Year : 2010 | Volume
: 51 | Issue : 1 | Page : 39--51
Abstracts from Nigerian medical association annual scientific meeting. April 21- 25, 2010 International Conference Centre, Abuja
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. Abstracts from Nigerian medical association annual scientific meeting. April 21- 25, 2010 International Conference Centre, Abuja.Niger Med J 2010;51:39-51
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. Abstracts from Nigerian medical association annual scientific meeting. April 21- 25, 2010 International Conference Centre, Abuja. Niger Med J [serial online] 2010 [cited 2023 Feb 7 ];51:39-51
Available from: https://www.nigeriamedj.com/text.asp?2010/51/1/39/70994
The Evolution of Health Care Systems in Nigeria: Which Way Forward in the Twenty-First Century?
One of the most consistent phenomena of life is "change". The complexity of life itself is brought about by change. The entire theory of evolution glorifies "change". The profession of medicine and the health care systems in which the profession is practiced undergo constant changes and, except for a few exceptions, the changes are for the better. My call is to review the evolution of healthcare systems in our beloved country, NIGERIA. This review will touch upon the changes that have occurred and I will leave you to determine whether these changes have meant progress, stagnation or retrogression. In pre-explorers and pre-western trader's Nigeria, traditional medicine was the system of health care delivery. Traditional healing and medical practices included herbalists, divine healers, soothsayers, traditional midwives, spiritualists, bonesetters, mental health therapists and surgeons. In spite of more than 150 years of introduction of Western style medicine to Nigeria, traditional healing and medical practices remain a viable part of the complex health care system in Nigeria today.
It would seem from available accounts that the earliest forms of Western-style health care in Nigeria were the doctors brought by explorers and traders to cater for their own well-being. The services were not available to the indigenes. It is stated that the first health care facility in the county was a dispensary opened in 1880 by the Church Missionary Society in Obosi, followed by others in Onitsha and Ibadan in 1886. However, the first hospital in Nigeria was the Sacred Heart Hospital, built by the Roman Catholic Mission in 1885 in Abeokuta. By Independence in 1960, Mission owned hospitals were more than Government owned hospitals ( 118: 101). Because of the evangelical functions of these Mission health facilities, it was left for the government to organize and develop policies for general health care.
The health care services in Nigeria have been characterized by short-term planning, as is the case with the planning of all aspects of the Nigerian life. The major national development plans are as follows: The First Colonial Development plan from 1945- 1955 (Decade of Development); The Second Colonial Development plan from 1956- 1962; The First National Development Plan from 1962- 1968; The Second National Development Plan from 1970 1975; The Third National Development Plan from 1975- 1980; The Fourth National Development Plan from 1981- 1985.
Efforts will be made to review the state of our health care systems during these planning periods in Nigeria. Efforts will also be made to suggest how we can move forward today. The solution appears to be in our hands as physicians. The solution appears to be in the hands of the Nigerian Medical Association.
Medical Education and Research in Nigeria in the Last 50 Years: The Journey So Far
B. J. Bojuwoye
University of Ilorin, Ilorin
The first Medical School in Nigeria took off in the University of Ibadan (then University College), which was established in 1948. It started as an affiliate of the University of London and awarded the MB;BS (London) until 1966 when graduates of the School started to earn MB;BS (Ibadan). The other first generation Medical Schools came on board in Lagos, Enugu, Zaria, Ile-Ife and Benin-City in the early to mid 60s. They run the traditional curriculum with the training hospital-based, although Ibadan established a community outreach training programme at Igbo-Ora and Eruwa. The crop of second generation Federal-owned Medical Schools were established after 1975 at Ilorin, Jos, Port-Harcourt, Maiduguri, Calabar, Kano, Sokoto and Nnewi. They were to run an innovative curriculum designed to sensitize the medical students to the health care needs of Nigerians without compromising international standards. The curriculum was to be community-oriented, student-centred and problem-based.
From the eighties, a few States have set up their own Medical Schools at Sagamu (Ogun State), Ikeja (Lagos State), Osogbo (Oyo and Osun States), Abakaliki (Ebonyi State), Uturu (Abia State) and Ekpoma (Edo State).
Other Medical Schools recently established are in Abuja (Federal), Makurdi (Benue State), Ado-Ekiti (Ekiti State) and Akwa-Ibom State. A few private Medical Schools have also been established, e.g. at Okada (Igbinedion) and Madonna. As at December 2005, 40, 000 medical doctors had been registered by Medical and Dental Council of Nigeria (MDCN) and currently, more than 45, 000 have been registered. Apart from the brain drain phenomenon, nearly 80% of doctors practise in urban areas where only 20% of Nigerians live.
In 1966, Dr. J. Ola Mabayoje, then Registrar of the Medical Council, first mooted the idea of starting postgraduate medical education in Nigeria. In 1970, the Nigerian Medical Council (Postgraduate examination format and syllabi) were published. In 1971, the first intensive 6-month basic medical sciences courses were commenced in Lagos and Ibadan. The first Primary Fellowship examination took place in 1972 followed, in November 1973, by the first Part I examination in Physic (Internal Medicine). 24th of September 1979 marked the formal take-off of the National Postgraduate Medical College of Nigeria, thus severing the umbilical cord connecting it to the Council. Over 2000 Fellows, by examination, have been produced across the 14 Faculties of the College. These Fellows now man our Medical Schools as Clinical Teachers and Consultants in Teaching and Specialist Hospitals in the public and private sectors nationwide.
Medical Teachers and Teaching Qualification
Professor Uche Onwudiegwu
Obafemi Awolowo University/Teaching Hospitals Complex, Ile-Ife, Osun State.
'Medical Education' is the study, research and application of educational processes involved in the training of physicians for continuous quality and standard in the production of competent physicians for improvement of healthcare delivery. It has evolved into a discipline with its own specializations such as Curriculum Development, Educational Foundations and Theory, Assessment Techniques, and Educational Methodology among others. Worldwide, high quality training and education of physicians is increasingly being recognised as critical to global health and emphasis is being made that the training of these physicians be done by professionally competent medical teachers. Medical school teachers should therefore be trained in educational foundations and theory as well as in modern educational instructional methodologies. Expertise does not automatically translate to effective teaching. In Nigeria, nearly all medical school teachers have no professional or formal training in teaching though they are experts in their fields (i.e. content experts). Evidences from research show improved learning of medical trainees when instructed by teachers trained in pedagogy and other educational processes. Teacher evaluation though alien to the Nigerian medical schools system, is an integral aspect of pedagogy and should be undertaken to ensure that teaching quality and facilitation of learning are enhanced. However such evaluation makes sense only when the teachers have been trained. There is a real necessity that medical school teachers be trained through short term courses, workshops and seminars so that the quality of teaching and imparting knowledge can be improved and sustained. Invariably, this is a call also for the establishment of departments of Medical Education in our Medical Schools across the country.
Medical Education and Research in the Last 50 Years: Should undergraduate Medicine be Post-Baccalaureate?
Professor Sebastian N N Nwosu
Department of Ophthalmology, Nnamdi Azikiwe University Guinness Eye Center Onitsha Nigeria
In 1960 the first 13 medical students fully trained in Nigeria to internationally accepted standard graduated from the then University College Ibadan, earning the Bachelor of Medicine, Bachelor of Surgery (MBBS) London degree. Since then thousands of doctors trained to international standard have been produced from different medical schools in Nigeria.
The Medical & Dental Council of Nigeria has now registered about 50, 000 doctors most of whom trained locally in Nigerian universities. The doctors were admitted into the universities with WASC or GCE O'Level or SSCE or its equivalent as the minimum entry requirement. These doctors have acquitted themselves by admirably working hard to in various capacities, including research, teaching and clinical services, to address and solve the health needs of Nigerians and beyond.
Recently the National Universities Commission (NUC) proposed and may soon implement a policy that would make the university first degree the minimum qualification for entry into medical schools in Nigeria. The new policy advocates a 4 year medical undergraduate curriculum. However this would in effect translate to a minimum of 9 years post-secondary school to produce a medical doctor. Given the perennial instability in the health and educational sectors in Nigeria as well as the difficulties in obtaining placement for housemanship, it may practically take up to 15 years post-secondary school to fully register a doctor. Therefore the new NUC policy will have the effect of producing aging young doctors which will in turn put the lives of Nigerians at increased risk. Whatever be the flaw with the current 5 or 6 year straight MBBS programme is not due to the fact that SSCE or its equivalent is the minimum entry qualification. A minimum medical school entry qualification that has served Nigeria well for more than 50 years should not be jettisoned without convincing scientific evidence that it is detrimental to Nigeria's health policy and medical education process.
Medical Education: Regulatory Role of Medical and Dental Council of Nigeria
Abdulmumini A. Ibrahim
Registrar MDCN, Abuja, Nigeria
Medical Education in Nigeria began with the establishment of the Yaba medical school in 1930 by the British Authorities. In 1948, the faculty of medicine of the University College, Ibadan was established and the Yaba medical school was subsequently closed down. During this pre-independence era, the regulation of medical education resided with the colonial masters via the relevant British Medical Regulatory Authorities.
Post-independence, a number of medical schools were established in the country. Some of these started off by upgrading the facilities of existing general hospitals to the standards of teaching hospitals. A milestone in medical Education was reached in 1963 with the establishment of the Nigerian Medical Council (NMC) through an Act of parliament. The NMC was statutorily charged with the responsibility of regulating the practice of medicine as well as the training of doctors in Nigeria. It was the forerunner of the Medical and Dental Council of Nigeria (MDCN) which was a creation of Decree No 23 of 1988. However, prior to the creation of MDCN, the role of supervising post-graduate medical education had been ceded to the newly established National Post-graduate Medical College in 1979.
The extant governing Act of Council, the Medical and Dental Practitioners Act, CAP M 8, laws of the Federation of Nigeria, 2004, is a further amendment to that Decree. The main function of Council as provided in the Act is to approve courses of instructions/qualifications, approval of institutions where these courses are to be given and to supervise the nature of such instructions. Medical Education in Nigeria is aimed at the production of a sound scientific and professional basis for the training of doctors capable of meeting local needs as well as international standards. Regulation of medical education involves the sending of Visitation Panels to medical training institutions where they use criteria developed by Council to evaluate the capabilities of such institutions to train doctors. At least four successive and successful visitations are mandatory before a new medical school could attain full accreditation to turn out doctors. Accreditation lapses automatically every 4 years and a re-accreditation becomes necessary. Medical Education in Nigeria is challenged by the following problems:
Medical schools exceeding their allotted quotas, Dearth of qualified staff and inadequate infrastructure, Insufficient positions in hospitals for doctors to complete their internship training, and The incessant dissolution of Council by the government which tends to militate against continuity of evaluation. Measures put in place by MDCN to overcome these lapses include:
Introduction of Indexing of Students, Decision to start Continuing Professional Development (CPD) for all doctors, Appeal to the government not to treat health Regulatory bodies as political organisations which could be dissolved at anytime. Inspectorate Unit of Council for monitoring and enforcement and also to tackle simultaneous services and movement of medical teachers. The Role of Teaching Hospitals in Medical Education: The Relationship Between Ahmadu Bello University Teaching Hospital (ABUTH), and the Faculty of Medicine, Ahmadu Bello University (ABU), Zaria as a Case Study
Abdulmumini Hassan Rafindadi
Ahmdu Bello University, Zaria
Most of the teaching hospitals in the country were part of universities, where they function as the practice centre for their medical students. After the reforms of 1975, the teaching hospitals were excised from the universities and were brought under the ambit of the Federal Ministry of Health. However, statutorily, they are still required to cooperate with their corresponding universities in the teaching of medical students. The ABUTH, with its 700 beds has taken this role seriously and still functions as the practice centre for the over 3, 000 medical graduates who qualified from the Faculty of Medicine, ABU in nearly 40 years of its existence. The hospital has 15 clinical departments that serve not only for the care of patients but also for training of medical and other paramedical students of the ABU. The challenges faced in this regard include the large number of students compared to available patients; limited space for academic activities e.g. lecture rooms, seminar room, library space, etc.; conflicting interests between the need of the students and the hospital; and occasional misunderstandings between the two parties.
Overall, one can say that success has been achieved in the role of the ABUTH as the practice centre for the ABU medical school.
Universities and Medical Education in Nigeria
Prof. A. O. Malu,
Benue State University Teaching Hospital, Makurdi.
Formal attempts at Medical Education in Nigeria began in 1927 with the establishment of an institution in Lagos for training medical manpower to diploma level. They were trained to practice only in Nigeria. The program was not popular and was discontinued. Following the report of the Elliot Commissions on higher education in West Africa it was decided to establish the University of London College at Ibadan, with a Faculty of Medicine as one of the initial faculties. This was realized in 1948. The debate on what type of doctor to produce for Nigeria ended with the decision to produce high caliber doctors of the same standing as British trained doctors.
In 1960 the Ashby Commission on Higher Education in Nigeria recommended the establishment of more training institutions, including those for medicine. This led to the establishment of the University of Lagos with the College of Medicine. The three initial regional governments all established their universities with medical faculties.
Medical education has expanded rapidly with the expansion of universities, and we now have Federal and State governments as well as other organizations or private individuals owning universities with medical schools. Regulation of undergraduate medical education has continued to be under the dual oversight of the National Universities Commission and the Medical and Dental Council of Nigeria. The main problems of the medical schools have been the shortage of properly trained staff and poor facilities, curriculum stagnation and lack of modern teaching and assessment instruments. To tackle these problems training in educational methods should be mandatory for academic staff; there should be greater synergy between the NUC and MDCN, and curriculums should be reviewed to reflect modern trends.
Quality Assurance in Medical Education
Professor Akinyinka O. Omigbodun
Provost, College of Medicine, University of Ibadan, Ibadan, Nigeria
Professor Akinyinka Omigbodun graduated from the Medical School of the University of Ibadan with Distinction in June 1980. After undergoing specialist training in Obstetrics & Gynaecology, he was awarded the Fellowship of the West African College of Surgeons in 1987 and of the National Postgraduate Medical College of Nigeria in 1988. He had further training in Oncology at the University Hospital of South Manchester, Withington, England from 1990 to 1991. He was a Visiting Research Scholar at the University of Pennsylvania, Philadelphia, USA from 1993 - 1997. After his appointment as a Lecturer by the University of Ibadan in 1988, his career progress was steady and he was appointed to the grade of Professor in 1997.
Professor Omigbodun's research interests are wide-ranging, from public health to medical education, but his major focus has been on environmental factors in reproductive biology, particularly as they relate to reproductive tract cancers. Professor Omigbodun became the Provost of the College of Medicine, University of Ibadan in August 2006. He has been the Editor of the Tropical Journal of Obstetrics & Gynaecology since 1999. He was the Chairman of the Faculty of Obstetrics & Gynaecology of the West African College of Surgeons (WACS) from 2003 2007 and he has been the Chief Co-coordinator of Courses (for all 7 Faculties) at the WACS since 2002. He has been the recipient of many international awards, including the Audrey Meyer Mars Fellowship of the American Cancer Society in 1992 and an award by the American Society for Reproductive Medicine at its 50 th meeting in Boston in 1996, for distinct contribution to science.
Collaborations in Medical Education are now the major focus of his attention, with particular emphasis on better postgraduate training and research. In terms of postgraduate training, he leads the West African Network in Biomedical Education, a partnership of Universities participating in a programme to enhance teaching skills among academics in Schools of Medicine and allied professions in West Africa. He is also an active participant in the Consortium for Advanced Research Training in Africa (CARTA) that is trying to develop a new paradigm for doctoral training in Population and Public Health in a network of African Universities and Research Institutes.
Performance of our Medical Graduates within and outside Nigeria
Over 47, 000 doctors are fully registered with the Nigerian Medical Council as of 2010. These include doctors who trained in Nigeria and abroad but practiced or are practicing in Nigeria. Recently, training of doctors in the country, even in what are known as the first generation universities are shoddy and this has led to the deterioration in the general performance and attitude of the Nigerian trained doctors. The deterioration is attributable to the general decline that has pervaded the whole country from the mid-eighties. Also the big drain of the eighties saw many of our highly qualified lecturers moving out to Saudi Arabia, USA and Europe where they performed various medical fits to the detriment of training of Nigerian undergraduate and postgraduate doctors. The result is poorly trained doctors with little or no motivation or innovation. Nigerian medical doctors practicing in Nigeria have lagged behind in the technological advancement that is taking place in advanced countries of the world, even though they cannot be totally blamed for this. Unfortunately lack of facilities, funding and support and poor government commitment have contributed to the slow improvement in the performance of Nigerian doctors.
The medical schools do not prepare the students to acquire the necessary skills to succeed in a business world. However, despite all the shortfalls, Nigerian trained doctors have done very well and have established and distinguished themselves all over the world in various fields of medicine and have been associated with many scientific breakthroughs.
Multi-lateral Research in Medical Education Why Should it be Encouraged?
Independent Consultant / Pharmaceutical Expert, BonScience Pharma Consult and Training, P.O. Box 7806, Newark, Delaware 19714, USA. Email [email protected]
As every medical school student, licensed physician, dentist or medical school educator knows, the pre-licensure educational curriculum of physicians, dentists and other medical professionals is already bursting at the seams with required courses and electives. There is hardly enough room to fit all the courses which are considered essential for adequate formation and grounding of new graduates. Post licensure, programs such as residency, specialist and continuing education training for practicing physicians and dentists present a competing array of course offerings, all deserving, but which cannot fit into the waking hours available to these already sleep-deprived professionals. In addition, unlike the US where students typically enter medical school after obtaining a first degree and thus some exposure to undergraduate research in some cases, the typical Nigerian student enters medical school after obtaining a high school diploma or in other cases, with a narrowly prescribed post-secondary educational qualification. Given this situation, should yet one more candidate, multilateral research, be introduced into the medical education curriculum in Nigeria? If so, how, and at what stage of the medical education continuum should this be done? Despite the time constraints to adequately cover "basic medical education" or "specialist" courses, multilateral research is an invaluable teaching and learning tool for both pre-licensure and post qualification physicians, dentists and other medical professionals. As such, it should be encouraged in the medical school curriculum and post-licensure continuing education programs for practitioners. Some potential benefits of multilateral research will be highlighted.
Medical Education: Status and Travails of Medical Publications
Prof. SNC Anyanwu
Nnamdi Azikiwe University Teaching hospital, Nnewi
It is generally accepted that the level of healthcare delivery in a society is directly related to the amount of research and dissemination of research information. Journals are a veritable tool in driving research and in continuing medical education. Previous studies have alluded to the underdeveloped CME and poor reading culture among Nigerian doctors. A review of the role of Nigerian medical publications in world literature shows a level probably similar to our Health status indices with poor per capita contribution to world knowledge. A review of causes using two journals with national spread implicated the following poor funding, poor infrastructure, poor distribution systems, poor institutional support and sharp author and editorial practices. Remedial factors highlighted included institutional commitment to philosophy of research and publications, institutional review boards and measures to eliminate common author-associated fraudulent practices.
Malaria, An Unending Challenge
Prof. E. Ezedinachi
Although malaria is now preventable and treatable, malaria is an ancient disease. Early 5th century BC, to 1897 AD, when R. Ross described the role of mosquito in malaria transmission, the mere mention of the name "malaria" evokes a devastating awe, as the disease burden, did not only include numerous Popes, 8 Germany Emperors, millions of soldiers, but it sacked villages in swampy areas of Europe. Now, it is variously described as neglected and/or disease of the poor, as the poorer countries of Sub-Saharan Africa bear about 90% of the world malaria disease burden, while South America and parts of Asia among others share the rest. Earlier malaria control campaigns excluded the Sub-Saharan Africa, where malaria was not only holoedemic, but the epicenter of the enormous disease burden. Malaria did not only cause social deprivation and poverty in Africa, but inhibited both individual growth and national development as it makes the poor poorer. Even in the 1950s in the World Health Organisation led malaria control campaigns, success was only limited, except in Europe and North America. Now that another ongoing campaign, the Roll Back Malaria, which includes Africa, is ten years ( 2010) old, an overview of malaria control, within the Golden Jubilee of NMA appears apt, to evaluate the targeted milestones vs. the unending challenges of malaria. The factors responsible for the apparently intractable malaria situation in Nigeria are discussed.
Malaria In Pregnancy: Stemming the Unending Scourge
Okpere Eugene E., Enabudoso Ehigha J.
Dept. of Obstetrics & Gynaecology, UBTH Benin City
Malaria remains one of the highest contributors to the precarious maternal mortality figures in sub-Saharan Africa. At least 6 million women worldwide are at risk of malaria infection in pregnancy. Malaria contributes to at least 10, 000 maternal deaths and to at least 200, 000 newborn deaths annually. Malaria is a contributor or aetiologic factor in pregnancy complications including anaemia, spontaneous abortion, prematurity and stillbirths. Pregnancy results in increased incidence and severity of malaria. Cerebral malaria, acute renal failure and severe anaemia, rare complications in adults living in malaria endemic areas, may complicate malaria in pregnancy. Research implicate reduced maternal immunity from increased steroid levels in pregnancy, increased attractiveness of pregnant women to mosquito bites and increased adherence of parasitized erythrocytes to Chondroitin sulphate A expressed in the placentae. This is worse in the first and second pregnancies. With infection with the Human Immunodeficiency Virus [HIV], the effects of malaria in pregnancy are even worse.
Over the decades, there have been concerted worldwide collaborative efforts, spearheaded by the World Health Organization [WHO] and including governments and allied agencies to tackle the scourge of malaria in pregnancy. The main thrusts of such efforts have been: to increase the use of insecticide treated mosquito bed nets [ITN]; intermittent preventive treatment of malaria [IPT]; and adequate case treatment of acute malaria attacks in pregnancy. While for IPT, Sulfadoxine-Pyrimethamine [SP] combination has been proven to be of benefit in preventing acute and latent malaria in pregnancy and its associated complications, the WHO has introduced the use of Artemisinin-Combination Therapy [ACT] for the first-line treatment of uncomplicated malaria in pregnancy, the need to confirm malaria before treatment and the enforcement of completion of therapy once started.
The Roll Back Malaria [RBM] campaign was launched as a strategy to curtail the incidence and scourge of malaria especially in the vulnerable groups including pregnant women. The Millennium Development Goals [MDGs] offer a new hope if adequately pursued to achieving eradication of malaria and its complications in pregnancy. There is need to support research into effectiveness and utilization of established and newer control measures.
Malaria Treatment Services in Nigeria: A Review
Benjamin S. C. Uzochukwu
Department of Community Medicine, College of Medicine, University of Nigeria, Enugu-Campus
E-mail: [email protected] Phone: 234- 803- 3130050
Malaria remains a major Public Health problem in Nigeria and causes death and illness in children and adults, especially pregnant women. Malaria case management remains a vital component of the malaria control strategies. This entails early diagnosis and prompt treatment with effective antimalarial medicines. The objectives of this review is to enable health professionals to understand and apply the concepts and principles of essential medicines and rational medicine management with a focus on malaria, to recognise the need for a national medicine policy environment, to improve knowledge for rational malaria management within the Nigerian health system contexts. The review therefore looks at a spectrum of issues including clinical disease and epidemiology of malaria, objectives of treatment, resistance to antimalarial medicines, antimalarial treatment policy, diagnosis of malaria, treatment of uncomplicated and severe P. falciparum malaria, treatment of mixed malaria infections, case management in the context of malaria elimination, intermittent preventive treatment and cost of treatment. The review concludes that for improved malaria treatment services in Nigeria, there is an urgent need to develop adequate strategies that will ensure better access to medicines by getting evidence-based and effective medicines to the people who need them, whether by reducing their costs, promoting research and development, improving their distribution, increasing their efficacy and acceptability, or slowing down the development of antimicrobial resistance.
Reducing Perinatal Transmission of HIV
Dilly OC Anumba,
Consultant in Obstetrics & Gynaecology/Subspecialist in Fetomaternal Medicine. Department of Human Metabolism Academic Unit of Reproductive and Developmental Medicine, The University of Sheffield, 4th Floor, Jessop WingTree Root Walk Sheffield S 10 2SF, United Kingdom
Abstract. 1200 children acquire HIV every day, which equates to 420, 000 new infections per year. Mother to child transmission (MTCT) is the predominant route. Over the past decade MTCT has become relatively uncommon in high-income settings and developed economies, running at 1% or less. This progress is attributable to near universal antenatal screening, the use of highly active antiretroviral medication, and the adoption of safe alternatives to breast feeding. Unfortunately such success has not been achieved in the less developed economies of the world where HIV infection and MTCT remains highly prevalent, with MTCT rates up to 20- 40% if maternal infection is undiagnosed. Whilst the uptake of routine antenatal screening for HIV is 90% in most European countries, uptake in sub-Saharan Africa, is often no better than 25%. With more than 90% of the 1. 4 million HIV-infected pregnant women who give birth yearly living in low and middle income countries, strategies for reducing MTCT of HIV in this setting need to be developed, despite the economic and organisational challenges that require to be surmounted. It is in this context that the recent experience of implementing strategies that have proved very effective in the UK is discussed. The evidence base for the quantum of claimed and real benefits for individual interventions aimed at preventing MTCT is also explored, and a case made for focussed implementation of those interventions that could prove cost-effective in Nigeria. Synergistic action between governmental agencies, health care professional stakeholders and an integrated research and health care delivery strategy will also be proposed.
A Comparison of CD 4 counts between HIV infected patients with and without TB at the Jos University Teaching Hospital (JUTH), Jos Nigeria.
Agbaji O., Akolo C., Inuwa B., Hassan Z. and Idoko J. A.
Department of Medicine, Jos University Teaching Hospital, Jos Nigeria.
Background: Studies have shown that HIV infected patients can develop TB at high levels of CD 4 counts but the risk is higher at low CD 4 count low levels (below 200 cell/μl). This study was therefore designed to find out the difference between the CD 4 counts of HIV infected patients with and without TB at Jos University Teaching Hospital (JUTH), Jos in North Central Nigeria.
Methods: A total of 173 HIV positive patients attending the Anti-Retroviral clinic at the JUTH, Jos as part of the National ARV treatment programme who consented were recruited into the study. Out of these 53 patients showed clinical and radiological evidence of TB. All the patients had their CD 4+ counts done using the Dynabeads technique.
Results: Of the 173 HIV positive seen, 33% ( 57) were males and 67% ( 116) were females. 30. 6% ( 53) had TB and 69. 4% ( 120) did not have TB. The mean CD 4 count for patients with TB was 121 cell/μl (CI = 17. 87) while the mean CD 4 count for those without TB was 146 cell/μl (CI = 25. 05). There is a significant difference between the means of the two groups (using the t-test at 0. 05 level of significance).
Conclusion: HIV infected patients with TB were found to have significantly (p< 0. 05) lower CD 4 counts as compared to those without TB in JUTH, Jos. The result of this study underscores the need to provide patients with low CD 4 counts (< 200 cell/ul) with tuberculosis prophylaxis.
HIV/ TB Co-infection in Nigerian Children
Ebele F. Ugochukwu
Associate Professor/Consultant, Neonatology/Retrovirology/Infectious Diseases Unit, Dept of Paediatrics, Nnamdi Azikiwe University Teaching Hospital, Nnewi
Tuberculosis (TB) is an important cause of childhood morbidity and mortality. The burden of childhood disease is not as well documented as that of adult disease, partly because of the difficulty of confirming the diagnosis. In Africa children have been estimated to account for 20- 40% of TB case load. Children infected with M. tuberculosis have a high risk of progression to disease, the younger children being at highest risk. Infected children represent a reservoir of future adult disease. The incidence of childhood TB has increased in developing countries. This resurgence is partly attributed to the coexisting burden of human immunodeficiency virus (HIV) disease, which is most pronounced in Sub-Saharan Africa, Nigeria ranking third highest prevalence. The pattern of childhood HIV and TB infection mirror these epidemics in the adult population. The number of children co-infected with HIV and TB is rising, and so is the incidence of congenital and neonatal TB. In addition the emergence of multi-drug resistance TB and extensively drug-resistant TB has occurred within the context of a high prevalence of HIV and TB. The diagnosis of TB has always been difficult in children and is compounded by HIV co-infection. The clinical symptoms in both diseases are similar, and the radiological changes may be nonspecific. Treatment of both conditions in children is a challenge due to drug interactions and problems with adherence. There are few stable syrup formulations of antituberculous and antiretroviral drugs in children, and hence division of tablets gives rise to unpredictable dosing and emergence of resistance. To reduce the morbidity and mortality of TB and HIV, existing childhood TB programs must be strengthened, and antiretroviral drug therapy and prevention of mother-to-child transmission programs scaled up. HIV prevalence in the adult population must also be reduced. An increased emphasis on childhood TB, with early diagnosis and treatment, must be a priority.
HIV/AIDS and Cancer: Implication for the Surgeon
A. Z. Sule
Department of Surgery, Jos University Teaching Hospital, Jos
Background: The most recent UNAIDS report on the global epidemic estimated 2. 5 million persons were prevalently HIV-infected as of 2007. Although HIV prevalence appears to be stables, much remains uncertain about the direction of the epidemic. In the developed countries, the increased cancer risk among immunocompromised persons with HIV/AIDS (PHA) is well observed. Now a person diagnosed with HIV as a young adult in a resource-rich country can expect to live for 30 or 40 years after infection. In recent, large scale cohort studies, the incidence of non-AIDS morbidity and mortality rivals that related to AIDS and these non-AIDS conditions including cancer occur at higher rates in those with on-going HIV replications and lower CD 4 cell count.
Method: A review to describe the present state of knowledge about HIV/AIDS and cancer and its implication for the surgeon.
Results: The severe immunodeficiency caused by advanced HIV infection has been recognized as capable of causing three types of malignancies: Karposi's Sarcoma (KS), non-Hodgkin's Lymphoma (NHL) and Cervical Cancer. Karposi's sarcoma and non-Hodgkin's lymphoma occur at exceptionally high incidence with relative risk being hundred-fold above those in uninfected populations. Cervical cancer is an AIDS-defining cancer when it occurs in HIV-infected woman and the relative risk is 5 to 10fold. Although these are the only forms of cancer that have been designated as AIDS-defining, several other malignant diseases have been reported to occur more frequently following HIV infection than in its absence. The distribution of these cancers varies with the socio-demographic characteristics of the population studied indicating risk factors for cancer differs amongst populations. There remain some controversies as to why cancers occur at increased rates. In immunosuppressed PHA, risk of AIDS-related cancer generally increased with degree of immunosuppression. In Hodgkin's lymphoma, incidence has an inverse relationship with CD 4 count. Some tumours are observed more frequently in PHA because of lifestyles that expose them to specific carcinogens such as lung cancer. Other tumours have been reported to have marginal or inconsistent increases in PHA, and their associations are still controversial. Over the past 25 years, AIDS has been transformed from a disease that was almost inevitably fatal to a chronic condition that is manageable. The longer survival will likely increase the importance of cancer as a clinical problem. In recognition of this increasing importance of cancer as a cause of death in PHA, managing persons affected according to standard practices regardless of HIV status is stressed. These practices should emphasize helping patients change their lifestyles such as smoking, screening for early detection of cancers; paying detail attention to safety practices and choice of procedures for HIV related cancer surgeries; monitoring preoperative chronic conditions such as diabetes and hypertension, etc. With the population's geographic and social diversity, Nigeria also presents unique research opportunities relating to cancer for the surgeon that can be embedded in programs targeting HIV/ AIDS.
Implications of Low Oral Health Awareness in Nigeria
Oral health awareness includes the knowledge and perception of oral diseases and their prevention as well as oral health related attitudes and practices. Oral health awareness amongst different groups in Nigeria has been reported to be poor in many studies and the most common reason for dental visits is avoidable pain. In recent pasts, the importance of oral health as an integral part of general health has been the subject of interest and body of evidence linking oral health status with aspects of general health such as cardiovascular accidents, preterm low birth weight babies and diabetes mellitus e.t.c had been published in scientific publications.
This presentation looks at oral health awareness from three perspectives: the lay public, other health care professionals and policy makers. It reviews past findings related to the three perspectives. The various implications of poor oral health awareness and practice and subsequently low utilization of oral health care services are highlighted. It also looks at the public health challenges of oral health care in Nigeria.
In conclusion, the paper makes recommendations on possible strategies to address the identified challenges and low level of awareness in Nigeria.
Incidence and Management of Oral Cancer in Nigeria
Professor Jonathan O. Lawoyin
Head Oral Medicine/Oral Pathology, College of Medicine, UCH lbadan & Adjunct Professor of Oral Medicine, University of Pennsyvania, U.S.A
Cancer generally is a major health problem and it represents one of the most frequent causes of death .The incidence of oral cancer is relatively low as compared with other cancer sites and comparative epidemiology of oral cancer has a wide global variation raging from 0. 3- 12%. It is lowest in the Scandinavian and highest in India. In Nigeria most studies ( 345) still place the percentage of oral cancer at under 5% of all body cancer with a slight geographical variation recorded in reports from Ibadan, Enugu and Maiduguri. Squamous cell carcinoma constitute the predominant histological type of oral cancer found in Nigeria and this aligns well with what obtains everywhere in the world. Linked to the incidence of oral cancer are various etiological/ cultural factors. Apart from common carcinogens e.g alcohol and tobacco, few cultural and social factors have also been identified as predisposing factors among Nigerians.
Management of oral cancer has continued to remain a huge challenge in Nigeria like other developing countries. Associated mortality rate is particularly high not because it is hard to discover or diagnose the disease but due to being routinely discovered late in its course. Complications from mutilating surgery and metastasis to distant sites have made oral cancer management in Nigeria a distressful exercise.
The Role of General Dental Practitioner in Oral Health
ProfessorAlagumba Lewis Nwoku
Department of Oral, Maxillofacial, Plastic & Reconstructive Surgery Faculty of Dentistry, Lagos State University College of Medicine Ikeja
Although it is widely acclaimed in the recent past that the Nigerian has healthy set of teeth and no oral health problems, our findings show that over 2. 3 million Nigerians between the ages of 3 and 70 years attend dental clinics yearly for treatment. In spite of this, provision of oral health care and services at the local outage is highly deficient.
Just as the eyes may be the window to the soul, the mouth is a window to the body' health. The state of oral health can offer lots of clues about the overall health as these are more closely connected than one might realize. Oral health is connected to many health conditions beyond the mouth, and indeed, sometimes the first sign of a disease may show up in the mouth. The mouth is normally teeming with bacteria, and some researchers believe that these bacteria and inflammation from the mouth are linked to other health problems including heart disease. Other diseases that affect the oral cavity include, but not limited to caries, infections of the gum and the jaws, malformations, benign and malignant tumours, as well as diabetes.
The general dental practitioner therefore has very important duties. These include early recognition and diagnosis of oral health problems, oral health promotion, education and provision of care and services. Dental professionals should make dental patients aware that oral health care can't wait. They should market their practice to increase business and oral health care awareness.
Improving Oral Health Awareness in Nigeria; The Roles of the Dentists, the Government & Non-Governmental Agencies
A. O. Olusile
Faculty of Dentistry, Obafemi Awolowo University, Ile-Ife, Nigeria.
Oral Health describes the well-being of the oral cavity including the dentition and it's supporting structures and tissues. Currently, tooth and gum diseases affect the lives of many Nigerians, productivity and self-esteem are reduced, speech impeded, and the pain, discomfort and difficulties with eating affect their health and quality of life.
Of all the factors militating against good oral health care delivery in Nigeria, low awareness and lack of access may be the two most important. Concerted efforts among the Dentists, Government Health Authorities and Non-Governmental Organizations are paramount in a broad-based approach to address low dental awareness and inadequate access to dental care.
Effect of Nutrition on Oral Health
Agbelusi Gbemisola Adewumi
Dept of Oral Medicine, Faculty of Dentistry, University of Lagos Consultant (Oral Medicine), Lagos University Teaching Hospital, Idiaraba, Lagos.
Nutrition affects oral health and oral health affects nutrition. Nutritional deficiencies are associated with changes in the integrity of the oral tissues which are frequently the first clinical signs of deficiency. The effects of malnutrition on oral tissues can be seen in all stages of human growth and development from conception to old age. Malnutrition affects the host defence system thereby increasing the vulnerability of oral tissues to disease and pathogens leading to cracks and fissures at the angles of the mouth, atrophy of the oral mucosa, depapillation of the tongue, oral ulcers, scurvy and cancrum oris. These diseases are prevalent in malnourished children and may be disfiguring and life threatening. Although dental caries is a disease of affluence, its prevalence is on the increase in resource poor countries due to the increased consumption of sugars and low exposure to dietary fluorides. Dental caries incidentally has a negative effect on nutrition as the resultant pain and tooth loss impact negatively on food intake. Dental enamel hypoplasia (hypoplasia and/ or hypocalcification) may result from pre-natal malnutrition. Such developmental defects have been shown to constitute a significant independent precursor of caries in the primary dentition. In HIV infection, immunity is compromised thereby making the oral mucosa more vulnerable to opportunistic infections like oral candidiasis and herpes simplex infections which in turn compromise nutrition. This paper will examine the effect of compromised nutrition on oral health and the reverse. It will also seek to determine the effects of nutritional/ dietary intervention on the prevention and management of oral diseases.
The Health Status of Nigerians & Selected ECOWAS Countries: A two-point comparison in 10 years
Ibrahim M. T. O.1, 4, Abiola A. O.2, 6, Isah B. A.1,4, Yunusa E. U.1,4, , Gana G. 1,5, Ango J.1,5 and Sabri C3,4.
Departments of Community Medicine1, Public Health2 & Economics3, Usmanu Danfodiyo University4 /Teaching Hospital5, Sokoto & Federal Medical Centre, Birnin Kebbi, Kebbi State6.
Introduction: The health status of a people is determined not by the number nor the magnanimity of hospitals that are built but by their accessibility to potable water supply, adequate environment, the literacy status, lifestyle, income and the house they live in. this study therefore attempted/ endeavoured to investigate and compare the health status indices of Nigeria in an interval of 10 years and to compare the health status of the country nine 9 others ECOWAS countries.
Methodology: The study employed a cross-sectional descriptive design to study Nigeria and other nine randomly selected ECOWAS member countries.
Result: Nigeria's GDP of 1. 2 and 4th best of 10 in 1995 dropped to 0. 7 and 4th worst in 2006. The country's GNI of 260 and 4th worst in 1995 rose to 640 and 3rd best in 2006. In 1995, 29% of Nigerians were earning less than 1 US $/day and were the worst of the 3 countries with available data. Nigeria is the worst of all the countries in the region listed with 71% of it's populace earning less than 1 US $ / day in 2006. Government expenses on health of 1% and 7th best in 1995 remained 1% and 3rd worst in 2006. Government expenses on education remained 3% for the period 1996 2006 but 4th and 3rd worst respectively. The percentage of skilled attendants at delivery improved slightly from 31% to 35% in the period under review but Nigeria moved from being 4th worst in 1996 to 2nd worst in 2006.
The proportion of LBWs reduced from 16% ( 2nd worst) in 1998 to 12% ( 4th best) in 2008 better than Senegal, Gambia, Benin etc. Our 7th best of 10 countries in U 5MR of 191 / 1000 live births in 1998 had moved to 6th best though remained at 191 / 1000 after 10 years. Our MMR of 1000 / 100, 000 and 5th worst in 1995 had worsened to 1100 / 100, 000 live births in 2008 and 4th worst. Life expectancy of 52 and 4th best in 1998 had worsened to 47 and 3rd worst in 2008. Our percentage of the populace with Improved water sources of 50% ( 5th best) in 1998 depreciated to 48% and only better than Niger in 2008.
Conclusions: The implications of the study findings shall be fully discussed.
Epidemiology of HIV and HIV-TB Co-infection among Patients on Art in Sokoto State, Nigeria.
1Abiola A. O., 2Shehu M. T., 3Sani Y. M., 4Akinleye C., 5Isah B. A., 5Yunusa E. U., and 5Ibrahim M. T.O.
1Department of Public Health, Federal Medical Centre, Birnin Kebbi. 2Tuberculosis/Leprosy Unit State Ministry of Health Sokoto, 3Department of Medical Laboratory, Specialist Hospital Sokoto, 4FHI/GHAIN Sokoto, 5Department of Community Health, Usmanu Danfodiyo University, Sokoto.
Background: HIV/AIDS and tuberculosis (TB) are commonly called the "deadly duo". HIV weakens the immune system and TB accelerates the progression of HIV to AIDS. This study aimed to describe epidemiology of HIV and HIV/TB Co-infection in Sokoto state, Nigeria.
Methods: Data were extracted from medical records of HIV infected patients on ART in health facilities that offer comprehensive care for HIV and HIV/TB co-infected patients in Sokoto State, and analysed.
Results: Majority of the 353 study subjects were females ( 60. 6%), 30- 39 years age group ( 37. 4%) and lived in Sokoto state ( 78. 5%). Commonly used care entry points were MOPD ( 36. 8%),
GOPD ( 35. 4%) and VCT ( 23. 5%). Enrolment for HIV care was highest in May ( 13. 4%) and lowest in March ( 5. 1%). The functional status of majority ( 75. 8%) of the study subjects was asymptomatic normal activity. 33( 9. 3%) of the study subjects were HIV-TB co-infected. HIV only cases and HIV/TB co-infected cases were similar with respect to age and sex but differ significantly with respect to WHO clinical stage, CD 4 count and functional status at start of ART. Conclusion: HIV only cases and HIV/TB co-infection cases have similar demographic characteristics but differ with respect to CD 4 count at start of ART. There was a significant association between WHO clinical stage at start of ART as well as functional status at start of ART and TB status at start of ART. There is need to intensify TB case finding among people living with HIV-AIDS (PLWHA).
Key words: Epidemiology, HIV, HIV/TB, Co-infection, Sokoto, Mode of Presentation: Power Point
Nigerian Medical Association: From Crisis to Peace
Background: The history of nations and of human organizations is often marked by lack of agreement on fundamental issues like basis of unity, governance, mode of change of leadership as well as sharing and handling of revenue. These disagreements eventually lead to hot arguments and irreconcilable differences resulting in varying degrees of unrest like civil wars in nations, unilateral declaration of independence by component units of countries and emergence of factions and factional leadership in human organizations like professional associations, clubs and political parties.
Materials and methods: This study utilized both primary and secondary methods of data collection including interviews of key participants and interactive sessions with stakeholders as well as information from books, journals, newsletters and memoranda.
Results: The result of the study revealed that Nigerian Medical Association is a typical human organization and is therefore not immune to disagreements of diverse magnitudes which can lead to dire consequences. Hence, the study confirmed that the series of crises that engulfed the NMA from the mid 1990s to early 2000 represent the reality of human organizations linked to contradictions in the governance process of such bodies.
The study further revealed that the crises led to the inexorable balkanization of the Association into three factions. Consequently, the study documented several steps in Alternative Dispute Resolution mechanisms which were undertaken to restore Unity to the Association in April 2000 and beyond.
Conclusion: Thus, the celebration of fifty years of NMA as a veritable organization provides a unique opportunity to assess a major event of her history and draw lessons from the experience.
NMA as a Potential Catalyst in Revitalisation of PHC
Ohanyido F. O.
Over the past six years the Nigerian Medical Association (NMA) has gradually transformed itself into a prominent institutional advocate and catalyst for reforms in the health sector. It has also been part of a large donor-funded programme that effectively intervened in communities to improve the social sector, especially primary health care. This is within the purview that part of the critical approaches to revamping the primary level of healthcare may lie in broad-based partnerships that include strategic professional health associations like NMA, leveraging their advocacy niche and knowledge systems to improve healthcare delivery for the bottom of the pyramid.
The purpose of this paper is to present the potential inherent in NMA harnessing its programmatic experience to synergise with the current strategic thrust towards the revamping of the primary level of care. This is particularly to ramp up advocacy activities, tackle challenges of huge capacity gaps at that level by building a sustainable mentoring-cascade culture and learning, anchoring the systematization of standards of practices, technical skills transfer, effective referral mechanisms, operational research and monitoring and evaluation.
Desk and institutional capacity reviews (DICR) of NMA's roles and organization's capacity were examined. Evidence suggest that NMA's advocacy and catalytic approach to mentoring as well as other organisational skills-set can be effectively deployed towards supporting primary healthcare revitalisation.
Advanced Videoscopic & Laparoscopic Surgery Centre…AVLSC
John C. Ojukwu
Consultant and Director, Minimally Invasive Surgery, Advanced Laparoscopy and Operative Endoscopy, Surgical Oncology
High technology Medical Treatment is presently at an equinox in Nigeria. Usually performed by Specialists in diaspora who conduct specific missions back home or by 'returnees' who have acquired the skills and practiced for awhile prior to returning home. Despite these advancements, there is a booming trade called medical tourism with old frontiers, the United Kingdom and the United States of America, being surpassed by emerging nations like South Africa, Egypt, India, Thailand, Malaysia, Singapore and Turkey.
To improve high tech medical treatment in Nigeria, we the specialists must convince our colleagues and patients that it can be done safely here. Financing to assist in the procurement of the necessary equipment remains vitale.
The Doctors in diaspora must be tapped to visit regularly and transfer knowledge. High tech medicine is already here, kidney transplantation, prosthetic knee and hip replacement, cardiac surgery, laparoscopic cholecystectomy are all being conducted safely in Nigeria today.
Factors influencing medical tourism in Nigeria
Natioonal Hospital, Abuja
Medical tourism describes the rapidly-growing practice of traveling across international borders to obtain health care services. This is now a viable and an exploding business enterprise all over the World. In many countries, factors that have led to the increasing popularity of medical travel include the high cost of health care, long wait times for certain procedures, the ease and affordability of international travel, and improvements in both technology and standards of care in many countries. The situation in Nigeria is vastly different and the drive for medical tourism in Nigeria is multifaceted. The need to access good medical care is the single most important reason Nigerians go outside the country to seek medical care. Key excuse for this is the poor medical infrastructure and decline in quality medical care in the country as a whole. There has been significant decay in all aspects of medical care and morbidity and mortality rates in all conditions are higher than they should be. Critical care and specialised equipment for investigations and management are lacking even in the designated centres of excellence. Of course, this stark reality was underlined by the President himself, Mr Yar Adua in his recent travel to Saudi Arabia for medical care.
The second important reason that Nigerians travel is affordability. Many of the patients who choose to travel have access to funds either through the governmental agencies or through private enterprises. Health care through medical tourism is more expensive for Nigerians when compared to costs of treatment at home. Nigerians for example spend as much as $ 20 billion per year on health costs outside Nigeria (Neelankantan, 2003). For as long as someone else is picking up the bills, Nigerian patients will seek medical treatment abroad.
This is even more so because of direct and indirect remunerations. Travelling for health enables the patient to obtain a visa to European countries and the United States of America easily. This may have been for the individual person previously near impossible. There are also direct financial rewards for government officials to travel abroad for medical care. Foreign currency is often paid to such government officials as expenses. This is a major incentive to the patient to consider medical tourism to the detriment of medical practitioners in Nigeria. Of course, there are those who see foreign treatment as a status symbol and a sign of their affluence. Regardless, of the reason for medical tourism, all must remember 'caveat emptor' (let the buyer beware) as medical tourism can sometimes not be a bed of roses.
Key Words: Primary Healthcare, Health System, Catalysis, Sustainability, Partnerships Advocacy
Abstract On Polio Eradication In Nigeria
Director Immunization Services and National EPI Manager at the National Primary Health Care Development Agency, Abuja. Mob: + 234- 705- 737- 6034; Email: [email protected]).
The 58th World Health Assembly (WHA) resolved to eradicate Wild Polio Virus (WPV) globally by the Year 2000. As of that time, there were 250, 000 cases of WPV in 125 countries. Implementation of recommended Global Polio Eradication Strategy commenced in Nigeria in 1996. However, activities and efforts to achieve WPV interruption in Nigeria suffered several setbacks-majorly, the 2003 controversy on Oral Polio Vaccine Safety until (a) a change of strategy from the National Immunization Days (NIDs) SIAs to immunization Plus Days (IPDs) in 2006, and (b) the introduction and use of monovalent oral polio vaccine (mOPV) also in 2006 which resulted in a drastic reduction in WPV case count in Nigeria in 2007. The non-sustainability of qualitative activities however resulted in the 2007/ 2008 resurgence of WPV in Nigeria.
The three types of poliovirus (including type 2- vaccine-derived poliovirus) were in circulation as a high proportion of children in key northern states remained unvaccinated or under-vaccinated. However enhanced political accountability and traditional and religious leadership engagement have been associated with improvements in vaccine delivery and changes in the patterns of poliovirus circulation of types 1, 2 and 3 that suggest that interruption of poliovirus transmission is attainable in the very near future.
The shifting focus of Primary Health Care in the context of Nigeria's Health Systems reform
Godswill Amechi Nnaji
Primary Health Care Unit, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University , Nnewi Campus
Introduction: Primary health care in low income countries such as Nigeria has an oversimplified concept both in practice and teaching. The set of values and principles on which PHC was founded to guide the health care delivery system have not been met. A huge gap exists between the expectations of citizens and performance of the health care delivery system.
Aim: To critically examine the concepts of PHC with a view to a better understanding and possibly providing bases for a shift in its focus and implementation in Nigeria.
Materials and methods: Desk and internet based review of relevant articles and official documents.
Discussion: Four main concepts/ approaches to PHC include; Selective PHC; Primary care; Alma Ata comprehensive PHC; and Health and human rights approach. In well-resourced contexts Primary care refers to physicians with a specialization in family medicine or general practice. In contrast, the concept in the low income countries is unacceptably restrictive. WHO recommends a shift in focus of Primary health care through four sets of reforms in the health system; universal coverage reforms through universal access and social protection; service delivery reforms through patient centred primary care; public policy reforms by integrating public health action and primary care; leadership reforms by the inclusion, participatory and negotiation based leadership.
Conclusion: Inability of health services to deliver levels of national coverage that meet stated demands and changing needs has been a source of worry. The health systems need to respond better and faster to the challenges of a changing world.
Recommendation: We recommend a conceptual shift in teaching and practice of PHC in Nigeria to reflect the current WHO recommendation.
Key words: Primary Care, Primary Health Care, Universal coverage, Reforms and social protection .
Task Shifting in Nigerian Health Care
There is ample evidence that numbers, quality and distribution of health workers correlate with positive health outcomes. The World Health Report of 2006 however indicated that 57 countries are experiencing critical shortage in human resources for health (HRH) thereby leaving a global deficit of 2. 4 million Doctors, Nurses and Midwives required to meet the millennium development goals (MGD). The fact that 36 out of the 57 countries are in Africa posses a major challenge to health development. Rural areas where majority of the African population reside are worst hit. One of the innovative approaches currently being implemented globally to tackle the health workforce shortage is task shifting which has been described by the World Health Organization as a process whereby specific tasks are moved where applicable to health workers with shorter training and fewer qualifications thereby ensuring a more efficient use of existing human resources and ease bottlenecks in service delivery. Some of the tasks/professional areas where task shifting is gaining popularity and have traditionally been applied include: scaling up HIV and AIDS control especially antiretroviral treatment, Maternal and Child Health, Primary Health Care, Surgery, Basic and Comprehensive Emergency Obstetric Care. In addition to a review of the experiences in Nigeria and other African countries in task shifting, this presentation also examines some of the challenges. Also highlighted are the requirements for a successful implementation of task shifting and resolution of the human resources for health crisis.
Healthcare Practice in the last 50 Years
M. B. W. Dogo-Muhammad , FRCS, mni,
National Health Insurance Scheme, Abuja
It is both the desire and responsibility of governments at all levels to develop appropriate policies that would ensure the well being of the generality of the populace. Globally, governments, irrespective of their ideology, strive towards achieving the highest level of health status for their citizenry, both as an end in itself and also as a means towards achieving an enduring socio-economic development of the nation. In achieving this, a key concern for most governments (particularly the developing nations like Nigeria) is how to put in place an equitable, sustainable healthcare financing strategy that will ensure that the generality of the population are not denied access to qualitative health care services.
In line with the philosophy of social justice and equity enshrined in the Nigerian National Health Policy, the Nigerian government desires to eliminate all forms of barrier to access to health care services (physical, financial & social) to enable Nigerians (and legal residents) have unhindered access to services irrespective of their socio-economic background. Accordingly, "the Federal, State and Local Governments of Nigeria have committed themselves and all the people to intensive action to attain the goal of health for all citizens by the year 2000 and beyond, that is a level of health that will permit them to lead socially and economically productive lives at the highest possible level" (FMoH, National Health Policy, 1996).
Towards achieving this National objective, a number of healthcare financing options have been designed and implemented since the year 1960 when Nigeria got its independence. Fifty years post independence today, Nigeria has witnessed an evolution in the way the health system is being financed, starting initially with tax based financing, through the introduction of different forms of user fees and now with social health insurance high on the agenda. The first two options (tax based financing & user fees) have over time, proved unsustainable and inequitable respectively, largely as a result of a combination of several factors, including; population explosion, changing morbidity & mortality profile, emerging and re-emerging diseases, rising cost of healthcare, rising poverty, etc. A recent WHO study ( 2008) prior to the introduction of social health insurance in the country has indicated that over 60% of healthcare expenditure in the country is out-of-pocket expenditure, clearly underlining the heavy financial burden on Nigerians (mostly socio-economically disadvantaged Nigerians) and the pervasive inequity in access to healthcare services in the country.
With a desire to address this heavy financial burden and gross inequity in health services provision, the Nigerian government introduced Social Health Insurance lately (officially launched June, 2005), as a financing strategy to complement and supplement existing sources of funds for the health system towards eliminating both financial and physical barriers to access to healthcare services for Nigerians. The National Health insurance Scheme (NHIS) is the regulatory authority mandated (by Act 35, 1999) to put in place appropriate social health insurance programmes to cover the different socio-economic groups in the country. The NHIS has a presidential mandate to ensure universal health insurance coverage for all Nigerians and legal residents by 2015.
Rational Decision Making: Future Nigerian Health System using inputs from Health Economics, Systems and Policy
Prof. B. C. Ozumba, O. Onwujekwe
College of Medicine, University of Nigeria, Enugu.
In sub-Saharan Africa health improvement remains a major development challenge and countries are constantly reforming and re-engineering their health systems for improved effectiveness, quality, efficiency and equity. However, one of the greatest problem preventing appropriate delivery of care, improved access to care and the financial viability of the Nigerian health system has been the absence of inputs from Health Economics, Systems and Policy in decision making, resource allocation and programme implementation. Nigeria and most sub-Saharan Africa (SSA) countries lack the capacity for health system analysis; health system management; health economics and policy; and overall health management techniques. These are essential skills that are required to improve the health system and ensure that the country attains and maintains the Millennium Development Goals (MDGs), institutionalize an efficient and equitable health sector reform programme and ultimately improve the health status of the people.
Health systems and policies amongst other things provide us with frameworks to analyse health policies and systems and their performance. Health economics provides us with: systematic approach to assessing costs and consequences of actions, where resources are scarce; frameworks for understanding incentives facing providers and operation of markets; and tools for measuring impact of interventions, including financial burden and equity. There is now an emerging but growing body of literature in Nigeria in Health Economics, Systems and Policy, which should be harnessed for improved evidence-based decision making in Nigeria that can lead to effective reforms that will kick-start the birth of the Future Nigerian Health System, that will not be ranked 187 out of 191 as was done by WHO in 2000 and wake it up from its present comatose state. Hence, the session will be used to introduce the delegates to principles and methods of Health Economics, Systems and Policy, as well as presenting excerpts from studies undertaken already in the areas in Nigeria that are useful for building a Nigeria health system for the future.