Tag: Public health

As  stated in the first part of this article,  the word policy has been defined, described and explained in many different ways by many authors and  for the sake of simplicity, only  three of these were selected,  to let us know how and why any  decision by Governments at any level to do something about major health problems of a people or to  ignore  issues relevant to the yearnings and aspirations of ordinary people concerning their quality of life simply constitute intrigues and manipulations in  public policy. By way of  recall, a notable  Scholar, Ira Sharkansky defined  policy  as actions taken by government whereas another Author Dye  writing three years later sees policy as whatever government chooses to do or not to do . A  fairly succinct definition  of public policy is the one  put together by  Augustine Ikelegbe, a Nigerian world class and well known   expert on policy matters . According to him,  a  vital characteristic  of  policy  is that  leaders, groups or organizations  elect to make a choice among  apparently competing alternatives for the  benefits of  all concerned. Put in another way, public policy involves top  people  in government, and the  people  who are bound by law to  accept with little or no arguments the choices and decisions taken by the people in power.

In  practice and particularly for the ordinary man  what is fundamental to the issue of  public policy bother on ACTION. It is either that something is done or nothing is done.  Many have argued  that many of the experimental policy modules  that were  tried during the  periods of military rule  yielded good results , probably because  the Military ruled by decrees and so  much of the achievements recorded in that period  was the result  of the military style approach in the processes of policy formulation, particularly during the stages of  implementation, monitoring and evaluation.  It has been argued that in the past few years,  democratic  systems in this country have  functioned in the duo of the actors in government and the social class in power with so many people trying to ensure  their separate  demands ,concealed  or obvious become manifest. Experts in policy analysis  contend that it is in fact  perplexing  that many of the highly placed individuals involved in policy making and analysis during these post war periods  and  who presided over and may even have been deliberately or inadvertently responsible for failed policies have had the privilege of  being part of succeeding  governments. Sadly, the insinuation is that over the years, dishonesty has been at the front seat  with regards to issues concerning public health ,such that even when    heads of Governments genuinely mean well for the  people they govern, other interest groups; mainly from the social class in power  very quickly abduct the  whole system with the result that   it becomes   a matter of intrigue versus intrigue perpetuated by these persons from one government  to the other  to the detriment   of the ordinary man.

This has continued to defy  efforts by  concerned Nigerians, mostly  members of the academia to successfully  find solutions.  It explains why nothing  is working  and we  continue to  go  one step forwards and two steps backwards  in terms of access to essential medicines, poverty eradication(as opposed to poverty alleviation) elimination of extreme hunger as opposed to reduction, among many others .

As new and strange diseases continue to declare their presence in populations, now is the time to take a closer look at   our health care delivery system; where we are, where we are supposed to be , what we have achieved as opposed to what we are expected to have achieved. In this respect, taking stock must necessarily include asking our selves pertinent questions and then  finding honest answers to them.  Carrying out a thorough check or appraisal of successes and failures should include identifying the human factors  responsible for these failures.  Permanently circulating certain categories of people in the orbits of different systems of governments with nothing good to show is one reason we are stagnating. Giving way for  vibrant  young men and women with the right education, commitment to innovation  and experience to, come in and force a turn around  instead of  square pegs in round holes will enable us tap the wealth of human resources available in this country.  It should not be considered appropriate at all times to ask what you can do for your country; at times it is  time  a country was asked to explain what had been given to hard working citizens by way of good food, shelter, healthy environment , affordable education  as well as  high quality but affordable  health facilities.

Whereas,  relevant  institutions  in Nigeria are  yearly rolling out thousands of  intelligent resource persons, they are readily lost to labor markets outside the country, where they acquire additional training  and  become inventors and innovators.  On the other side of the divide, It is equally disheartening to hear of foreign consultants  managing  the policy directions of this country  in many areas which  most often require taking decisions  on matters directly related to the lives of ordinary citizens.  How much  do these consultants from foreign countries  know about our culture?  What yardsticks are available to measure the extent of their commitment? Not surprising therefore that even before any of these issues leave the tables where they were discussed, more than half of the money(denominated in dollars or euros) allocated is  wasted on  meeting the non essential  demands  associated with these persons whose background we know little or nothing about. Frequently, Nigerians only become aware of their existence or participation when huge amounts of money allocated to a vital sector is discovered (never reported) missing.

Way forward

There is  natural fear on the part of some  scientists  and research investigators that with the passage of time, unseen organisms; most likely viruses may gradually take over and inherit the earth.

As I write this piece, seven  out of the 36 states of the country have registered confirmed cases of bird flu. Like the virus responsible for Ebola bleeding fever,  the single most important    measure for preventing spread  is hand washing with soap and water. Just assume that  particles of the Ebola virus managed to enter  one or two bags of sachet water  and  such infected bags got into the kitchen of a boarding school?

We therefore urgently need to do something about ensuring that  safe water is available and in adequate quantities. There should be regulatory policies on  the production of bottled water, and drinks, to involve among others  analysis for bacteriology, and metal toxicity. Some states in the country have no provision for waste disposal and yet many of the bottles, cans and plastics containing drinks and food items are recycled.  The infection potential of  these  containers is  unknown.

A casual or unceremonious visit to animal slaughter houses  in our cities will reveal how lucky indeed we are to be alive. Most of them are located near slow moving, stagnant or oxbow lakes, from where water is taken to clean or wash whatever is finally taken to the markets. What ever you find in a shopping mall most certainly passed through these very unhealthy places and it should be known that dangerous microbes can survive ice cold conditions for as long as six weeks, just as you also have organisms capable of surviving boiling or oven temperatures

Who are the people overseeing these places and the activities taking place there. Health services provision involves many players  and intersectoral collaborations. The  re emergence of  forgotten, but  highly infectious diseases like Ebola virus disease means we should package and sustain public health policies that will enable  specially trained personnel rise up to  epidemics anytime they declare themselves. It is important to note that despite the impressive drop  in the  number of people dying from ebola virus disease, there has also been an increase in the number of new infections. This means that it will be unwise  for anyone currently travelling to and from Ebola stricken countries to think that the battle has been won.

Of the  very important  and interrelated factors  which determine the  tendency to become infected by an infectious disease and to  fight it long enough to respond to treatment  and outlive the infection;  poverty and education stand supreme. It is sad news that the literacy level has dropped from about 65% about a decade ago to about 58% at a time these neglected tropical diseases are beginning to  make their appearance. We urgently need action on issues that can improve the nutritional status of ordinary people, empower them to know when deviations from normal occur and to take correct   decisions  to go to the right places when they become ill. It is not enough to have a regulatory body that presides over medicines so expensive that  they can not be purchased to treat common ailments.  What is needed rather is an establishment that regularly ensures that  local manufacturers are encouraged and medicines coming from outside go straight to Government stores without passing through the unnecessary  bottlenecks crafted into the distribution system by middlemen with the sole purpose of making  annoyingly huge profits. Beyond that,  it is double jeopardy to have people retire  without  getting  their benefits and yet have nothing to live on as they age .New social welfare schemes should be  operational or activated  to take care of senior citizens.

A complete review and restructuring  of the Health insurance scheme  is urgently needed at this time when structural adjustment in the economy is likely to increase the health requirements of the ordinary  man as he battles to stay alive. Operators of the scheme and other care givers involved in the more sophisticated  aspects of managed care do have avenues where relevant government agencies can mainstream and come up with reasonable and equitable pricing system, otherwise, there are bound to be an upsurge in the number of street persons and persons on the street. When that happens, the Nation might not be able to cope with the  unavoidable  social and mental consequences.

Concluded