The Nation Newspaper

Tag: PUBLIC

  • Two armed robbers shot dead in Abuja

    Two suspected armed robbers were at the weekend shot dead by Army Headquarters garrison defence battalion’s Quick Response Group in Abuja.

    A statement by the Deputy Director, Army Public Relations, Lieutenant Colonel Omale Abraham Ochagwuba, said ten suspected armed robbers dressed in haphazard Army camouflage uniform with assault rifle had attempted to rob trapped motorists in Gauraka Village along Abuja-Suleja road.

    “The quick response group while responding to a distress call from trapped motorists were engaged by about 10 suspected armed robbers dressed in haphazard Army camouflage uniforms with assault rifles.

    “In the firefight that followed, one suspected armed robbers was shot dead on the spot, while another who gave his name as Mr. Dauda Markus sustained gunshot wound on the stomach, he was rushed to Suleja General Hospital for medical attention where he later died,” Ochagwuba said.

    He added that both bodies have been deposited at the Suleja General Hospital mortuary. Some of the suspects fled into the bush with gunshot wounds.

    “The general public, both private and government hospitals are please advised to report any case of gunshot wound to the nearest security agency for prompt action. Some of the items recovered included two locally made guns, two machetes and a fake assault rifle curved out of wood to look like an assault rifle to an untrained eye. The general public is advised to note that the military has a dress code which is strictly adhered to”,  the army spokesman  explained .

  • His final public address

    His final public address

    Dear friends, I’m happy to be with you, surrounded by the beauty of creation and your well-wishes which do me such good. Thank you for your friendship, and your affection. You know this day is different for me than the preceding ones: I am no longer the Supreme Pontiff of the Catholic Church, or I will be until 8 o’clock this evening and then no more.

    I am simply a pilgrim beginning the last leg of his pilgrimage on this Earth. But I would still … thank you … I would still with my heart, with my love, with my prayers, with my reflection, and with all my inner strength, like to work for the common good and the good of the church and of humanity. I feel very supported by your sympathy.

    Let us go forward with the Lord for the good of the church and the world. Thank you, I now wholeheartedly impart my blessing. Blessed be God Almighty, Father, Son and Holy Spirit. Good night! Thank you all!

  • Health in interest of the public

     

    Conclusion of text of the Inaugural Lecture delivered by the Provost, College of Medicine, Lagos State University Teaching Hospital, Prof Olumuyiwa Odusanya, at the college.

    • Continued from last week Thursday

    Universal health coverage

    Universal Health Coverage (UHC) refers to a system in which everyone in a society can get health-care services they need without incurring financial hardship. The concept implies that each one is able to get required health service when needed without suffering or having to sell personal belongings. Equity of access to health services of all types is key to a universal health coverage policy. The current Director General of the World Health Organization (WHO), Margaret Chan asserts that universal health coverage is “the single most powerful concept that public health has to offer”.

    The three dimensions of universal health coverage are the proportion or types of persons in a population enrolled, the services available and what proportion of costs are covered. Health issues, especially emergencies, do not give advance warning yet they must be attended to.

    In this audience, if any of the well-to-do persons has a son requiring appendectomy in the middle of the night, where will she/he readily find the money to pay or buy required drugs without cash at home, especially in this era of cashless policy? Would not it be easier if the person has prepaid insurance or other forms of advance payments in order to readily access the required services? May I ask: how many of us here have a health insurance?

    The inability of having a ready source of payment often delays presentation to hospital or delays payment for services and hinders timely interventions among the poor. Evidence suggests that broader health coverage generally leads to better access to health and improved population health, particularly for poor people. The relationship between prepaid health financing, health coverage and health outcomes is shown in Figure 10.

    Figure 10. Causal pathway between pooled prepaid health financing, health coverage and outcomes.

    At the heart of UHC is health financing. The funds may be raised from a variety of sources; direct and indirect taxes, social insurance and community funds. Available funds must be raised and pooled in a way that allows cross-subsidization across the income groups and financial risks of illness to be shared between the sick and the healthy. In the absence of universal health coverage, the various forms of paying for health include out of pocket payment and selling of property. A review of coping strategies for health care services in 15 African countries revealed that borrowing and selling of assets ranged from 23% of households in Zambia to 68% in Burkina Faso, and that the highest income groups were less likely to borrow.81 Selling of assets and borrowing were more profound for households with higher inpatient expenses than those with outpatient care or outpatient medical expenses. Payment of user fees is often a critical obstacle to access to health care.

    Sixty-nine (69%) percent of government employees in Abakaliki, Ebonyi State relied on out-of-pocket payment to pay for health services, 28% claimed to use the Nigerian Health Insurance Scheme (NHIS) and 2.6% borrowed money.82 The use of out-of-pocket mechanism was associated with difficulty in accessing quality health care services and most of the employees resorted to self medication, delayed seeking health care, patronized herbalists or ignored the illness.82 The state of health of such a population can be best imagined.

    Another group of researchers from the same area found that the poorest households were more likely to utilize informal care providers such as traditional healers, whereas the higher socio-economic groups used out of pocket payments. Decreasing socio-economic status was associated with sale of livelihood assets while exemptions and subsidies were non-existent.83 in many countries, removing or reducing user fees was found to increase the utilization of curative services and perhaps preventive services as well but may have negatively impacted service quality.

    The Nigeria Health Insurance Scheme (NHIS)

    The NHIS was launched on 6th June, 2005 and commenced services in September 2005. It is a voluntary insurance scheme and has focused on the formal sector. It covers mainly employees of the Federal Government and only a few states Enugu and Cross River States have enrolled. The contributions are earnings-related, fixed currently at 15% of basic salary. The employer pays 10% while the employee contributes 5% of basic salary.

    Health benefits under the NHIS include out-patient care, prescribed drugs in the NHIS essential drug list, antenatal, postnatal and maternity care for up to four (4) live births for every insured woman to mention a few. The scheme does not cover special treatments including occupational injuries. The system works through appointment of health maintenance organizations (HMOs) who receive capitation fees, and health care providers who receive fee for service from the HMOs.

    One of the major challenges faced by the NHIS is the low coverage; thus, it has not been the path to UHC for Nigeria. In addition, other problems include conflict of interests about financial payment among the many stakeholders, long waiting period to access service, bureaucracy, antagonism of labour unions and the voluntary nature of the scheme with workers in many states and private sector not enrolling. The impact of the NHIS will improve if it expands its scope to cater for the informal sector (being piloted in a few places), facilitates integration of the private sector as well as aggressive advocacy and education of the populace.

    Achieving Universal Health Coverage (UHC)

    There is no one common pathway to achieving UHC. The trajectory towards UHC has three common features; a political process driven by a variety of social forces to create public programmes or regulations that expand access to care, improve equity and pool financial risk; growth in incomes and a concomitant rise in health spending which buys more health services for more people; and an increase in the share of health spending that is pooled rather than paid out-of pocket by households.86 All countries that have achieved universal health coverage have done so with extensive government involvement (policy) in the financing, regulation and sometimes direct provision of health services.87 The key health financing options at different stages of the evolution of UHC is shown in Figure 11.

    The political will to exercise stewardship for UHC must exist. A decision must be made on the type of health insurance whether it would be tax-based or social health insurance. There is also the place of external funding at least at the initial phase. A systematic review of the impact of health insurance in Africa and Asia showed that community-based health insurance and social health insurance improved service utilization, protected members financially by reducing their out-of-pocket expenditure but weakly impacted on quality of care and social inclusion. A study from southeast Nigeria revealed that respondents in rural areas and those in the lower socio-economic classes wanted comprehensive benefits from community based health insurance whereas those in urban areas and the richer showed a preference for basic disease control interventions.89

    The structure of health financing in nine developing countries. In most of them risk pooling is through multiple sources and service delivery is through a variety of sources. The dimensions of UHC in those countries is high. The coverage in Nigeria remains low. Whatever the form of payment, mechanisms for exemption and subsidies must be put in place to protect the poor.

    In Ghana, South Africa and Tanzania, health-care financing was progressive (groups with higher income contributed a higher percentage of income) but the overall distribution of service benefits favoured richer people more than the lower-income groups suggesting the need for equity.

    THE=total health expenditure, NHIS=National Health Insurance Scheme, BPJS=Badan Penyelenggara Jaminan Sosial (Social Security Administrative Body). PhilHealth=Philippine Health Insurance Corporation. Mutuelles=Community-Based Health-Insurance Schemes. RAMA= La Rwandaise d’Assurance Maladie (Rwanda Health Insurance Scheme). MMI=Military Medical Insurance. VSS=Vietnam Social Security. RSBY=Rashtriya Swasthya Bima Yojna (National Health Insurance Programme). NHIF=National Hospita l Insurance Fund. RAMED=Regime d’Assistance Medicale (Non-Contribution Medical Assistance System). AMO=Assurance Maladie Obligatoir (Mandatory Health Insurance). *Data retrieved from World Bank world development indicators database. †Data retrieved from WHO global health expenditure database. ‡Legislation to create the programmes in Indonesia and Mali has recently been passed and implementation is at an early stage.

    Private sector health provision for public financing may be thought of as the best way to achieving universal health coverage. However, there are some caveats to be noted: the issues of profit, the orientation of services for the middle class and the challenge of providing services that show benefit only if large enough proportions of the community are covered e.g. immunization. Undoubtedly, the private sector has a role to play in achieving UHC.

    Evidence suggests that increases in funding especially through donor aid, has helped to reduce mortality from malaria, maternal mortality and child mortality, especially in developing countries. Political commitment through sustainable public funding is the preferred option. It is argued that addition to aid for health could bring the world to universal coverage whereas cuts in aid at the present time could undo the great progress of the past decade. “Universal coverage for health” is within our reach if we persist.

    Conclusion

    Public health medicine and public health actions hold the key to improving the complete physical, mental and social well being of individuals, communities and nations. Health actions and services should be customer (public) focused. Key areas for action include social determinants of health, immunization, quality of health services, rational use of drugs and universal health coverage.

    The way forward to improving the health of the public

    If indeed the health of the public would improve, a paradigm shift is inevitable. The health system and services must stop to focus on themselves but make the public the centre of all its activities. There is the need to actively engage the community through community participation. The health workers must become advocates of healthy public policy and put the health agenda on the front burner of government decisions. There is the need to increase awareness on the social determinants of health and adoption of healthy behaviours by the community. We all need to advocate better funding for education.

    Immunization coverage must be vigorously sustained, especially to ensure that poliomyelitis is eradicated from Nigeria. Government funding for immunization must increase, routine immunization services strengthened and complimentary control measures e.g. improved sanitation need to be aggressively pursued.

    The health system in the country should be strengthened especially with regards to quality of service. Rational use of drugs remains a challenge but continuous training holds the best promise of improving drug use. The issue of universal health coverage must be properly addressed. Perhaps, now is the time for Nigeria to move into some form of compulsory insurance. Universal health coverage is one of the most important determinants of health status. The present coverage of the National Health Insurance Scheme cannot lead to improvement in the health indices of the Nigerian public.

     

     

     

     

     

     

  • Seeking public trust in civil service

    Seeking public trust in civil service

    In 1960s up to the mid-70s, civil service job was seen as a clarion call for any citizen to come and serve his or her father land.

    It was an allegiance to dutiful service. Indeed, the earliest civil servants served the people and the nation with their heart and might.

    Names like Alison Ayida, Jerome Udoji, Simeon Adebo, Fola Ighodalo and Adeyemo Bero, to mention but few, remind one of top-on-the-shelf civil servants, who have left indelible mark on the sand of civil service history. Even as we speak, these finest public servants have remained legends never to be forgotten for their loyal, sincere and diligent services to their nation.

    Today, the story is largely different from that of the sublime and dignified 60s and 70s as the diligence and will to serve selflessly has greatly diminished if not totally disappeared.

    Arguably, the diminishing return was traced to the 1975 forcible rough surgery performed by the late General Murtala Muhammed administration in the name of restructuring of the civil service.

    Others however pointed to the sweeping restructuring by the General Ibrahim Babangida administration in the 80s, which corollary dislocated the joints of the civil service until today.

    Since the said restructuring – be it the first or the second one – the scar from the surgical scalpel has remained un-healed till now.

    A ray of hope may have appeared on the horizon for this hitherto revered white-collar job what is currently happening in the civil service of the State of Osun under Ogbeni Rauf Aregbesola as governor.

    A seed of innovation aimed at repositioning the service for optimum performance was sowed recently in the state and many have expressed strong conviction that it will germinate and bear edible fruits in the not-too-distant future.

    Aregbesola’s intention to have a clean break with the past tradition of hand-picking the Head of Service (HOS) significantly goaded him to x-ray, diagnose and provide long-lasting treatment for the ailing service.

    When he came to the saddle two years ago, he met a factionalised public service – one overtly split along political party divides-something that ordinarily should be alien to the civil service. A civil servant ought to be neutral and impartial on any subject matter pending government’s attention.

    Having carefully studied the situation at hand, in February this year, the governor set up a committee – Public Service Repositioning Committee- to look critically at the whole system with a view to repositioning it.

    Aregbesola tasked the 12-man committee headed by Dr. Goke Adegoroye, to help him achieve three things, namely – meritocracy, professionalism and capacity building.

    The governor strongly believes that with these three key qualities, the civil service can begin ascent to its former enviable echelon.

    The committee thus swung into action with the sole intention of creating a new order that will be a model for other public services – state or federal.

    The Adegoroye Committee therefore conducted assessment exercise for all the directors in the civil service of the state. Those who performed very well among them were subsequently invited for open interview for further assessment.

    At the end of the day, from over 70 prospective Permanent Secretaries that were assessed, this novel process threw up the best 29, who emerged as Permanent Secretaries across all the ministries. Before, the tradition is for the sitting governor to sit down in his office and hand-pick the permanent secretaries as well as the HOS.

    For Ogbeni, that was an undemocratic way of selecting the best out of crowd. For him, this traditional ancient regime has to wither and pave way for democratic experimentations.

    Hence, the new HOS would have to also be chosen by the workers themselves and not the governor. This was exactly what happened recently at the Bola Ige House, Government Secretariat, Abere, Osogbo.

    The last process was the emergence of the HOS and they were to be selected by their fellow civil servants from Grade Level 14 and above.

    All the 29 Permanent Secretaries were allowed to participate in Electoral College for so it appears. The civil servants, for the first time in the history of the state and perhaps that of the country, stood on the threshold of posterity to elect the man they want to lead them.

    As usual, in any democratic setting, the election process was a high octane one for it was an open ballot process. The names of the 29 Permanent Secretaries were printed boldly and pinned to a table with ballot boxes in front. The senior civil servants all voted and at the end of the exercise, three candidates emerged with the highest votes.

    They were – in descending order – Sunday Olayinka Owoeye (34); Adeyemi Adelowo (26) and Kolawole Adesina (19).

    These three names were subsequently forwarded to the governor from which, using his executive discretion, he would select a candidate, who automatically becomes the HOS.

    Aregbesola simply heeded the time-honoured Latin maxim – vox populi, vox dei. The people have spoken and so be it.

    Mr. Sunday Olayinka Owoeye thus emerged as the State of Osun’s new Head of Service. All these – voting, counting, selection and announcement – took place in matter of hours and not a whole day.

    To majority of the civil servant, this is a welcome development as they are now part of decision-making body in the determination of their own destiny.

    They all hailed the novel system, describing it as a bottom-up system of appointment rather that the slipshod old top-to-bottom approach.

    According to some of the civil servants, the impact of this novel process is that it has capacity for confidence-building and the workers tend to believe and will readily differ to a leader they elected themselves.

    Again, this new system will also help a great deal in quick resolution of government-worker’s face-off whenever one arises.

    Above all, the civil servants hail the governor as a real democrat and a great leader, who genuinely wants progress and development for the state.

    During the swearing-in of the Permanent Secretaries and the HOS, an elated Aregbesola said that in appointing the Head of Service through the electoral college of the Permanent Secretaries, his administration has applied the best possible method that can be obtained from humans.

    He openly declared that for the first time in the history of the service, government has introduced merit and professionalism as the basis of career advancement and the new system will remain so he enthused.

    He continued: “The candidate not only became Permanent Secretary through merit but was selected by the merits as the best merit possible within the pool of merits.’’

    “Of course, this is subject to human error of judgment beyond which we have little control if we have not yet attained divinity….Your appointment is not a call to sycophancy and supine conspiracy. I have no personal agenda and do not intend to cultivate personality cult.”

    Indeed, this is a democratic civil service a la Ogbeni Rauf Aregbesola that needs to be emulated across the states of the federation.

    •Kunle Owolabi is of the Bureau of Communications and Strategy, Office of the Governor of the State of Osun.

  • Public session in Rivers today

    Rivers State Governor Rotimi Amaechi and members of the Senate will today hold a state public session on the review of the 1999 Constitution under the chairmanship of Justice Adolphus Karibi Whyte.

    Speakers are Prof. Nimi Briggs, Prof. W. O. Wotegbe-Weneka, Prof A. O. Ijeoma Gabriel and Prof. Obianime

    A statement by Amaechi’s Chief Press Secretary David Iyofor said Civil Society Organisations (CSO), Civil Liberty Organisation (CLO), professional bodies, trade unions and associations, political groups, traditional leaders, opinion leaders, women’s groups, youth organisations and all other stakeholders have been invited.

    The event will start at 10am at the Main Bowl of the Alfred Diete-Spiff Civic Centre, Port Harcourt. All invited guests are expected to be seated by 9:30am.