain, grief and death. In this edition, Sam Egburonu, Chris Oji, Nwanosike Onu, Ogochukwu Anioke and Sunny Nwankwo present, as the first instalment, the reports from the Southeast zone

     

     

    IF your automobile is not a truck or a rugged Sport Utility Vehicle (SUV) with an auxiliary gear, it may be advisable to steer clear of Enugu-Onitsha expressway and most of the other federal roads in the country that are now in horrifying and extreme deplorable condition.

    Even if you are travelling with such special vehicles, the squeaking sound that will punctuate every move across the ditches and life threatening bumps will continually confirm to you the toll on your life, on the lives of other commuters and on the vehicles.

    Also, as you crawl through the upsetting stretch at less than 15 Km per hour, you would be confronted by the roadside signs announcing speed limit of about 100km per hour. This is not a joke on the irony of our existence in this part of the world; it is the hard reality. Welcome to Nigeria’s highways of grief!

    An investigation conducted by The Nation shows that most of the federal roads in the Southeast zone have become death traps. From Enugu-Awka-Onitsha road to Enugu-Okigwe-Umuahia-Aba-Port Harcourt road; from Oba -Nnewi -Okigwe road to Anam Kogi road; from Aba-Ikot Ekpene Expressway to Aba- Azumini federal Highways, commuters told The Nation that the situation has become too bad to contemplate. It seems only some of the federal roads in Ebonyi State, which were reportedly reconstructed and rehabilitated by the state government, and a few others are today still in admirable condition, according to our correspondents who commuted along the highways in the zone to witness the situation first hand.

    Our investigation on the state of federal roads is not limited to the Southeast geo-political zone. In fact, reports from our correspondents in other parts of the country, which we will present in subsequent editions, like that of the Southeast (in this first instalment), are also bitter tales of woes, anguish, frustration and pain.

    Aware of the plight and cries of commuters, the Federal Government of Nigeria has not only made promises but has also reportedly awarded contracts for immediate reconstruction and rehabilitation of most of the deplorable roads in the country. Our reporters, who attested that reconstruction and rehabilitation works have actually commenced on some of the roads however reported that in the last few months, some of the contractors stopped works, a development that has worsened the situation and had led to speculations that the government may have abandoned the roads.

    Government agents, who spoke to our correspondents, denied such insinuations, blaming factors like the rains and other contingencies for what they described as the ‘temporary lull.’ But because of the untold sufferings, commuters are not impressed and are therefore calling on the Muhammadu Buhari-led federal government to come to their aids.

    It would be recalled that in April this year, the federal government gave specific reassurance on its commitment to reconstruction of deplorable federal roads in the Southeast when it said it was executing 58 roads and bridges projects in the Southeast geo-political zone alone.

    The then Minister of State for Power, Works and Housing, Alhaji Mustapha Shehuri, who made the declaration in Abuja when he received a delegation from Igbo World Union (IWU) led by its President General, Dr. Mishak Nnata, cited Enugu-Port Harcourt road, Onitsha-Enugu expressway, Onitsha-Owerri road, Ninth mile-Orokam road, Nnewi-Enugu road and Onitsha Eastern Bypass as parts of the ongoing road projects.

    As he puts it: “At the inception of this administration in 2015, we met a lot of mess in the system, particularly, in the area of infrastructure.

    “As I speak to you now, we need nothing less than N3 trillion to fix road infrastructure in the country and as at 2015 when we came in, budgetary allocation for road was just N18 billion.

    “The N18 billion would not have gotten anywhere, but in view of the President Muhammadu Buhari’s commitment to developing infrastructure in the country, the budgetary allocation was increased to over N480 billion in 2016.

    “The allocation was increased, notwithstanding the dramatic fall in the price of crude oil that led the country to recession at the beginning of the administration,” he said.

    He also explained that “the federal government had come up with several initiatives, which included the Sukuk Fund, Presidential Infrastructure Development Fund and Tax Credit Policy to address funding challenges in the execution of the road projects.”

    Given that the same roads the government said it had commenced reconstruction works on seven months ago are still being described as death traps today, observers are curious to know why this and successive governments in the country have remained seemingly unable to fix the roads and save commuters from ceaseless agonies and untimely deaths.

     

    Huge budgets apart, Enugu-Onitsha expressway remains a nightmare

    ENUGU-Onitsha Federal Expressway has been a reoccurring decimal in the Federal Government of Nigeria Budget since 2005.

    But the road can be described as the worst and most dilapidated express way in Africa.

    A normal journey of 1 hour 30 minutes from Enugu to Onitsha now takes close to six hours.

    The rehabilitation of the road project which has appeared in the Federal Government of Nigeria Budget for about 15 years is yet to be half done let alone completed.

    Following are the appropriated amount for the said road from 2005 – 2019 year by year and amount in Naira.

    2005—–N236,368,922.28

    2006—- N2, 052,860,000.00

    2007—- N5,250,000,000.00

    2008—- N800,000,000.00

    2009—- N2,000,000,000.00

    2010 —- N4,800,000,000.00

    2011—- N1,125,000,000.00

    2012— N1,800,000,000.00

    2013—– N3,000,000,000.00

    2014—- N1,500,000,000.00

    2015—– N1,500,000,000.00

    2016 —– N5,468,119,561.00

    2017—– N7,500,000,000.00

    2018 — — N5,634,524,077.00

    2019 —– N2,637,286,449.00

    Total  —- N45,304,159,009.28

     

    As at the time of filing this report, no work was ongoing on the road.

    When our Correspondent made enquiries at the Federal Road Maintenance Agency (FERMA) office in Enugu over the condition of the road, he was referred

  • State House Clinic still crawling

    President Muhammadu Buhari, in the first quarter of this year, ordered reversion of the name of ‘State House Medical Centre’ to ‘State House Clinic’ to return to its original purpose. But the clinic in the past six months is still finding it difficult to attain its past prestigious position in service delivery. AUGUSTINE EHIKIOYA examines the current travail of users of the clinic

     

    THE State House Clinic, created to save lives, is fast becoming a shadow of itself. Apart from the fast dilapidating structures and facilities, the services being rendered in the clinic are at their lowest ebb.

    The clinic, which was recently changed from ‘State House Medical Centre’ to ‘State House Clinic’, was initially created to cater to the medical needs of the first family and State House officials. But it was made a tertiary medical centre under the administration of former President Olusegun Obasanjo, thereby extending its mandate.

    In the spirit of commercialisation to attract more revenues, the services of the State House Clinic were also made open to other Nigerians through the National Health Insurance Scheme (NHIS).

    Many of the outside Villa public workers, who initially picked the State House Clinic as their service provider, have started changing their minds as the clinic is fast becoming less attractive.

    Some patients are said to have transferred their NHIS service provider from State House Clinic to other better and promising hospitals in the city.

    The present situation in the clinic can now be described as jumping from ‘frying pan’ to ‘fire’. Most users now see the State House Clinic as a place for those who do not value their lives and are ready to die.

    Apart from the First Lady, Mrs Aisha Buhari who, a few months ago, raised the alarm over the worsening services at the clinic, President Muhammadu Buhari, in April this year, directed that the name revert to State House Clinic from State House Medical Centre to keep to its original purpose.

    Some of the prevailing challenges at the clinic, according to some users and staff who spoke in confidence with The Nation, are now becoming numerous and unbearable by the day. One of the major challenges presently is the poor electricity supply.

    The hospital is mostly thrown into long hours of darkness the moment electricity supply is disrupted by the electricity company. The alternative functional power generating plant in the clinic hardly comes into use. It’s being kept idle due to unavailability of diesel, insiders said.

    The sources disclosed that on a good day, the generator set hardly supplies up to two hours of electricity to the clinic during frequent power outages. Even at that, permission must be sought from the Medical Director of the clinic before the generator can be put to use, emergency or no emergency.

    With these scenarios, the clinic, they said, is always in darkness day and night. The entire operations in the clinic are dependent on electricity and frequent power outages have completely grounded the power generator. The immediate casualty of the endless power outages is the machines and equipment in the clinic that need to be powered by electricity to function.

    Worried by the situation and to make the clinic more functional, a particular medical doctor is said to always volunteer some amount of diesel to power the generator set for long hours anytime the Medical Director is away from Abuja. In order not to leave the clinic in total darkness day and night, the various units in the clinic have also been supplied with rechargeable lamps by the management.

    Another major challenge, according to sources, is the non-functionality of X-ray machines at the Radiology unit.

    The machine for chest X-ray is said to be malfunctioning as it cannot rotate and turn as expected.

    Apart from most of the machines grounded due to lack of repairs and maintenance, one of the sources said lack of X-ray films have also worked against the functionality of the unit.

    Some patients, who came for X-ray were said to have been turned back for unavailability of X-ray films at the clinic.

    Their phone numbers were written taken by the officials in charge with a promise to get back to them as soon as X-ray films were available.

    The Magnetic Resonance Imaging (MRI) equipment, according to sources, have remained non-functional due to frequent power outages and shortage of diesel for the generator set. The equipment uses the powerful magnetic field, radio waves and computer to produce detailed pictures of the inner human body towards diagnosing or monitoring treatment for conditions within the chest, abdomen and pelvis.

    One source narrated to our correspondent how recently, a certain patient was asked to buy diesel for the generator set to have the MRI test conducted on him.

    The commonplace story of ‘no drugs’ at the pharmacy after doctors’ prescriptions, is fast gaining currency when drug supplies are exhausted.

    Also, most of the ambulances at the clinic are said to be grounded due to non-maintenance and “lack of fuel”.

    The ones still moving around, according to the sources, are empty as they do not have the necessary beds and chairs.

    The extension project of the main building in the clinic, which was started under the administration of former President Goodluck Jonathan, has remained the way it was in 2015.

    Due to lack of consumables, many patients, generally, are also asked to buy one item or the other; like hand gloves before they could be attended to.

    The only unit in the clinic that is performing above average, according to one of the sources, in the laboratory.

    With the falling standard of the clinic, many of the State House staff and other users have been wondering what could be responsible for the dilapidated structures and increasingly poor services at the clinic.

    They keep wondering if budgetary allocations are still being released to the clinic over the years, or if they are being diverted.

    Other questions on their lips include: Was there no benefit accruing to the clinic through collaboration with the NHIS? Are there other unseen factors working against the optimal operation of the clinic?

    Investigations have revealed that releases were far below what was budgeted for the clinic in the past five years.

    Available information revealed that allocations for the clinic in 2018 was N1.03 billion; 2017 – N3.2 billion; 2016 – N3.87 billion; and 2015 – N3.94 billion. However, it was gathered that only N1.2 billion was released for expenditure from 2015 to 2017.

    Speaking to The Nation on the issues, the Permanent Secretary of the State House, Jalil Arabi, attributed the present poor state of the clinic to poor funding and the rendering of its services to the public free of charge.

    For instance, he said, no money has been released for capital expenditure at the clinic in the 2019 Budget. Arabi said it costs the State House N5 million monthly to maintain the MRI, CT scan and other machines at the clinic.

    He said: “Let me give you background information that will help you in passing your judgement. Often, observations, reservations and constructive criticism are done subjectively. The State House Clinic, which used to be State House Medical Centre, is just like any other government hospital.

    “But the State House Clinic happened to be completely different from the perceived government hospitals. No government hospital or facility, I stand to be corrected, renders total free service in this country. But the State House Clinic does, from the point of entry to consultations to test, to examination, you don’t pay a kobo.

    “With all sense of responsibility and respect, if you talk about probably the least attended medical centre within the city, you can’t just go and open the gate and get free service. The least you do is pay for your card. And if there are tests, you have to pay for them. But the State House Clinic doesn’t.

    “And that was why when it was time to face reality, we had to face reality. We were all along relying on subvention. Whatever is appropriated, not even budgeted, because I know that about two years ago, you must have heard the hue and cries that certain amount was budgeted for but nobody could account for it.

    “But of course, that is history because we were able to convincingly tell the public, including Ad-hoc committee of the National Assembly because they ought to know budgeting processes better. You normally indicate your desire, which is your proposal, and then the government thinks of its priorities and makes it a budget. And the National Assembly, in its wisdom, will now appropriate from that budget. And it doesn’t stop there, because you have to rely on what is released to you.

    “We were able to point out all these processes and procedures. We were able to defend it because we came out with documents and we said they were verifiable. At that time, the government’s policy was zero-based budgeting, which directed you to complete projects that were commenced and not to initiate any new one.

    “So from 2015 to date, of course, there was the procurement of equipment based on what was appropriated and what we requested for. But more than 80 per cent of what you see there were projects we inherited, which government was committed to and we were compelled to finish them. So, if there was money, we did, and when there was no money, we don’t.

    “I know people will want to comment about the services they received at the medical centre, but confirm to them that the State House Clinic is run on subvention. At a point in time, we had more than 44,000 patients that came in. We wouldn’t send them away, we didn’t shut the door against them.

    “So, if you are relying on the only subvention and you don’t charge a kobo from patients, unlike other government hospitals, and you have sophisticated equipment to maintain because we have one of the best MRI machines. MRI machines, in particular, have to be left 24/7 with air-conditioners and so on. Where do you get the money to maintain them, it’s through subvention.

    “And then, you have one of the best CT scans, X-ray machines, all these are for free for patients coming in. So also the drugs.

    So, whatever you get as subvention is what is utilized to sustain the clinic.

    “Certainly, the last person to come to take the last drug will be the last person that will get the drug. So, if somebody comes after him, they will say there is none. Because there is no subvention on it, so they will complain.

    “I think with all sense of responsibility, people should be arguing on moral grounds. I am not saying that people must pay through the nose to get medical attention. But we should be able to contribute to our upkeep as much as possible.

    “One of the policies we tried to introduce, even we requested for the President to approve, is that the clinic was meant to be a clinic. It was transformed or made a tertiary institution as a medical centre. But are we getting value for money? No. It just became over-bloated. It was just a glorified clinic in the name of the centre, knowing fully well that it’s not sustainable.

    “So, we felt there is no harm, we can still be good to the public. But what it was conceived to be was to serve a particular purpose, and we have mentioned that to Nigerians. It is high time we knew there were problems, there were gaps.

    “So what we are trying to do as a first step, we say we cannot shut people out. But they should transfer their NHIS profile to the State House Clinic. You cannot have your NHIS service provider in another clinic, and just because of proximity you just walk to the State House Clinic. It is like you are getting it free and overstretching us when as a matter of fact what the HMOs are supposed to remit to the State House Clinic as your entitlement, are going to the hospital that you choose.

    “So, we asked them to transfer their profiles here so that when we serve you as a patient, we can lay claim to the HMOs, which will help us to maintain things you enjoy as a patient. But people don’t want that.

    “There is no way you can have a project that you don’t have enough money to sustain and then you expect it to be the first-class like others that are charging money to survive. That is the reality. People should know and appreciate that a time will come just like you walk to National hospital, Wuse hospital, Asokoro hospital or Maitama hospital and pay.

    .”If you want your complaints to be heard, pay for the service. Then if the services are not extended to you, you have every right to complain. But now, the little we get is what we spend”.

    In spite of the constraints, as stated by Arabi, many still believe that the clinic can be brought back to life given the political will on the part of the authorities concerned.

    The sum of N723,003,927 has been proposed as total allocation for the clinic in the 2020 Budget and waiting for approval of the National Assembly. Bit it’s doubtful if the amount can take the clinic anywhere even if all the budgeted sum is approved and released.

    Some have also argued that accruable benefits of the partnership between the clinic and the NHIS should be exploited and made to have bearing on the effective and efficient running of the clinic.

    According to them, the positive impact of the partnership should be there for all to see, and if there is none, then no harm in reverting to the original mandate for which it was created.

  • How JAMB caught candidates who altered UTME scores

    Pupils who altered their Unified Tertiary Matriculation Examination (UTME) scores are battling to extricate themselves from facing the law. The Joint Admission and Matriculation Board (JAMB) is insisting they must serve as a deterrent to others, writes FRANK IKPEFAN

     

    KINGSLEY Unekwe is 18 years old. He sat for the 2019 Unified Tertiary Matriculation Examination (UTME), organised by the Joint Admissions and Matriculation Board (JAMB). Ordinarily, by now, Unekwe ought to either have written the post-UTME examination in his university of choice or concluded his admission processes in the school. But, instead, he is battling to save himself from being sent to jail.

    Perhaps, if he had known the consequences of engaging in unlawful alteration of one’s original UTME results, he may not have attempted it. But, like most young people of his age, Unekwe may not have thought through the consequences of his act.

    JAMB accused him of manipulating the original result issued to him by the board in May this year, from 201 to 269. He later confessed to the crime during a sitting at the Sheraton Hotels, Abuja, before a panel set up by JAMB to probe cases of alleged ‘double results’ witnessed this year.

    Unekwe is one of four UTME candidates, who may soon be arraigned in court for allegedly altering their examination results. The other three are – Adah Eche (19), Cletus Kokowa, and Rejoice Mordi (19). They were all apprehended between June and September this year by JAMB and handed over to the police for investigation and prosecution.

    Eche was arrested on June 24 for allegedly changing his score from 153 to 290.

    The 19-year-old allegedly confessed to the crime. He confessed that some social media users (whose identities he failed to disclose) helped him to alter the results.

    He said the unknown social media users claimed they could alter JAMB results. Eche said he called the numbers provided by the fraudsters to seek their help to add to his score. What turned out to be a fake result slip was later sent to him.

    Kokowa was arrested in Abuja on July 4 by officials of the Nigeria Security and Civil Defence Corps (NSCDC) on an allegation that he engaged a syndicate to alter his score from 162 to 206 after paying N10, 000.

    Mordi was apprehended on September 8 for allegedly altering her score from 164 to 264. The candidate told JAMB that she got the fake results from an agent identified as Iyanu Oluwa through WhatsApp.

    JAMB seeks prosecution

    JAMB Registrar Prof. Is-haq Oloyede has vowed to ensure that Unekwe and others are prosecuted by the law of the land. Oloyede said his agency has recorded five of such cases of candidates caught in result falsification.

    How the bubble burst

    Unekwe would have been an undergraduate by now, but for his parent’s disapproval. When he wrote the examination in 2018, he scored 232 in that year’s UTME and was offered admission by JAMB to study Geology. But his father, a professor of Medicine of over 30 years standing, was said to have rejected the course, insisting that his son must study medicine. His parents wanted him to study medicine at the University of Nigeria, Nsukka.

    Earlier this year, when Unekwe presented his 2019 UTME score to his parents, they were happy, thinking that their son was on a good path to ending up in the same profession as his father. Unekwe was said to have presented 269, as his score, to his mother, which she printed to process his admission into the university.

    When the school invited him for the post-UTME test, discrepancies were noticed in his score. What the school had from JAMB as his score was 201, while he paraded 269 as his score. Subsequent checks of the result from JAMB portal showed his earlier score of 201.

    Angered by the confusion, Unekwe’s parents caused a petition to be written to JAMB, in which they among others, blamed the examination body for the inconsistencies and demanded that it corrected the error in the result released to their son.

    At the receipt of the petition, JAMB invited the angry parents to its headquarters in Bwari, Abuja, and subsequently to the sitting of its probe panel, which sat in Sheraton Hotels, Abuja. But only his mother turned up with the son. The panel of the investigation was particularly set up by the board to look at cases of alleged double results by candidates, arising from the conduct of the 2019 UTME.

    Initially, Unekwe had tried to play a smart one on the board by insisting that the 269 UTME score was his original result, not knowing that the software used by JAMB had registered his activities.

    For a long time, he maintained his initial story, insisting that he never tampered with the UTME result issued to him. At some point, his story almost made him the victim. But that story soon changed after he was shown evidence of the several attempts he made to check his result.

    In the course of the panel’s proceedings, members excused mother and son to enable them to have a private moment where the mother conversed with his son on the issue. When they returned about 30 minutes later, the story changed.

    Unekwe told members of the panel and reporters (who witnessed the proceedings) how he allegedly manipulated the initial score to reflect the 269.

    He said: “When JAMB released results, people were checking and I was checking mine and nothing was coming out. People were checking and getting their results, so I gave a friend my phone to help me check. When he came, he showed me 269 as a screenshot.

    “But when I went to my room and shut my door and checked, I saw 201. I was shocked and checked again, it was 201, that was when my dad called if I had seen my result and I said no, I have not seen it yet. He now said okay, I should leave till the next day.

    “The next day, I still saw 201. I was now confused. When my parents asked again, I showed them 269.”

    Reacting to the turn of event, the mother said she felt betrayed and dumbfounded by the boy’s revelation that 201 was his actual score. “I’m dumbfounded. Had it been he told me all this, we won’t have come here,” she said.

    Possible causes

    Unekwe’s case brings to the fore a possible negative effect of parental influence on children, as often noted by Oloyede. He had repeatedly blamed parents for the increasing rate of examination malpractices in the country.

    Oloyede had accused parents of putting pressure on their children beyond their strength. He once argued that the pressure from parents often prevents children from focusing on their areas of strength.

    “Because your father is a professor of Medicine, he wants you to study Medicine at all cost. That is the problem; that is where parents create problems for their kids and that is why you got yourself involved in this type of faking in other to convince them.

    “You are the fifth person. Two of them are already being prosecuted because we showed them clearly that they forged their results to deceive their desperate parents like your parents are for you to study medicine.

    “We will prosecute you for attempting to damage the image of the board. We told your father that we have all the facts, if we find out that the facts are not correct you will be prosecuted,” he said about Unekwe’s case.

    What the law says

    Under the Criminal Code Act (applicable in the Southern part of the country), forgery is an offence. The Act provides, in Chapter 44, two to three years jail term, with an option of fine, as punishment for forgery. The Penal Code Act (applicable in the Northern part) also has similar provisions (with a maximum of 14 years), where the guilt of the alleged offender is proved.

    On the offence of forgery, the Criminal Code Act reads: “Any person, who forges any document, writing, or seal, is guilty of an offence which, unless otherwise stated, is a felony, and he is liable if no other punishment is provided, to imprisonment for three years.”

    The task before the prosecutor

    A rights activist Sunday Essienekak, said: “Forgery can be found under Section 262-380 of the Penal Code Law of the Federation. And, under the Criminal Code, which is available in the South, the punishment for forgery is about two to three years. The punishment in the south is lower than the punishment in the north. And the provision for forgery in the south is provided under Section 293-312.”

    Essienekak, who is a public interest litigation lawyer, added: “If they (alleged offenders) have forged documents and are brought before the court and the court convicts them, the years and terms of imprisonment can extend to fourteen years imprisonment with an option to pay fine.

    “But before they can prove forgery, the state or JAMB must be able to show that the document was forged and that the boy was in possession of that document and that he had knowledge that that document was forged and that he wanted to dishonestly use it.

    “Those are the things that the prosecution must have to scale through. They must prove that the document was forged, they must prove that the guy knew that the document was forged, they must prove that he was in possession of the forged document then they must also prove that he intended to use that document for a purpose either to his advantage or to his disadvantage.”

    JAMB’s strategies against malpractices

    On JAMB’s strategies against malpractices, Oloyede said unknown to some fraudsters, the board was ahead of them. He said that JAMB has decided to release candidates’ results directly to institutions of their choice to forestall situations in the past where candidates falsified results and presented them to their institution for admission.

    Also, JAMB’s Head of Information, Dr Fabian Benjamin, said that the board has cancelled the results of the candidates. He said that anybody who does post-result infractions will have their results withdrawn by the board.

    Benjamin said that the board would continue to act responsibly in its fight against infractions. The JAMB spokesperson said that whosoever was found wanting would be dealt with according to established laws irrespective of his/her position in the society.

    He said: “Our major preoccupation in this area is to keep the various laws concerning examination malpractices active, we will not abdicate our responsibilities and whoever is found wanting will be dealt with according to established norms and laws irrespective of his/her position in the society. Our staff are not exempted from this renewed resolve on the board.

    “To announce clearly that it’s no longer business as usual, the board has spread its anti-examination malpractice dragnets to all nooks and crannies of the nation. Malpractices as it affects public examination, implied infractions before the conduct of examination, during registration, at the conduct of examination and after an examination.

    “Even when admitted, a candidate could be apprehended and accordingly punished if found to have benefited from such unholy acts. The good news here is that we are committed to screening candidates all through the processes even after they are admitted.

    “At the moment we are running checks on candidates currently in our tertiary institutions through several platforms and once anyone is caught, he/she will not only be expelled but prosecuted.

    “We advised any candidate who had benefited from any infraction to own up before it’s too late and for upcoming candidates to stay away from such acts as with our present facilities, they will certainly be caught.”

    JAMB’s deterrent measures

    The JAMB spokesperson explained that over 200 candidates were arrested for one infraction or another during the 2019 UTME.

    He said some of the candidates were arrested during registration exercise and are being prosecuted, adding that the board has secured several convictions in Zamfara and Kebbi states.

    “A good number was equally arrested during the main conduct and after the examination, some were arrested for result falsification.

    “The recent arrests are those arrested for result falsification. About seven candidates were arrested for falsifying results and claiming that the board issued them two separate results.

    “Such candidates were invited to come forward with their claims and when confronted with proofs they confessed that they forged the results due to pressure from their parents for them to read programmes that require higher score and because they scored less they decided to falsify the results not knowing that they could be detected.

    “These candidates are presently being prosecuted and the board is determined to follow up to ensure that they are convicted to serve as a deterrent to other,” he added.

     

  • Tracking DFID’s £400m humanitarian cash

    The Department for International Development (DFID), a United Kingdom (UK) government’s department responsible for administering overseas aid, is executing 52 active projects worth £400 million to help Nigeria overcome humanitarian challenges through promoting sustainable development and eliminating world poverty, Foreign Desk Head BOLA OLAJUWON writes.

     

    MILLIONS of people in the Northeast rely on humanitarian assistance to survive, according to the United Nations (UN) Office for the Coordination of Humanitarian Affairs.

    Despite significant improvements in 2017 and 2018, the food security and nutrition situation remains fragile in the Northeast, with 2.7 million people in the Borno, Adamawa and Yobe (BAY) needing food assistance in 2019. More than five million people need health assistance, with two-thirds of health facilities in the BAY states being damaged by the conflict. Basic survival needs are also compounded by access and security impediments in other affected Northern states.

    The Department for International Development (DFID), in a recent statement, said it had committed N18.5 billion to address the deteriorating nutrition-related crisis in Borno, Yobe and Adamawa states from April 2019 to March 2020.

    The fund is expected to succeed in eight areas, notably community-based management of acute malnutrition, infant and young child feeding practices, micronutrient supplementation, health, child protection, water and sanitation hygiene, early childhood development and surveillance.

    Aside the Northeast crisis, critical national needs are also grim. The agency and other international bodies are also supporting the Federal Government in meeting the  needs and other international goals such as Sustainable Development Goals (SDGs).

    Executing 52 active projects totalling £400 million in Nigeria

    The DFID is assisting Nigeria to fill the required humanitarian and national needs. The United Kingdom (UK) aid arm is presently executing 52 active projects totalling £400 million in Nigeria. So many projects have been executed in the past. But, the projects, which began on October 10, 2006, will end on August 31, 2027, lasting 21 years.

    From report collated by The Nation from Project Trackers, the projects’ are focusing on critical areas, which include health, disaster relief, government and civil society, banking and financial services, multi-sector, education, industry, refugees, environment, other social infrastructure and services.

    Philosophy behind operation

    Stressing the philosophy behind its operation, DFID said it knows Nigeria is facing many challenges to its future growth. It believes that conflict continues to affect its oil-rich delta region and there is a violent Islamist insurgency in its Northeast, a situation, which keeps causing a humanitarian crisis.

    According to the UK agency, despite significant natural resources, about a third of Nigerians – about 60 million – live below the national poverty line with another third just above. The agency said many of those living below the national poverty line are highly vulnerable and at risk of being trafficked to the UK.

     DFID: Fed Govt taking the lead to tackle issues

    The UK agency said though the Federal Government is taking the lead to tackle these issues, it struggles with corruption as well as the capacity and resources. The agency noted that it focused on helping Nigeria to overcome these challenges through its goal of promoting “sustainable development and eliminating world poverty”.

    Nigeria is one of the top 10 countries where DFID works, others are Pakistan, Bangladesh, Ethiopia, Afghanistan, Syria, Tanzania, Yemen, Uganda and South Sudan.

    Records from past and current projects

    According to statistics, no fewer than 6.49 million children under five and pregnant women were reached through DFID’s nutrition-relevant programmes from 2011/12 to 2015/16. Also, 450,000 children were supported by the agency in primary and lower secondary education between 2011/12 and 2015/16. From 2011/12 to 2015/16, 5.13 million people were reached with one or more water, sanitation or hygiene promotion intervention. It was also established that 780,000 births were delivered with the help of nurses, midwives or doctors through DFID support between 2011/12 – 2015/16. Ten thousand additional women used modern methods of family planning through DFID support between 2011/12 and 2015/16.

    Plethora of projects

    The Nation learnt from the agency’s website that a project, “Financial Sector Development Programme”, designed to enhance stability in Nigeria’s financial sector and expand access to financial services for the poor, began in October,10-10-2006, with a budget of £38,699,992.

    Another project is “Support to National Malaria Programme, Nigeria”, which aimed at strengthening the delivery of National Malaria Control Effort in supported states. The implementation started on January 08, 2008 at a cost of £29,376,390.

    Another is titled: “Deepening Democracy in Nigeria”. It aimed at strengthening the democratic character of Nigerian political processes and outcomes by providing support to key electoral bodies with technical assistance.

    “This will benefit numerous Nigerians and change their perception about the non-counting of votes during elections. This will contribute to broader good governance by encouraging Nigerians to turn out massively to vote during elections and this will result in the election of credible leaders,” DFID said on its website. The ongoing project began on August 04, 2009 with a budget of £35,139,989.

    Also, “UK Action Against Corruption (UKACT) Programme”, which started on December, 09, 2009, with a budget of £39,126,318, was designed to reduce the incentives of corrupt individuals in developing countries to use the UK to launder money; and for UK business and nationals or their agents to bribe in developing countries. The programme is geared towards increasing UK law enforcement’s capacity to trace, confiscate and return stolen assets to developing countries and to tackle bribery in developing countries.

    According to DFID, “working to Improving Nutrition in Northern Nigeria (WINNN)”, is aimed at improving nutrition by providing treatment of malnutrition, including community-based management of acute malnutrition (CMAM), vitamin A supplementation and deworming and promotion of improved infant and young child feeding (IYCF) practices. The project will benefit 6.2 million children under five across five states – Kebbi, Katsina, Jigawa, Zamfara, and Yobe – in northern Nigeria.

    “This will reduce the prevalence of stunting, wasting and underweight by at least 4 per cent over the six years. This will contribute towards our MDGs targets by achieving a 43 per cent reduction in childhood mortality (220/1000 live births to 125/1000 live births) in Nigeria. The implementation date was July 15, 2011, with a budget of £61,300,275.

    Some other projects are: “Girls Education Project (GEP) Phase 3” designed to improve social and economic opportunity for a girl with a budget of £88,299,996 and Teacher Development Programme meant to improve student learning in six states in Northern Nigeria for six years. The teachers’ programme, the website indicated, will be achieved through creating a cohort of 66,000 more effective teachers of Mathematics, Science and Technology and English.

    “For every year that these 66,000 teachers continue in service, they will improve the learning outcomes of up to 2,000,000 students in primary and junior secondary schools. In the Colleges of Education, a total of 816 lecturers, working in Primary Education and Junior Secondary School Departments, will be trained. In turn, 4,000 student teachers will benefit from improved training through pre-service methods in Colleges of Education,” the website said. With a commencement date, which reads October 18, 2012, the project will cost the UK government £34,073,456.

    Also, “World Bank Governance Partnership Facility Programme”, which is to improve management of public finances, by working to improve their transparency, increasing citizen engagement in their use, and on better service delivery, started on October 31, 2012, and it will cost £18,999,999.

    As part of its private sector development programme, DFID, through CDC Group Plc, granted Indorama Eleme Fertiliser & Chemicals Limited a debt investment loan to fund a project to build and operate a fertiliser production facility. As well as being a major job creator in the region, the investment aims to contribute to improved farm yields and agricultural productivity, which are critical to Nigeria’s long- term food security. The project, which started on February 18, 2013, did not provide budgetary cost.

    Also included are Women for Health (W4H) Programme, Child Development Grant (CDG) Programme, Rural and Agriculture Markets Development programme for Northern Nigeria (PrOpCom Mai-Karfi); Advocacy for Primary Health Care Reform, Maternal and Newborn Child Health Programme, Sanitation, Hygiene & Water in Nigeria (Phase 2), British Council – Nigeria.

    Also included are CSSF Northeast Nigeria Conflict Management and Stabilisation, Fleming Fund – Country and Regional Grants and Fellowships Programme, Others include Anti-corruption in Nigeria Programme, Nigeria Security & Justice Reform Programme, North East Nigeria Security and Conflict and Stabilisation Programme, Nigeria Security & Justice Reform Programme, Northeast Nigeria Security and Conflict and Stabilisation Programme and Northeast Nigeria Transition to Development Programme, Nigeria Countering Organised Crime and Corruption, Nigeria Delta & Maritime Security and Stability Programme.

    Others are: Chevening Scholarships in Nigeria, Nigeria Delta & Maritime Security and Stability Programme, Frontline Diplomatic Enabling Activity (Economic Security and Opportunity) in Nigeria, Contributing towards Eliminating Blinding Trachoma in the Commonwealth, Supporting Human Rights, Democracy and the Rules-based International System in Nigeria, Partnership for Learning for All in Nigerian Education – PLANE and Promoting Learning in Agribusiness using New Technologies.

    Organisations, which assist the agency in carrying out the projects, include PeaceWorks Action Against Hunger (UK); ActionAid International; Adam Smith International; AECOM; Africa Network for Environment & Economic Justice; African Revival; Amnesty International (UK) and others.

     

  • Understanding preventable deaths’ most common cause

    Although thrombosis or blood clot in the deep veins of the body is treatable, experts say it is the most common cause of preventable hospital deaths, reports Associate Editor ADEKUNLE YUSUF

     

    THROUGHOUT her husband’s service years, which entailed active involvement in local and foreign military operations, Mrs Lizzy Payok admitted that the fear of losing her sweetheart constantly reduced her to an emotional wreck. “I was daily worried about dangers and hazards of warfare,” she said. But it was not an ambush bullet, bombing or landmine that took her husband’s life ten years ago. Rather, it was a blood clot in Mr. Payok’s leg that was left to fester, which ultimately travelled to his lungs and killed him and his blossoming military career.

    Unlike the gallant soldier who succumbed to pulmonary embolism (a blood clot that breaks off and travels to the lungs), Eniola Adunni, a teacher, still lives to tell her story. In August 2016, Adunni, 35, was overjoyed after delivering a bouncing baby boy – her first. It was a pretty easy delivery, with everything appearing perfect until things almost turned haywire. As is the practice in the private hospital she patronized, she and the newborn were placed on observation for a few days before they were discharged. However, just before going home with her bundle of joy, she felt a Charley horse in her left leg and reported to the nurse on duty, who assured her that it was not a big deal.

    To be doubly sure, a day after she was discharged, Adunni said she called her doctor to intimate him of her condition. Not a person that leaves things to chances, she reported for a medical check-up immediately. Like the nurse, the doctor also allayed her fears, assuring her all was well. Yet the pain progressed from minor to an excruciating level. Days after, when the pain refused to abate, she had to return to the hospital – this time a better one. Tests later showed that there was a blood clot in her leg. She was admitted to the hospital with a week-old baby in tow. In a nice twist of fate, she survived the treatment, having been diagnosed as suffering from a pulmonary embolism brought on by blood clot formations in the veins of her leg. Many are not that lucky, as haematologists insist a blood clot left untreated can lead to serious complications, including death.

    Deep vein thrombosis explained

    According to Prof. Sulaimon Akanmu of the Lagos University Teaching Hospital (LUTH), deep vein thrombosis (DVT) is a condition caused by the formation of potentially deadly clots or blood that has turned into solid form within the blood vessels. When the blood clot forms in the vein, part or whole of the clot can detach and travel in the circulation to lodge in the lungs, causing a condition referred to as pulmonary embolism (PE). Both DVT and PE are collectively referred to as venous thromboembolism (VTE). The risk factors for developing VTE are many and varied. High-risk factors include hospitalisation, with up to 60 per cent of all VTEs are hospital-associated. This also includes hip and knee surgery and estrogen-based therapy. While moderate risk factors are age (60+), personal or family history of blood clots, cancer/chemotherapy and estrogen-based therapy, its other factors include obesity, pregnancy or recent birth, smoking and alcohol consumption.

    Arteries have thin muscles within their walls to be able to withstand the pressure of the heart pumping blood to the far reaches of the body. Veins don’t have a significant muscle lining, and there is nothing pumping blood back to the heart except physiology. Blood returns to the heart because the body’s large muscles squeeze the veins as they contract in their normal activity of moving the body. The normal activities of moving the body return the blood to the heart. Being mobile causes this blood return system to fail, and the resulting stagnated blood may clot.

    There are two types of veins in the arm or leg; superficial veins and deep veins. Superficial veins lie just below the skin and are easily seen on the surface. Deep veins, as their name implies, are located deep within the muscles of the extremity. Blood flows from the superficial veins into the deep venous system through small perforator veins. Superficial and perforator veins have one-way valves within them that allow blood to flow only in the direction of the heart when the veins are squeezed.

    There are both superficial and deep veins in the limbs or extremities (arms and legs). A blood clot in the deep veins is a concern because it can cause life-threatening complications. A blood clot (thrombus) in the deep venous system of the leg becomes dangerous if a piece of the blood clot breaks off or travels through the bloodstream, through the heart, and into the pulmonary arteries forming a pulmonary embolism. A person may not have signs or symptoms of a small pulmonary embolism (blood clot in the lungs), but a large embolism can be fatal. Risk factors for blood clot formation include immobility, a genetic tendency toward blood clotting, and injury to veins or adjacent tissues occurs. For DVT or blood clot in the leg, symptoms include pain, swelling, warmth, tenderness and redness of the leg or arm. Doctors diagnose the condition is with blood tests, and then is confirmed by ultrasound or other imaging tests.

    According to experts, a blood clot (thrombus) in the deep venous system of the leg or arm, in itself, is not dangerous. However, it can become potentially life-threatening when a piece of the blood clot breaks off and embolises and travels through the circulation system through the heart, and enters into one of the pulmonary arteries and becomes lodged. This can prevent blood from flowing properly through the lung and decreasing the amount of oxygen absorbed and distributed back to the body.

    Blood is supposed to be fluid. But if circulation becomes sluggish, which can happen to anybody after sitting for hours without moving, doctors explain that a gel-like clot can form inside the veins. If a blood clot develops in a deep vein, usually in the legs, it’s known in the medical parlance as DVT. If the DVT blood clot breaks off and travels up to the lungs, it becomes a pulmonary embolism (PE). While DVT and PE are the same diseases, their symptoms are different because the blood clots are in different locations in the body, explained Prof Akanmu. By itself, a DVT is not life-threatening. But a PE can be. It can clog an artery in the lung, robbing the body of much-needed oxygenated blood. Between 20 to 30 per cent of people with a DVT will develop a PE, he said, adding that most people with PE will survive if they access medical treatment immediately.

    Why is VTE important

    According to the Nigerian Society of Haematology and Blood Transfusion (NSHBT), VTE, which the body said its prevalence is increasing in Nigeria, is important because of its high rate of morbidity and mortality. It is also important to know about DVT because it can happen to anybody and can cause serious illness, disability, and in some cases, death. The good news is that DVT is preventable and treatable if discovered early.

    In a communiqué signed by Prof Aisha Gwarzo and Dr. AbdulAzizz Hassan, president and secretary of NSHBT president, respectively, VTE is said to be sometimes “asymptomatic, misdiagnosed, unrecognized and untreated or undertreated.”

    “VTE is a potentially deadly condition because the symptoms are not specific. Some of the symptoms, which include pain, leg swelling, warmth, discolouration of the leg for DVT and shortness of breath, chest pain, rapid breathing and lightheadedness for PE can be mimicked by several other medical conditions.

    “It is relatively common with an incidence of one in one thousand in older adults. The prevalence has been reported to be increasing in Nigeria. Up to 14.9 per cent of patients admitted to medical service and up to 40 per cent admitted to surgical service will have VTE without appropriate prophylaxis. The danger of VTE lies in its silent nature and has been reported to be the most common cause of preventable hospital death. VTE is potentially fatal but highly preventable. The good news about VTE is that most of the cases are preventable,” NSHBT said.

    Akanmu, a professor of haematology and blood transfusion and former president of NSHBT, said no fewer than 50 per cent of patients on admission in Nigerian hospitals may develop DVT. VTE kills mostly before needed specialised medical intervention is obtained, he said during a press conference organized by Sanofi, a multinational pharmaceutical company, to mark the 2019 World Thrombosis Day.

    Although the actual statistics on DVT-induced deaths in Nigeria is not known, thrombosis is responsible for 370,000 deaths in Europe, far higher than the number of deaths from AIDS, breast cancer, prostate cancer and traffic accidents combined. It is estimated that thrombosis is responsible for 1 in 4 deaths worldwide and remains a leading cause of mortality in the world. Prof. Akanmu cited a research study in 32 countries showing that 50 per cent of patients admitted in surgical wards and 30 per cent of those admitted in medical wards had thrombosis risk.

    A similar study conducted in 14 African countries, including Nigeria, also revealed the same result. However, less than 20 per cent of the African patients had a diagnosis of thrombosis risk while only a fraction of them received correct thrombosis prophylaxis. According to him, thrombosis is more common among patients in the hospital than individuals at home. Thus, if an individual in the hospital is evaluated and found to be at risk as high as 40 per cent, such a person is most “hundred per cent likely” to develop thrombosis before he leaves the hospital. “This is why we say when anyone is on admission bed, please let them be subjected to thrombosis risk,” he stressed.

    Even in the United States, the precise number of people affected by DVT/PE is said to be unknown, although as many as 900,000 people could be affected, resulting in about 100,000 premature deaths every year. This translates into 1 to 2 per 1,000 each year in the US. Available estimates suggest that as high as 60,000-100,000 Americans die of DVT/PE yearly, with reports suggesting that 10 to 30 per cent of people will die within one month of diagnosis. Sudden death is the first symptom in about one-quarter of people who have a PE, with experts predicting that one-half of people who have has a DVT will have long-term complications (post-thrombotic syndrome) such as swelling, pain, discolouration, and scaling in the affected limb.

    DVT management and treatment

    DVT can cause pain, swelling, and redness or purple discolouration of the skin in an armour, most commonly, the legs. PE can cause chest pain and shortness of breath, which may lead to coughing up blood or fainting. Doctors said the risk of DVT and PE increases in people who sit for long periods without moving, such as on lengthy car trips or long-haul flights. To prevent a first or subsequent DVT and PE experience, wearing compression stockings on long car rides and flights are advised. If possible, alcohol consumption should be avoided, while drinking plenty of fluids, such as water, can play the role of dehydration in travel-related DVT events. During long-hour flights, travellers are also enjoined get up from their seat as much as possible or make frequent stops if driving on a long journey, at least every two to three hours.

    If detected and reported early, DVT can be easily managed or treated, haematologists said. Essentially, its treatment is aimed at disallowing the clot from getting bigger and preventing it from breaking loose, thus stopping DVT from snowballing into a pulmonary embolism, which is more life-threatening. The most common treatment employs the use of blood thinners or anticoagulants. Either when injected or taken as pills, these are drugs that reduce a person’s blood’s ability to clot. Although anticoagulants don’t break up existing blood clots, they can prevent clots from getting bigger, thus lowering a person’s risk of developing more clots.

    In cases involving a more serious DVT or pulmonary embolism, clot busters or thrombolytics are also used because they break up the clots quickly. Clot busters are either administered intravenously to break up blood clots or through a catheter placed directly into the clot, but they are generally reserved for severe cases of blood clots because of side effects. For those not willing to take medicines to thin their blood, hope lies in the use of a filter, which can be inserted into the vena cava or a large vein in the abdomen. With the help of a vena cava filter, clots that break loose can be prevented from lodging in the lungs.

    Dearth of haematological experts

    As preventable VTE is, it is not easily recognizable by non-specialist doctors. This why Prof. Akanmu lamented that the dearth of specialists and equipment for the management of thrombosis in Nigeria is contributing to the crisis. According to him, most cases of thrombosis in Nigeria are often detected during post-mortem. To buttress this, he revealed that the few available figures on thrombosis in the country are obtained through post mortem studies.

    However, Sanofi, a multinational pharmaceutical company, has stepped into the fray by raising awareness campaigns and training all categories of medical personnel so that all hospital workers in the country are skilled in the diagnosis and management of VTE. According to Folake Odediran, general manager, Nigeria-Ghana Sanofi, the company has embarked on a massive awareness campaign to address VTE challenge as part of the company’s community social responsibility (CSR). She disclosed that the process has been integrated into the company’s business strategy to better meet patients’ needs. The company, she further said, is focusing on capacity building and partnership with healthcare associations to drive awareness on VTE.

    She added that Sanofi was launching its ‘VTE Safe Zone programme’ in major health institutions across the country to help improve the care of hospitalised patients and reduce their risk of a VTE.

    “The programme is focused on educational programmes for doctors, pharmacists and nurses, development of VTE risk assessment tools and setting up of institutional thrombosis committees. This project has been successfully implemented in UCH Ibadan and is in the pilot phases in UNTH Enugu, UBTH Benin and AKTH, Kano. We have also partnered with healthcare associations like the NSHBT to disseminate the first-ever VTE guidelines to guide healthcare practitioners on management and prevention of VTE,” Odediran said.

     

  • Furore over transfer of NDDC to Niger Delta ministry

    BOLAJI OGUNDELE writes about concerns over the recent transfer of Niger Delta Development Commission’s (NDDC’s) supervision from the Secretary to the Government of the Federation’s (OSGF’s) Office. 

     

    SHORTLY after being appointed as Niger Delta Minister, Senator Godswill Akpabio ‘attacked’ the Niger Delta Development Commission (NDDC), which at that point was being overseen by the Office of the Secretary to the Government of the Federation. Some wondered why he was talking as if the interventionist agency was under his ministry.

    Akpabio, The Nation learnt, took his initial steps on the NNDC because he was instructed to focus on the NDDC’s activities, but stakeholders in the Niger Delta were not briefed about the new development. So, when the minister started executing his new mandate, virtually all the critical stakeholders in the Niger Delta found it absurd.

    President Muhammadu Buhari’s Independence Day nationwide broadcast, however, sorted it out by placing the NDDC under the ministry. According to the president, it would make the commission better placed to deliver on its mandate.

    However, there is a snag; the legality of Buhari’s ‘new intervention’. The apex Itsekiri national mouthpiece, the Itsekiri Leaders of Thought (ILoT), in a response by its National Secretary, Sir Amorighoye Sunny Mene, said the President’s new turn was unlawful, suggesting rather that the commission and the ministry control their individual budgets, but should be partners in the task of developing the region.

    “We want the government to stick to the law. Besides, we don’t want the NDDC to be bogged down by several layers of bureaucracy with the attendant patronage. Let the Ministry of Niger Delta Affairs manage their budget, but partner the NDDC and other developmental agencies when necessary,” he said.

    Another Itsekiri body, the Iwere People’s Congress (IPC), in a statement, observed that the transfer of supervisory authority of the commission from the Presidency to a ministry was a violation of the law that established it. Provisions under NDDC Act, the group said, are explicit enough.

    ”Under Part II of the Act ‘Functions and Powers of the Commission, etc.’, specifically in Section 7(3) of the Niger Delta Development Commission (Establishment etc) 2000 Act No 6, Laws of the Federation; it was clearly stated that: ‘The Commission shall be subjected to the direction, control or supervision in the performance of its functions under this Act by the President, Commander-in-Chief of the Armed Forces of the Federal Republic of Nigeria.’ Also, Part VI, Section 23 of the Miscellaneous Section of the above stated Act also infers that, ‘Subject to the provisions of this Act, the President, Commander-in-Chief of the Armed Forces may give to the Commission directives of a general nature or relating generally, to matters of policy with regards to the performance by the Commission of its functions and it shall be the duty of the Commission to comply with the directives.’

    “What the above-stated provisions signify is that the Establishment and Control of the Commission is the responsibility of the Presidency as provided for under the Act, which states summarily that the organisation will be run under the directives of the President of the Federal Republic of Nigeria. The above position is what will better serve the interest of the Niger Delta people, to do otherwise, is to short-change the region. For anything to be different, the Niger Delta Development Commission (Establishment etc) Act will have to be amended under due process to reflect any such change.

    “However, it is also trite to state that, the Commission is older than the Ministry of the Niger Delta as the Commission was established under the Obasanjo Presidency while the Ministry of the Niger Delta was established under the Yar’Adua Presidency; we do not think it is right, therefore, to place the Commission under the control of the Ministry of the Niger Delta. The Niger Delta people will prefer that the running of the Commission be left the way it is. We wonder if the NDDC is to be supervised by the Niger Delta Ministry, why do the members of the Commission have to go through Senate confirmation as it is the practice with agencies under the Presidency. Why also does the NDDC budget require Senate approval?”

    A group, Accountable Leadership for Better Nigeria Initiative, last week threatened legal action if the government failed to rescind its action within 14 days, starting from October 10. According to a petition by counsel to the group, Tolu Babaleye & Co, and addressed to the Attorney-General of the Federation and Minister of Justice, Mr Abubakar Malami (SAN), the group said it is going to court at the expiration of the 14-day ultimatum.

    “We shall take to our clients’ outstanding instructions of taking the matter to court at the expiration of the time stated above if the matter is not resolved to the knowledge of Nigerians. Our clients are a reputable organisation with commitment and passion for an orderly society and a better Nigeria. They believe that things are done by leaders, following the laid down legal standards to engender good governance for the betterment of the citizenry. Our clients, as good governance watchdogs, wish to use this medium to express their displeasure and sadness over the recent illegal and unlawful action taken by the duo of the Minister of Niger Delta Affairs, Mr. Godswill Akpabio and the Chief of Staff to the President, Mr. Abba Kyari, which if not checked might lay a bad precedence in the country. Our clients feel very strongly that this must be brought to the notice and knowledge of the Chief Law Officer of the Federation and Justice Ministry to unearth the underlying factor necessitating such action,” the petition read.

    The Pan Niger Delta Development Forum (PANDEF led by the Ijaw elder statesman, Chief Edwin Kiagbodo Clark, and other leaders of ethnic nationalities across the oil-rich region, said its concern was not about the change of the supervisor to the commission, but how the Ministry of Niger Delta Affairs would combine its statutory role with maintaining sanity in the commission.

    PANDEF’s National Secretary, Dr Alfred Mulade told The Nation that the president’s argument could not be faulted.

    “The explanation proffered by Mr President for the relocation of the NDDC to the Ministry of Niger Delta could not be faulted in its face value. The worry lies in the capacity of the ministry to provide effective coordination and supervision alongside its primary objectives, for the region. What matters most is the political will to effectively fund the NDDC and the Ministry to enable them deliver on their respective mandates to the people of the Niger Delta region,” Mulade said.

    The apex socio-cultural organisation of the Urhobo ethnic nationality, the Urhobo Progress Union (UPU), said its primary concern was the effective performance of the NDDC and not the supervising body, adding that the commission had failed in that regard. Its National Publicity Secretary Abel Oshevire said people of the region expected that the commission should do better under the ministry.

    “What the Urhobo people want from the NDDC, just like other stakeholders, is performance. Who supervises the Commission is only a matter of semantics, whether the Presidency or the Niger Delta Ministry, is not an issue to the people of the region. What matters to the people of the Niger Delta now is an NDDC that will develop and transform the place into a status befitting an oil-producing region. The NDDC has failed to live up to the expectations of the people since its establishment more than 15 years ago. It has been more of a curse than blessing to the region. It has been all stories of corruption, leaving the region poorer and under-developed with each successive administration.

    “It is expected, however, that bringing it under the Ministry of Niger Delta Affairs should produce better result since the minister is from the region and the people should hold him accountable. One hopes that he will not play politics with it and strive to ensure that the Commission lives up to the expectations of the people. One is also confident of the new NDDC to do better, given the track records of the new board members. Both the Chairman, Dr Pius Odubu, and Managing Director, Olorogun Bernard Okumagba, are men of proven integrity, who have distinguished themselves in their previous public offices,” he said.

    The last has not been heard about the decision to make a ministry with less than N50 billion budgets to supervise an agency with over N80 billion budget.