The Nation Newspaper

Tag: health

  • Ekiti elders’ chief condemns Fayose’s outburst on Buhari’s health

    Ekiti elders’ chief condemns Fayose’s outburst on Buhari’s health

    A chieftain of the Ekiti Council of Elders, Dr. Bayo Orire, has criticized Governor Ayo Fayose’s claim that the All Progressives Congress ( APC) presidential candidate Gen. Muhammadu Buhari is suffering from health challenges which might hamper his capacity to function as President if elected.

    Fayose had alleged during last Tuesday’s presidential campaign rally of President Goodluck Jonathan in Ado-Ekiti that Buhari looked sickly and was deliberately planted as opposition presidential candidate to re-enact the crisis that trailed the uncertainty of the health status of the late former President Umaru Yar’Adua.

    But Orire, who is a medical doctor, lampooned Fayose for making what he called “unguarded clinical assumption” against Buhari’s health advising the governor to face the task of governance and convincing the electorate in Ekiti of the worth of the candidate paraded by his party.

    The former Chairman of Ekiti State Hospitals Management Board who spoke with reporters on Sunday berated the governor for his unrelenting attacks on the person of former President Olusegun Obasanjo advising the Ekiti chief executive to settle any issue with the retired general amicably rather than attacks on the soap box.

    He argued that “a well-cultured Yoruba man does not abuse elders recklessly” saying it is only a politician that is bereft of ideas that will leave issues and be attacking personalities.

    Orire, who is also the Publicity Secretary of the APC Elders’ Forum in the state said Nigerians are tired of the PDP stranglehold on power for 16 years at the centre and are determined to use the opportunity of next month’s general elections to effect a change.

  • Health workers vow to continue strike

    Health workers vow to continue strike

    MEMBERS of Union of Allied Health Professionals (NUAHP) have vowed to continue their strike, which has paralysed hospitals.

    They blamed the Federal Government for not meeting their six-point demands two months after the industrial action started.

    NUAHP President Felix Faniran said this yesterday while addressing a news conference at the University College Hospital (UCH), Ibadan.

    But, hospital wards at the UCH, Ibadan were deserted yesterday and some out-patients, who were around, could not be attended to.

    Those on admission have been forced to discharge themselves as they could no longer access the needed healthcare services.

    However, Faniran advised the president to resign “because of his seemingly incompetence and failure to handle situations in the health sector.”

    He asked the government to show some level of trust by implementing the agreements reached with the unions as well as court judgments.

    Faniran mentioned the minimum conditions for suspending or calling off the strike as including:  the immediate release of the circular on adjustment of salary, immediate payment of two months arrears on newly adjusted salary structure with the promise to pay the remaining in 2015 budget and the immediate release of circular on the payment of arrears on skipping of CONHESS 10 salary.

    Other demands of the aggrieved health workers include: the immediate issuing of circular on retirement age of healthcare workers from 60 to 65 years, payment of arrears of specialist allowance to all hospital-based healthcare professionals, who possess a relevant post-graduate qualification, and release of circular amending the extant circular for medical laboratory scientists interns to include post-NYSC placement on Grade Level 09 Step 2 and stale officers across board.

  • ‘Obesity exposes a child to dangerous health conditions’

    ‘Obesity exposes a child to dangerous health conditions’

    Mrs. Iwalola Akin-Jimoh, a nutritionist and member, advisory board of the Ovie Brume Foundation speaks on the growing spate of child obesity in Nigeria and its health and psychological implications; even as she urges early preventive measures.

    While it might be said that Obesity in children in Nigeria has not reached an alarming stage, it nevertheless calls for concern seeing that cases liter our exclusive private schools; can you give us a current statistics?

    I cannot give you any statistics at this point in time, but to say that it is not yet at an alarming rate is something I won’t agree with. It’s quite alarming at this point in time, and the problem of obesity actually takes roots from the way you feed your infant, when the child is born right through the type of diet that the child is weaned on. I mean you can talk about private schools, where it seems to be obvious, but I really think the situation in which we’ve found ourselves needs urgent attention.

    There are controversies on whether obesity is a disease in itself or a condition; could you please explain obesity in simple terms?

    Obesity is a situation that predisposes somebody to certain other conditions, to certain diseases. For example, if you’re obese, you’re susceptible to high blood pressure, hypertension, cardiac diseases, and diabetes mellitus, particularly in adults. So it’s more like a dangerous condition that predisposes you to other diseases.

    Some people take pride in having their children looking chubby, especially at the early stage. What have you got to say to this?

    It’s good for a child to look healthy, but he doesn’t have to look overweight. When you have your infant, you should take him through a process called Growth Monitoring at a health centre, where they will measure his weight and height and let you know if he is thriving. If the child is overweight or prone to obesity, they would tell you.

    Is there a specific measurement of weight for height for children or even adult?

    Yes we do. For adult, you take your BMI and for a child, there is a standardised Growth Monitoring Chart, which is approved by the Federal Ministry of Health and which is actually used in all government health facilities, and approved private health facilities. The chart gives a range of what height is supposed to be for a particular weight. There is a range that tells you a child is healthy, malnourished, underweight and even overweight.

    What’s the difference between being overweight and being obese?

    When you’re overweight, your Basic Metabolic Index is probably over 25. The Basic Metabolic Index has a formula that you use to calculate it. Many people have questioned the authenticity of the BMI because if you’re familiar with the Nigerian population, you find out that almost everybody is overweight. And when you get to a certain range, you say somebody is obese; and when you get to another range, you say somebody is morbidly obese. The Basic Metabolic Index, which is a relationship between your height and your weight, actually tells if a person falls within any of these ranges. It is important to note here that there are certain tests that are also performed on individuals, because a person may be overweight and his biochemical parameters remain okay. Also, a person may be within the normal weight range, while already showing high cholesterol level. You might also be within the normal weight and already have high blood pressure. It’s just that when you’re obese, it predisposes you to some of these conditions. So once a person is above 40, 45; there is need to continuously check a lot of biochemical parameters in your blood, to see how you’re fairing health-wise.

    Obesity also seems to be more common amongst children of the upper-class and middle-class? Why is this?

    It’s actually related to diet. If you look at Lagos for example, you’d find that a lot of the upper-class parents are very busy. They don’t pay extra attention to diet and you find that their kids in the morning take cereal, sausage and chips, which is very high in calories diet. In the afternoon, they go for rice and maybe a quarter of a chicken, which is way too much. And in the evening, they go for maybe white bread, egg and sausage again. So the diet that a lot of kids in the upper-class take might actually contain a lot of fat, a lot of sugar and very high carbohydrate diet. Sometimes, it is also very high in protein, way beyond what you need. And when you take too much carbohydrate and protein, it is converted and stored under your skin. So your diet provides enough for you to meet your energy needs, it is excellent. Rather than consuming way more than you need and having it works against you.

    Do you then subscribe to the opinion that obesity is more common amongst the rich and upper-class?

    Being overweight has nothing to do with your economic class. It has to do with your diet. If you don’t eat right, you have a tendency to have malnutrition, irrespective of your economic class. Malnutrition can be over-nutrition or under-nutrition. Over-nutrition is a category in which we have the manifestation of obesity, which means you’re over-eating. And whether you’re living in Ajegunle or Mushin, if you fall in this category, you have the tendency to become obese. In children, it might not be very obvious, but in adult, it is quite evident. If you look at the Nigerian population; you’d find that people are overweight, irrespective of their economic class. I’m not saying that people are also not undernourished, but when you look at the trend in the last ten years and also project into the next ten to twenty years; you’d find that Nigeria could actually have a population in which a lot of people will actually be overweight, because they’re not just eating right.

    The general opinion is that obesity is preventable. How so?

    You can actually start preventing obesity right from infancy by breastfeeding your child exclusively for six months; all breast, no water. At least ensure that you do this for the first three months of your maternity leave. Even when you have to go to work, you can still manage by breast feeding them when you are at home; and by extracting and storing when you know you would be at work. Also, you can use weaning milk, peradventure you cannot give your child exclusive breast feeding, and stick to the instruction on the can. Do not give four level spoons, when the instruction says three, just because you can afford it. In any case, no health worker will encourage a mother to raise her child on infant milk, except in health cases such as when the mother is HIV positive etc.

    How do you reverse obesity in a child?

    To reverse obesity, you need to place the child on a diet, because the truth is your weight is almost 70 per cent of what you put in your mouth and 30 per cent of your physical activities. But you shouldn’t cut back too much on the protein because the child needs protein, but you’re reducing the fat. You shouldn’t cut back too much on the milk because the child needs calcium; you should not cut back on things like legumes, beans and all that, because the child is still growing. And then you want to increase the child’s physical activities. If you can afford it, swimming is actually a very good sport that engages the whole parts of the body and even strengthens the back. You might want to enroll the child in aerobics, dance class and generally increase his/her physical activities. So the child is exercising and also enjoying himself. Even simple exercises like brisk walking will go a long way. So you can use increased physical activities and diet modification to help a child lose weight. Another thing: if your child is used to ice cream, chicken and the likes, you don’t cut it out totally; simply reduce the portion size, otherwise when you turn your back, he goes back and binge on it. For a more effective approach, parents who can afford it should also see a dietician or nutritionist. Virtually all teaching hospitals has departments designated for them. The sooner the issue of a child showing signs of obesity is addressed, the better.

    Aside the health implications, there are psychological issues, which seems to even assail obese children much earlier. Do you have experiences to share in this regard?

    Of course it affects them psychologically and leads to issues of self-esteem because in a case where they are just one or two looking like that in a class, the tendency is for their mates to call them names such as orobo, facto and all of that. And it cuts through even the public schools, because we do a lot of work with public schools. It might even affect their studies in the long run, because they become too self-conscious. And then during sports there is the issue of performance, in which you might not be able to run as fast as your colleagues or compete generally in physical exercise. This does not necessarily apply academically though. Talking about the female gender, the image that is posted out there  whether on the internet or on the television; is the idea that an attractive lady is one who is slim and shapely. And if you’re obese, you don’t tend to fit into this image and it affects the way you look at yourself. And so parents really need to pay a lot of attention to this, so that when their children are obese, they help them get through the difficult period of self worth. The fact that you have only one body and cannot get a spare one in the markets, means that you need to strive to keep it as healthy as possible. Obesity is a condition that you don’t even want to find yourself. You should also cultivate the habit of taking fruits and vegetables. It is bad enough that children don’t like vegetables and fruits; but to now let them perpetrate a diet that is devoid of them means that you’re setting them up for something that will not benefit them in the future. Besides, if you don’t bring them up to take fruits and vegetable, how do they in turn transfer this healthy health habit to their children? Exercise is also key. A lot of parents lay too much emphasis on academic success, such that the child hardly pays any attention to physical exercise of any sort. And that is extremely harmful to a child because a child has a lot of energy. They need to learn how to multi-task and manage their time effectively. An active sports life will also help them avoid sedentary life and help then burn up extra calories and energy even when they over-eat. It is important for a child to start laying the foundation for healthy muscles rather than fatty tissues.

  • Health workers vow to continue strike as FG stops salaries

    Health workers vow to continue strike as FG stops salaries

    Health workers in the country have vowed not to end the ongoing nationwide strike until the Federal Governemnt addresses all the issues of dispute.

    The leadership of the health workers also urged its members not to succumb to the intimidation and tactics of the governemnt.

    Health workers under the umbrella body of the Joint Health Sector Union and Assembly of Health Care Professionals (JOHESU) in a statement issued in Abuja yesterday urged its members to press on with the strike action despite the stoppage of their salaries. The union has been on partial strike action since  November 12, 2014.

    A statement signed by the  JOHESU President,  Ayuba Wabba, and ten others, “urged all members to remain steadfast and do everything lawful to sustain the struggle, so as to ensue that the present acts of neo-colonialism and slavery in the health sector are put to a stop.”

    The group also expressed sadness that the government’s response had failed to meet its expectations.

    The group also  accused the government of not taking them serious, thereby foreclosing the possibility of resolving the issues of dispute.

    Expressing the union’s frustration at resolving the pending issues, the group had in December, 2015 said: “At the last meeting between the Federal Government and JOHESU on November 19, 2014, the government requested for 24 days to look into all our demands and consequently fixed another meeting for December 15, 2014.  Disappointingly at the meeting, key officials of the Federal Ministry of Health notably the minister, permanent secretary, and directors were conspicuously absent, thereby stalling the meeting.

    The group also accused the government of using the police to brutalize its members, an action the JPHESU said was against universal industrial actions.

    Wabba, therefore, warned that if the personal attacks and threats continued,  it would lead “to a breakdown of law and order in our health institutions similar to that witnessed in the ABUTH and other hospitals in the 1990s.”

    They also added,  “We are disturbed that instead of government showing concern and demonstrating commitment towards bringing an end to the plight of Nigerians and health workers by addressing the issues and restoring public health services, it resorted to acts of intimidation.

    The JOHESU president called on all well-meaning Nigerians to call on the Federal Government to live up to its constitutional obligation of respect for the rule of law by implementing the collective agreements reached since 2009 till date.

    The group said: “This is a struggle foisted on us and inasmuch as we find it painful to prosecute with our sincere concern for common Nigerians, we are left with no choice but to take this path of struggle as we call on the Federal Government to toe the path of honour and justice.”

  • Al-Makura: there’s no problem with my health

    Al-Makura: there’s no problem with my health

    Nasarawa State Governor Umaru Tanko Al-Makura has dismissed the rumour that his health was deteriorating.

    The governor, who spoke through his Director of Press, Yakubu Lamai, blamed the insinuation on the handiwork of attention-seeking politicians.

    Al-Makura said he was hale, hearty and alive.

    In a statement in Lafia, the state capital, the governor said he was reacting to the rumour because many people were making mischief out of the situation.

    He said there was no truth in the rumour, adding that the people were being fed with lies through the various media platforms.

    The statement reads: “Given the fact that we live today in an era of information chatter, where people are constantly bombarded with countless competing messages from various media platforms – ranging from television, radio to online sources – it sometimes becomes necessary to clarify and buttress what is true from what is a lie.

    “In this regard, our attention has been drawn to rumours being peddled, mostly online and by word of mouth, that the health of Governor Al-Makura is at risk or in question.

    “We wish to assure the entire citizens of Nasarawa State and confirm with clarity that Governor Al-Makura is alive, hale and hearty and in excellent health.

    “We recognise that this is an election campaign period and publicity strategists are likely to use every available tool to gain public attention, including the peddling of unfounded rumours about His Excellency’s health.

    “But Governor Al-Makura is no stranger to political campaigns, and he appeals to all and sundry to concentrate on making the ongoing campaigns and the forthcoming elections issue-based.”

     

  • Health for next generation through Universal Health Coverage

    When I served as a paediatrician in Rwanda’s public hospitals, I devoted myself to building a future where children could reach their full potential without fear of disease.  Today, as Rwanda’s Minister of Health, I can attest to the great progress our country has made to improve the health of everyone living in the “land of a thousand hills.” But I also recognize how critical it is to keep pressing onward, not only as a country, but also as a continent.

    Africa is home to some of the fastest growing economies in the world, but the benefits of this progress have not been felt equally.  For far too many, basic health care remains out of grasp. Millions of Africans simply do not have access to health facilities staffed with trained workers, or even to experienced community health workers. Even for those fortunate enough to live in close proximity to a health facility, many cannot afford to pay for basic healthcare services.

    The time has come to commit to making affordable, quality health care the cornerstone of Africa’s development. Several African countries have taken a stand on providing health services to all their citizens, and their efforts are already paying off through healthier communities.

    Twenty years ago, Rwanda was a nation devastated by genocide and war: Nearly eight in 10 people lived in poverty, our health system was all but destroyed, and one in four infants didn’t make it to his or her fifth birthday. Today, even though we still have a long way to go, Rwanda is flourishing. This is due to many factors, including a collaborative governance structure that aims to extract the most value for our people from the money spent. Rwanda’s visionary approach to prioritizing the nation’s health has also been instrumental in achieving this progress.

    Combining national resources with international donor support, we have developed a system to improve both geographic and financial access to quality basic care for all Rwandans.  Through our community-based health insurance scheme, called Mutuelles de Sante, approximately 90 percent of the population has health insurance, with another seven percent reached through civil, military, or private insurance. Even in the most remote villages, Rwandans can rely on local community health workers to deliver 80 percent of the preventive and primary care services and connect them to advanced care when needed. Under this system, Rwandans can access care without fear of financial ruin.

    The results of this approach, driven by a deep commitment to health equity, have been striking: Since 2000, infant mortality has decreased by 66 percent, child mortality has decreased by more than 70 percent, and deaths from HIV, malaria, and TB have fallen by nearly 60 percent.  Rwanda’s children were the first in sub-Saharan Africa to receive the vaccines for pneumonia and the human papilloma virus (HPV).

    Other African nations are also making important strides towards universal health coverage. Each country is developing its own model to provide coverage for its people—informed and influenced by our distinct cultures, histories, populations and settings. For example, in Nigeria, President Goodluck Jonathan has been a vocal supporter of universal health care and the National Health Insurance Scheme has recently intensified internal reforms. Going forward, it is necessary that each country feel ownership of both the successes and failures of the approach they opt to take.

    Whatever the approach, health systems should be participatory in nature, ensuring that communities provide “buy in” to the value of having health insurance, as well as a sustained political commitment to scale up these efforts.  This will help ensure that no one remains beyond the reach of efforts to provide affordable, quality care.

    The need for universal health care has never been greater throughout the world, and especially in Africa. Despite commendable progress in health over the past decades, Africa still faces the highest burden of disease, and continues to have far too many weak health systems. The recent Ebola epidemic has highlighted what is at stake for all of us if we fail to invest in both strong health systems alongside good governance.

    Health coverage is also a major financial challenge. Millions of Africans suffer financial hardship due to catastrophic expenditure whenever they are sick. According to the World Health Organization, about half of health care expenses in our region are paid out-of-pocket, and a 2009 study in Health Affairs found that one in every three households in Africa must borrow money or sell their possessions just to pay these fees.

    No family should have to choose between getting well and going bankrupt, especially when we’ve witnessed what a powerful force national health care can be for stability and economic growth. When governments invest in affordable health care, the whole population is healthier.  There are real economic benefits: there is less absenteeism at work, and the money saved by avoiding these consequences of poor health can be invested in building stronger futures for families and communities. School fees can be paid, new business can be started, and households can build savings.

    Politically, there has never been a better time for us to invest in universal health coverage. Two years ago today, the United Nations unanimously endorsed universal health coverage. Global institutions such as The Rockefeller Foundation and, more recently, The World Bank, have elevated the benefits of UHC globally, and to date more than 80 countries have asked the World Health Organization for assistance in implementing universal health coverage.

    Today, we mark the anniversary of this landmark decision with the first-ever Universal Health Coverage (UHC) Day, a global call-to-action that has garnered unprecedented support from more than500 organizations.

    As we look beyond the 2015 Millennium Development Goals, African leaders face an incredible opportunity: If we invest in our health systems now—which we know yields an impressive return for the investment—we can build an Africa where individuals, families, and entire nations reach their full potential. Together, we can chart a course for a stronger, more resilient Africa and world.

    • Binagwaho is Minister of Health, Rwanda

  • Protecting health workers from infections

    Protecting health workers from infections

    The Ebola Virus Disease (EVD) imported into the country in July showed the high risk health workers are exposed to. The index case, the late American-Liberian Patrick Sawyer, infected several health workers, including the late Dr Stella Adadevoh. How can health workers tackle infections? This was the thrust of a two-day training in Lagos. OYEYEMI GBENGA-MUSTAPHA reports.

    Prof Agbaje Onini (not real names), a Consultant Paediatrician at the Lagos University Teaching Hospital (LUTH), Idi-Araba, with over 20 years  experience, had a close shave with HIV when a two-year old child living with the virus was brought for treatment.

    There was the need to take some blood samples for analysis and the determination of the viral load. The resident doctor and the nurses had a huge task of obtaining the sample because the child was throwing tantrums. At a point, the needle was inserted into the arm of the child, but the vein was missed. The needle with some blood was withdrawn.

    Prof Onini, drawing from his experience, then offered to calm the child, to facilitate the drawing of the blood sample.  He succeeded. He held her arm, asked the mother to hold her well and beckoned on the resident doctor to take the sample. As the doctor was about inserting the needle, after ascertaining the point of the vein, the child, obviously scared of the needle, jerked its arm  twisted her body, and the blood stained needle went into the professor’s arm.

    He immediately washed his hands and other skin surfaces, and observed other Post-Exposure Prophylaxis (PEP), which involved taking anti-HIV medications.  A few weeks later, he went for screening and, luckily, he tested  negative to HIV.

    A Professor of Medical Microbiology and Parasitology, Prof Folasade Ogunsola, said that was a close  shave.

    “For the consultant paediatrician should have asked the blood stained needle to be discarded, in a provided box, not minding the cost of purchase and go for a new one. And in spite of his wealth of experience and exposure, he skipped some global best practices,” said Prof Ogunsola.

    Mrs Ogunsola, the Provost, College of Medicine, University of Lagos (CMUL), said occupational transmission of infections to health care workers is common because fewer people observe infection control guidelines in their workplaces.

    Speaking as a resource person at the two-day workshop for healthcare practitioners drawn from across the country, on global best practices, Mrs Ogunsola told the participants: “As a health care worker, you may be exposed to many sources of infection. Infections may be transmitted by blood, body fluids, air, respiratory secretions or by direct contact with other infectious materials. You can protect yourself from infection by following the infection control guidelines in your workplace, by using personal protective equipment (such as gloves and masks) and by treating all blood and body fluids as though they are infectious.”

    According to her, diligence in the following areas is needed to help reduce the risk of occupational transmission of infections to health care workers.

    She said: “Administrative efforts are needed. Here in Nigeria, some infection control guidelines are not put in place in some workplaces. And sometimes, when these provisions are made, they got stolen or vandalised out of ignorance or sheer carelessness. Hence, all health care organisations should train health care workers in infection control procedures and the importance of reporting occupational exposures. Organisations should develop and distribute written policies for the management of occupational exposures.

    “Development and promotion of safety devices should be prioritised. Effective and competitively priced devices, engineered to prevent sharps injuries should continue to be developed for health care workers who frequently come into contact with, for example potentially HIV-infected blood. Proper and consistent use of such safety devices should be continuously evaluated.

    “Monitoring the effects of Post Exposure Prophylaxis (PEP) is important. Data on the safety and acceptability of different regimens of PEP, particularly regimens that include new antiretroviral agents, should be monitored and evaluated continuously. Furthermore, health professionals who administer PEP should communicate possible side effects before treatment starts and should follow patients closely to make sure they take their medicine correctly. Though these recommendations focus on the hospital setting, the recommendations for personal protective equipment (PPE) and environmental infection control measures are applicable to any healthcare setting.”

    The convener, Dr Efunbo Dosekun, president of Anu Dosekun Healthcare Foundation, spoke on part of the reasons for the event, with the theme: ‘Introductory workshop on infection prevention and control’ said: “Though these recommendations by Prof Ogunsola focus on the hospital setting, the recommendations for personal protective equipment (PPE) and environmental infection control measures are applicable to any healthcare setting.

    Dr Dosekun said: “Healthcare personnel (HCP) refers to all persons, paid and unpaid, working in healthcare settings who have the potential for exposure to patients and/or to infectious materials, including body substances, contaminated medical supplies and equipment, contaminated environmental surfaces, or aerosols generated during certain medical procedures. HCP include, but are not limited to, physicians, nurses, nursing assistants, therapists, technicians, emergency medical service personnel, dental personnel, pharmacists, laboratory personnel, autopsy personnel, students and trainees, contractual personnel, home healthcare personnel, and persons not directly involved in patient care (e.g., clerical, dietary, house-keeping, laundry, security, maintenance, billing, chaplains, and volunteers) but potentially exposed to infectious agents that can be transmitted to and from HCP and patients.

    “Simple life-saving techniques of hand washing, cleaning with bleach or disinfectants are fast fading away. That is why, more HCPs are contracting infection. It is amazing how people don’t protect themselves again from airborne and aerosol diseases. As a health care worker, you may be exposed to many different sources of infection. Infections may be transmitted by blood, body fluids, air, respiratory secretions or by direct contact with other infectious materials. You can protect yourself from infection by following the infection control guidelines in your workplace, by using personal protective equipment (such as gloves and masks) and by treating all blood and body fluids as though they are infectious. This workshop discusses some of the infections that may be transmitted at workplaces and ways HCP can avoid getting them. And what to do when exposed.”

    She said the basics are: “Consider every patient to be infected and avoid contact with his or her blood or body fluids. Avoid risky behavior when using needles and other sharp instruments (including scissors, scalpels, blades and knives). For example, do not attempt to recap needles. Carefully dispose of sharp instruments in appropriate contain, (including gloves and face shields), to avoid getting blood on your skin or in your eyes when you are performing procedures that may cause splashes or spills. And be certain you are immunised against hepatitis B. Get tetanus vaccine as well. This vaccine should be offered to you in your workplace.”

  • ‘Review Health Insurance Law’

    A call has been made for the review of the law establishing the National Health Insurance Scheme (NHIS) to enable Nigerians benefit from it.

    National President, of Healthcare Providers Association of Nigeria (HCPAN) Dr Adenike Olaniba,  said though the scheme is commendable, “the enabling law that brought it into existence is limiting more Nigerians from having any form of health insurance coverage.”

    She spoke during the association’s 10th  anniversary in Lagos.

    According to her, there is a clause in the law that established the scheme that makes it optional for Nigerians to have health insurance.

    Dr Olaniba said: “We believe that the clause should be reviewed for it will create an avenue for all Nigerians to apply for health insurance. If reviewed, every Nigerian will have a form of health insurance coverage. About 96 percent of unreached Nigerians are in the informal sector.

    “As we are agitating for the uploading of all facilities in Nigeria unto the scheme, we also point out that the N400 Capitation under Mobile insurance is not acceptable. We should maintain the status quo of N750 per enrollees, in the face of fuel increament and other factors.”

    She said members want the decentralisation of both  certification and inspection of facilities. Because some facilities, though inspected have not been issued cerificates, NHIS does not have enough capacity to do both.

    “HCPAN commends the scheme for its extensive coverage for ensuring the provision of qualitative healthcare to federal civil servants; pregnant women and children less than five years of age,” said Dr Anibaba.

    She called for a structured health care delivery system to make funds and resources available for the benefit of citizens. She said though the health care providers were ready to deliver services to the best of their ability, primary health care centres were still substandard.

    Urging the government  to equip primary health centres  to make them perform optimally, Dr Anibaba said: “When these facilities are upgraded to meet global standards, health workers will be more dedicated to improve the health status of their patients and community by providing accessible, affordable, quality health care services to everyone, regardless of ability to pay. The NHIS under the leadership of the Executive Secretary, Dr. Femi Thomas had gone to higher levels, but much still needed to be done  to truly make health care delivery universal.”

    Mrs Olaniba said the advent of the NHIS had depleted the resources of many private health care centres, instead of boosting them; urging the Federal Government to spread funds and enrollees between the private and public health sectors to make for balance and proper care.

  • State of Kano’s tertiary health institutions

    SIR: The efforts of Kano State government in establishing new schools/colleges that will add value to the socio-economic status of the state is commendable. I refer to the coming of the School of Nursing, Madobi; School of Health Technology, Bebeji; School of Midwifery, Dambatta, and others.

    However, what is obtainable in the School of Nursing, School of Hygiene, and School of Health Technology, all in Kano in the area of human resources and laboratory equipment leaves much to be desired. It can only result in the production of half-baked graduates.

    The School of Nursing, Kano has few qualified and competent academic staff majority of which are diploma holders, which fall below the minimum requirement for teaching. Graduates’ lecturers are an insignificant few. Laboratory and other instructional media are also lacking. Where they exist, they are obsolete or dilapidated, hence the need for new and modern ones.

    The School of Health Technology shares the same fate. Indeed, the actually lost its accreditation to run community health for some years. As for School of Hygiene, though there are many graduates lecturers, majority specialise in physical  and health education or general health education which cannot satisfy the different specializations in environmental health, which the school is running. Besides, many new courses like ‘Diploma in Epidemiology’ and others were introduced even when there were no competent lecturers to handle it, thus jeopardizing the future of students who could not get the best in their chosen course. In fact, the school still lacks a well-equipped laboratory.

    For these schools to remain relevant, the state government should as a matter of urgency dig into the activities of the schools and do the proper things by overhauling the management.  In an age of globalisation, our health institutions should not be in the hands of those who cannot see beyond their noses. Let the proper things be done by getting the best hands to run the institutions. I am sure, Governor Kwankwaso is more than committed to leaving worthy legacies for the state.

     

    • Musa Zubair,

    Kano

  • Managing inter-professional relationships in health sector

    The past few years have seen a gradual widening of the gap between professional and operational staff within the health sector. There has been a clamour by the allied-health professionals challenging the existing roles of the medical practitioners in the sector and an increased agitation for a greater degree of participation in the decision-making process.

    Indeed serious conflict which have often degenerated into violent physical combat have occurred between practitioners who share the same physical operational space and several groups of allied-health professionals who have requested for greater degrees of autonomy in the discharge of their duties as against the dictates of the existing chain of command which places them under the supervision of the physicians. This has particularly been a nagging problem in the Laboratories and Medical Imaging Departments.

    Thus, the current state of inter-professional relationship in the Health sector is characterized by mutual suspicion, undue competition and rivalry, violation of intra- and inter-professional chains of command, sabotage of efforts of competing practitioners and at times outright hatred of other professionals.

    The PATIENT, who is the reason for the establishment of the sector, is the first casualty in this crisis.

    Several factors are responsible for the present state of things. One of which is the increasing demand for greater roles and greater authority in the management of patients by the different healthcare professionals in the hospital setting.

    The health sector, like other multi-professional systems like the aviation industry, the university system and even the manufacturing industry relies on each of the different groups of professionals contributing in different ways to the overall management of the patient. The reasons for this demand for greater roles may be too numerous to mention, but prominent among them is the desire by allied health professionals to achieve greater recognition as professionals within the hospital system and in the administrative reckoning of the civil service bureaucracy as well as in the eyes of the public. It could also be the desire by allied-health professionals for equal financial reward and recognition with the physicians, since the success of his efforts in managing an illness now depends on contributions from other professionals.

    There has also been a persistent failure of collective bargaining with all professional groups in the health sector through the years. Since the early days of the sector, aggrieved professional groups are usually engaged by government or its organs individually whenever their individual grievances were brought to the table rather than collective engagement with all groups to ensure that granting the desire of one group does not infringe on the perceived comfort or operational zones of another.

    In today’s modern healthcare system, the consequences of strained inter-professional relationships have serious implications for healthcare delivery. Imagine a patient who is admitted in a teaching hospital ward in Nigeria who by the time he spends five days on such admission would have encountered numerous healthcare workers of different professional orientation. The number of health workers to see a patient could be as many as 50 in countries with more sophisticated healthcare systems. Another immediate consequence of strained relationships is non-existent or poor communication channels between different categories of professionals. Hence the patient is confronted with conflicting instructions, suspicious practitioners which eventually affects the patient’s psyche, erodes public confidence in the health system and overall treatment outcome. Indeed whether we acknowledge it or not, the absence of these inter-professional communication lines affects patient’s morbidity and mortality because it stalls their investigation, evaluation and eventual treatment.

    The parlous state of inter-professional relationships in the sector has also encouraged the growth of a most undesirable culture of “territorialism” which has caused the decline of true, professionalism among practitioners. Each professional group converts its professional roles and even physical operating space into a “territory” that must be “guarded jealously” against any “violation” by any perceived competitor(s).

    Sadly, this odious culture of “Territorialism” is being passed to junior/up-coming practitioners. Strained inter-professional relationships have also led to the creation of complex, unwieldy organizational structures within each profession that only serves to nourish egos and reduce productivity. It has also contributed to the poor image of the public health sector among our fellow citizens and is a festering problem that requires urgent intervention.

    It stands to reason that as in many other sectors of the economy, the health care sector is also not immune to class struggle which has pitched the doctors against other professional groups in the hospital. The struggle for class distinction and leadership tussle by doctors has created acrimony among other professional which has not augured well for the overall effective discharge of their duties.

    In finding solutions to this challenge however, may involve a multi-dimensional approach.  Government at all levels must put in place policies that recognises the different roles of health professionals but at the same time encourage inter professional working relationship.

    The World Health Organisation (WHO) in 2010 defined inter-professional collaboration as a situation where: “Multiple health workers from different professional backgrounds work together with patients, families, caregivers, and communities to deliver the highest quality of care”. This is essentially a situation where Health care professionals assume complementary roles and cooperatively working together, sharing responsibility for problem solving and making decisions to formulate and carry out plans for patient care.”

    The key word here is “together”.  This model was also suggested by the Institute of Medicine (IOM) the American health policy think-tank as a veritable tool for improving multi-disciplinary care of patients. Critical components that make up this concept must however be put in place for it to succeed. These include: Clear role definition/role clarification of professionals in the health team. There should be clear, unambiguous guidelines  stipulating the roles, responsibilities and limits of all the different professionals in the sector. This surely has always existed in some form, but the lines of responsibility have been blurred in recent agitations. The Federal Ministry of Health has a role to play in this regard.

    There is considerable evidence that inter-professional team work enhances communication, reduces errors, and improves patient outcome and satisfaction as well as staff satisfaction. These outcomes also lead to enhanced patient/client self-care, knowledge and outcomes, provider satisfaction, skills and practice behaviours. It can also lead to system enhancement such as provision of a broader range of services, better access, shorter waiting periods and more effective resource utilization.

    Building effective healthcare systems does not depend on technical factors or infrastructural adequacy alone. Human factors are extremely important. We must advocate for inter-professional collaboration amongst ourselves because collaboration “divides the task and multiplies the success”. The timeless words of Mattie J.T. Stepanek may be very useful at this juncture: “Unity is strength. When there is Team work and collaboration wonderful things can be achieved”.

     

    Prof Olatinwo is Chief Medical Director, University of Ilorin Teaching Hospital