A randomized control trial in Nigeria

J-PAL has gotten a lot of attention for its unique approach to development interventions. They use the scientific randomized control trial (RCT) to test behavioral and community-based solutions and thus far have implemented or are in the process of implementing 280 of them. The group is known for their work on school attendance and teacher attendance. They have also covered such interventions as providing free eyeglasses to children in China and evaluating primary school performance (it helps) and providing microcredit in Morocco (it helped expand livestock but did not translate into enterprises).

J-PAL is now bringing their RCT methodology to maternal health, specifically to an area of Nigeria with some of the highest maternal mortality rates in the world. In the North East and North West parts of Nigeria the maternal mortality ratio is estimated to be between 1000-1500 maternal deaths per 100,000 live births. The Abdul Latif Jameel Poverty Action Lab (JPAL) will collaborate with the Planned Parenthood Federation Nigeria (PPFN) to evaluate community-based programs addressing maternal mortality in 96 villages in Nigeria.

What will they look at? In short, "the trial will evaluate PPFN's efforts to work at the community level in communities where the MSS has been implemented." The study is "working in villages where the MSS scheme has already been implemented in primary health centers and where PPFN's programs will serve as a complement to the MSS scheme by aiming to strengthen maternal health through community based interventions." Three groups will be compared:

1) Voluntary health workers alone (spreading birth preparedness and hygiene messages)
2) Voluntary health workers with a birth kit (our understanding is that this is a clean birth kit)
3) Voluntary health workers with community folk media

The primary outcomes of the study are maternal and neonatal mortality and morbidity. Additional outcomes include health knowledge and behavior as well as anthropometric indicators of infants.

We'll be watching this trial closely. Too often pilot projects implement just one of these initiatives or implement all three without knowing which of the initiatives really worked and which was most cost-effective. Knowing what we know about maternal mortality and the causes of death, we certainly wish that there were a way to include a fourth track-- and that is equipping voluntary health workers with the means addressing postpartum hemorrhage, the leading cause of death for women. But perhaps that can be a next phase.

The field really needs to hone in on the leading cause of death-- postpartum hemmorhage. Did any of these interventions reduce the amount of blood lost, the number of maternal complications, the number of deaths? What if another trial could be developed to compare iron folate supplementation, misoprostol administration in the community, measurement of blood loss and use of new technologies to STOP postpartum hemorrhage.

To be continued.
http://maternova.net/blog/randomized-control-trial-nigeria

IAS 2011: Assessing Nigeria’s position in the global fight against AIDS

By Kemi Yesufu,
Nigeria is one of the countries with the biggest Acquired Immune Deficiency Syndrome (AIDS) burden in the world. According to statistics, despite, the reduction to 4.4 from an over six percent national prevalence rate, Nigeria is only second to South Africa on the continent as per recorded cases of the disease. This makes Nigeria’s success in the control of AIDS pivotal to the global fight to curtail the spread of HIV.

It therefore was pertinent for Nigeria to attend the 6th International AIDS Society (IAS) Conference. The summit took place in Rome, Italy from 17th -20th July. Though Nigeria has made progress in management of the disease with the National Agency for the Control of AIDS (NACA) making head way with the national response on AIDS, the consensus is there is still a lot of work to be done. Since its inception, the IAS Conference has provided a platform for scientists, health equipment manufacturers, pharmaceutical companies, government agencies, public healthcare officials and the academia to exchange ideas on the management of the disease. The IAS conference 2011 theme, “HIV Pathogenesis Treatment and Prevention” has been described as timely and most appropriate, as it came a little after the world marked 30 years of the disease in human though scientists at the conference reminded attendees that SIV, (HIV in humans) had long existed in Monkeys and Apes.

Scientists at the conference equally stated that there is still no agreement on how SIV was transmitted to human from apes and why these primates never come down with AIDS like their close relatives, the humans, it is worthy of note, that scientists and health administrators were more concerned with using treatment as a veritable tool for prevention of AIDS. Notwithstanding the show of indifference shown by the absence of the Federal Ministry of Health which implements 85 percent of the HIV/AIDS treatment and prevention programs of government and that of the Women Affairs and Social Development ministry which oversees a large chunk of programs on infant and maternal survival, it is important to say that Nigeria stands to gain a lot by improving on its treatment model. Nigeria has placed 400 thousand Persons Living with HIV/AIDS (PLWHAs) on Anti-Retroviral; the number falls short of the country’s target of no less than one million persons. This much was acknowledged by the Director General of NACA, Professor John Idoko who led the Nigerian team to the conference. He said all efforts were being put in place to increase access to treatment especially for expectant mothers. Indeed, for experts at the conference the sure route to an AIDS free generation is for countries like Nigeria to stop pediatric AIDS. Idoko said, “treatment has helped a great deal in reducing new infections in Nigeria. When a person uses ARVs it reduces the viral load and this makes it less possible for the person to infect someone else. It is this principle that is used in reducing transmission of the virus. We have also adopted the principle that we will not restrict treatment for pregnant women whose CD4 count is less than 350. We use the HAART option, we give three drugs from the pregnancy, to delivery and to when the woman weans the baby, so you protect the woman and she will not transmit the disease during pregnancy, delivery or during breast feeding. The second option is to use two drugs from the time of pregnancy any time from 24 weeks to one week after delivery but in addition you will give the baby Neverapine syrup. All of these are to prevent transmission through treatment and we have recorded success though we are working towards doubling the number of success stories”.

Government has struggled with interventions in the health sector largely due to corruption, dilapidated structures and lopsided distribution of skilled personnel. However, NACA has pledged to continue with action aimed at stopping new infections by targeting hitherto overlooked groups. This much, Idoko disclosed. “There are two things recent studies have come up with. First you have the pre-exposure prophylaxis. These drugs work to break transmission of the virus from a HIV positive person to an HIV negative person when the latter is exposed to the virus either through sex or other means. Studies have shown that this drugs work for both Men who have Sex with Men (MSM) and heterosexual sero-discordant couples. I am part of a chore team set up globally to work on the use of prophylaxis and Nigeria has been chosen as one of the countries in which demonstration studies will be carried out to see how it works in certain environments. If we are successful, then, we will scale up the program”, he said.

He argued that it was not a case of misplaced priorities for Nigeria to take up use of prophylaxis. Hear him, “for a country like Nigeria where people might ask why we should be using resources on prophylaxis for uninfected persons when we need to double the number of sick people on ARVs, I would like to say that prevention should be the starting point for treatment. For us, we must prevent new infections among sero-discordant couples; the fact is that couples have the desire to live a normal life and to have children. So, once we send our proposal to this committee and we get the funds, we will commence the study in states with high prevalence rates”.

A major complaint among PLWHAs is that government doesn’t assist in the treatment of opportunistic infections such as malaria and tuberculosis. Though, the AIDS, TB and Malaria (ATM) Task force is headed by the minister of Health, government has often argued to the chagrin of PLWHAs that it will not be able to provide free treatment for these infections, blaming its position on paucity of funds. Another issue government has performed poorly on is its structural approach to the control of AIDS especially among commercial sex workers. This problem remains a stumbling block to stopping new infections. In Nigeria, a country where over 70 percent of new infections is recorded among heterosexuals, commercial sex workers have been identified as one of the groups that fuel the disease, yet, they are often criminalized just as they are stigmatized and discriminated against.

According to the NACA Director General even with the IAS conference tasking countries to seek innovative ways to integrate sex workers into their programs, such interventions remain a Herculean task in Nigeria. “Combination prevention strategy takes into cognizance, behavior, biomedical and structural intervention. For structural approach, it is about solving the problems we know that put people at risk of the disease, from the political, socio-cultural and socio-economic perspective. We have a big problem with commercial sex work in Nigeria. First thing is that commercial sex workers are not organised. There are a few commercial sex workers who have orgnaised themselves into groups but things are still patchy and this makes it difficult for us to reach them”. Continuing he said, “on this issue we also have to address the problem of stigma and discrimination, so they can be open to testing and getting treatment for those who test positive. We also need to create jobs or create the right conditions for income generation so some of them will leave what they are doing”.

Probably the most disturbing setback for AIDS control is the low percentage of research in Nigerian Universities and allied institutions. While most of the work presented at the IAS Conference 2011 came from or was done in association with the academia, Nigeria had only a few papers presented with Universities poorly represented. One of the few Nigerians with an abstract at the conference, Adamma Emejulu a Doctoral student and lecturer at the HIV Research Unit of the Biochemistry Department of the Federal University of Technology Owerri explains why there was a poor showing by Nigeria. “We hardly get funding for research. Here, I have seen colleagues from other parts of the world being funded by the UN agencies, the private sector or some of them are beneficiaries of research funds provided by their government. In Nigeria we have resorted to limiting ourselves to where our pockets can carry us and this is frustrating”. On resumption in office the current NACA DG had stated the need to focus on research as the agency stands to benefit from locally carried out research. On how much of the promise has been kept, especially as there are willing scientists who are being slowed down by lack of funds, he said, “We have established a research Unit in NACA, last year we brought in two professors on sabbatical and we have put a research policy together outlining our priorities. We are putting up a fund for we will soon advertise for people to apply to an expert committee who will now select proposals that will be funded by NACA. We are also planning on a fund for young scientists and young media scientists”.

In all Nigeria’s outing at the IAS is reflective of its position in the global fight against AIDS. NACA as the statutory body in charge of the control of AIDS is carrying out its duties within many limitations. Most of the prevention and treatment polices enunciated at the conference were already in practice in Nigeria but there is urgent need to scale them up particularly in the rural areas. The absence of the ministries who should spear head the control of the disease highlighted the disjointed nature of the national response to AIDS. The handful of researchers from Nigerian institutions mirrored the lack luster situation in the country’s academia.

http://www.independentngonline.com/DailyIndependent/Article.aspx?id=38310

Nigeria has highest rate of stillbirths in Africa – Report

By Onche Odeh,

The first comprehensive set of stillbirth estimates has said 42 out every child 1,000 children born in Nigeria would have been stillbirth, a record that has put Nigeria in the list of countries in the world with the highest rate of stillbirths.

Although other African countries were listed among countries with similar records, Nigeria distinctly had the worst records in this regards. The estimates published recently in the journal, Lancet, also listed Democratic Republic of Congo, Ethiopia and Tanzania as other countries in Africa with high rates of stillbirths.

In the report featured on the Africa Science, Technology and Innovation website (www.africasti.com), perinatal epidemiologist, Chair of the International Stillbirth Alliance, and author of the paper on stillbirths in high-income countries for The Lancet’s Stillbirths Series Vicki Flenady, was quoted as saying, “An African woman has a 24 times higher chance of having a stillbirth at the time of delivery than a woman in a high-income country.”

It points out that the rate varies sharply by country. It noted that in Nigeria, 42 stillbirths would be recorded out of 1, 000 live births. This is a sharp departure from the lowest rates of two per 1,000 births in Finland and Singapore and 2.2 per 1,000 births in Denmark and Norway. The highest was recorded in Pakistan with 47 per 1,000, 36 in Bangladesh, and 34 in Djibouti and Senegal.

The report showed that about 2.6 million third trimester stillbirths occur every year worldwide. However, an estimated 1.8 million stillbirths occur in ten countries including Nigeria, India, Pakistan, China, Bangladesh, Democratic Republic of the Congo, Ethiopia, Indonesia, Afghanistan and United Republic of Tanzania.

A rather more worrisome trend is that half of all stillbirths occur in Nigeria, India, Pakistan, China and Bangladesh alone, marked as countries with abysmal records on maternal and newborn deaths.

According to the report, two-thirds of stillbirths happen in rural areas, where skilled birth attendants, in particular midwives and physicians, are not always available for essential care during childbirth and for obstetric emergencies, including caesarean sections.

The report states that every day more than 7,300 babies are stillborn. This, it says happens more in the low income countries although wealthier nations are not immune, as it has been found that one in 200 pregnancies result in a stillbirth, with two thirds occurring in the last trimester of pregnancy, a rate that has stagnated in the last decade.

The report attributed the huge number of stillbirths in these countries to five main causes including childbirth complications, maternal infections in pregnancy, maternal disorders, especially pre-eclampsia and diabetes, fetal growth restriction and congenital abnormalities.

Accordingly, the Lancet’s Stillbirths Series, authored by 69 experts from more than 50 organizations in 18 countries says all causes of stillbirth combined would place stillbirths fifth on the list of leading causes of deaths worldwide. The series comprised of six scientific papers, two research articles, and eight linked comments.

However, the number of stillbirths worldwide has declined by only 1.1 percent per year, from 3 million per year in 1995 to 2.6 million in 2009. This is slower than reductions for child and maternal mortality.

According to Assistant Director-General for Family and Community Health at the World Health Organization (WHO), Flavia Bustreo,. “Stillbirths often go unrecorded, and are not seen as a major public health problem. Yet, stillbirth is a heartbreaking loss for women and families. We need to acknowledge these losses and do everything we can to prevent them.”

Joy Lawn, Director of Global Evidence and Policy, Saving Newborn Lives/Save the Children, a lead author of The Lancet’s Stillbirths Series who coordinated the new estimates, emphasizes that “almost no burden affecting families is so big and yet so invisible both in society and on the global public health agenda.”

The number of stillbirths can be slashed, say most experts. “Stillbirths need to be an integral part of the maternal, newborn and child health agenda,” Carole Presern, Director of The Partnership for Maternal, Newborn & Child Health (PMNCH) and a midwife said, adding, “We do know how to prevent most of them.”

Besides lacking visibility, stillbirths lack leadership both locally and internationally. “Parental groups must join with professional organizations to bring a unified message on stillbirths to government agencies and the UN,” J. Frederik Frøen, an epidemiologist at The Norwegian Institute of Public Health and member of the International Stillbirth Alliance said.

Almost half of stillbirths, 1.2 million, happen when the woman is in labor. These deaths are directly related to the lack of skilled care at this critical time for mothers and babies.

Another dampening revelation by the report is that, in comparison of 1995 to 2009 stillbirth rates, the smallest declines were reported in Sub-Saharan Africa and Oceania, at a time significant declines were reported for China, Bangladesh, and India, which had a combined estimate of 400,000 fewer stillbirths in 2009 than in 1995.

“Stillbirth rates have halved in China and Mexico since 1995, demonstrating what can be accomplished in middle-income countries,” Lawn said.

According to The Lancet’s Stillbirths Series, as many as 1.1 million stillbirths could be averted comprehensive emergency obstetric care Syphilis detection and treatment programme were in place.

Other interventions capable of averting stillbirths including the detection and management of fetal growth restriction, detection and management of hypertension during pregnancy, identification and induction for mothers with 41 weeks gestation.

Malaria prevention, including bednets and drugs, folic acid fortification before conception and the detection and management of diabetes in pregnancy are other courses scaling up stillbirths.

“An additional 1.6 million deaths of mothers and newborns could be averted if you add five additional interventions beyond stillbirth interventions, such as antenatal steroids and neonatal resuscitation,” Zulfiqar A. Bhutta, Chair, Department of Pediatrics and Child Health, The Aga Khan University, Pakistan said.

Despite the large numbers, stillbirths have been relatively overlooked as a global public health problem. They are not included in the Millennium Development Goals for maternal and child health set by the United Nations.

http://www.independentngonline.com/DailyIndependent/Article.aspx?id=38301

Tackling maternal and child mortality in Nigeria

By Biliqis Bakare

Global analysis of statistics from different sources has revealed that children and women are the most vulnerable to the threats of poverty and untimely death. According to a recent World Health Organisation report, more than 600,000 women have died in recent time due to childbirth or pregnancy-related complications while Nigeria accounts for close to 10 per cent of that figure. The global under-five mortality rate in sub-Saharan Africa and South Asia has not reduced sufficiently to reach the Millennium Development Goals by 2015. In fact, the highest rates of mortality in children under- 5 years continue to occur in sub-Saharan Africa, which accounted for half of child deaths worldwide in 2008. While substantial progress has been made in reducing child death, children from poorer households remain disproportionately vulnerable across all regions of the developing world. Most children in developing countries continue to die from preventable or treatable causes, with pneumonia and diarrhoea as the two main killers. Under-nutrition also contributes to more than a third of all under- five deaths.



While some progress has been made in reducing maternal mortality, the rate of decline is far from adequate for achieving the MDGs in 2015. Moreover, for every death, approximately 20 women suffer from injury, infection, disease or disability as a result of complications from pregnancy or child birth.



In the 2010 WHO report, Nigeria recorded 50,000 maternal deaths a year, thus placing it as having the second highest rate after India. And with every maternal death, there are more child deaths. The mortality ratio for children under -five years in Nigeria is 230 per one thousand births, 16 children less than five years die every 10 minutes. New born deaths account for more than a quarter of these deaths especially within the first week of life due to pregnancy and delivery related complications. As the statistics show, there is a close relationship between the well-being of the mother and the health of the child.



As a result of the enormity of the problem, 189 countries met under the umbrella of the United Nations in 2000 to address as a single package, child and maternal mortality in addition to other rights and developmental issues collectively adopted as the eight MDGs of which the fourth MDG aims at reducing child mortality by two-thirds by2015 while the fifth MDG proposes the reduction of maternal mortality by 75 per cent by the year 2015.



At the National Council of Health meeting in 2007, the Federal Ministry of Health adopted the Integrated Maternal, Neonatal and Child Health Strategy. This high- profile initiative, comprising high impact intervention packages, is to address the main causes of maternal, newborn and child death at community and health facility levels. Additionally, it will focus on integrated maternal, new born and child health services along the life cycle at all levels. The main goal is to essentially reduce maternal, neo-natal and child morbidity and mortality in line with the Millennium Development Goals. If fully implemented, the IMNCH Strategy will lead to a reduction of about 72 per cent of neo-natal deaths,70 per cent of under -five deaths and two- third of maternal deaths. In absolute terms, more than 200,000 mothers and six million children lives’ can be saved by 2015.To show its commitment toward the full implementation of this strategy, the Federal Ministry of Health has been collaborating with international agencies such as the United Nations International Children Education Fund, International Children Education Fund and Deux Construction Company through the building of maternal child centres.



Although global statistics depicting maternal and child health status have not fared better, the Lagos State Government has adopted the health vision enunciated in the Millennium Development Goals as the state’s minimum starting point for the sector. The state government, in realisation of the enormity of this problem, coupled with the attention the problem was getting, evolved the Integrated Maternal and Child Centres Policy, a vision tied to excellence in line with the Millennium Development Goals of the United Nations. Child survival intervention, especially immunisation, apart from constituting part of the right of the child, had been acknowledged as a veritable strategy towards achieving the Millennium Development Goals . This is why the state government conceived the National Immunisation Plus Days which it has been adhering strictly to. It has also gone further by working with neighbouring Ogun State and the Republic of Benin, along the border towns, in finding more effective ways to eradicate the scourge of poliomyelitis in the two countries.



Perhaps, the most important step which the Lagos State Government has taken towards reducing maternal and child mortality level to zero in the state is the inauguration of Maternal Child Centres, equipped with the latest medical and other facilities to enhance and ensure optimal performance, across the state. The centres are located on the premises of the General Hospitals at Surulere (Gbaja), Ifako- Ijaye, Amuwo-Odofin, Ikorodu, Isolo, Eti- Osa and Ajeromi/Ifelodun. Each of the centres has five clinics for mothers, babies and children. The 100 bed facility also has neo-natal unit for premature babies, labour ward with delivery room, emergency clinic, a theatre for Cesarean sections in complicated deliveries and much more.



If we are to tackle the twin challenge of maternal and child deaths headlong in the country, priority should be given to implementable action plans developed in collaboration with critical stakeholders. The time for action is now!



-Bakare wrote in from the Features Unit, Ministry of Information and Strategy, Alausa, Ikeja, vide taylo123456@rocketmail.com


http://www.punchng.com/Articl.aspx?theartic=Art201108030434517

Breastfeeding: Lagos to establish creches in ministries

By Chioma Obinna& Ebele Onuorah
LAGOS — As Nigeria joined the rest of the world to celebrate the 2011 World Breastfeeding Week, the Lagos State Government has concluded plans to establish creches in the various state ministries as part of strategies to promote exclusive breast feeding in the first six months of life.

The plan to establish creches is coming even as the Special Adviser to the Lagos State Governor on Public Health, Dr. Yewande Adeshina, said no fewer than 1.5 million lives could be saved through exclusive breastfeeding for the first six months of a child’s life according to research.

Speaking at a press conference to mark this year’s World Breastfeeding Week tagged, “Talk to Me: Breastfeeding a 3D Experience,” Special Adviser to the Lagos State Governor on Public Health, Dr. Yewande Adeshina, noted that ample evidence supports breastfeeding as the healthiest and most reliable nutrition for babies’ survival.

She said breastfeeding remained a high impact intervention for ensuring the survival, adequate growth and development of the child.

She explained that Lagos State had been in the forefront of the campaign for exclusive breastfeeding and would not only support private sectors in the establishment of creches but would set up these centres in all the state ministries.

Her words, “Breast milk alone is the ideal nourishment for infants for the first six months of life as it contains all nutrients, antibodies, hormones and antioxidants and other factors an infant needs to thrive. Research also has it that breast milk protects babies from diarrhoea and acute respiratory infections, stimulates their immune system and response to other diseases and to vaccination. It also promotes love and bond between mother and child which in turn improves the psychological well being of the baby.”

Adeshina who advocated the empowerment of women in order to breastfeed their babies appropriately said the theme of this year’s celebration, emphasises promoting communication of breastfeeding issues at various levels by using various communication strategies in strengthening breastfeeding practice and principles among the populace.

She urged husbands, fathers, parent-in-law, family members and the community at large to encourage women of child bearing age to initiate and sustain breastfeeding in their infants for the prescribed duration just as she stressed the importance of mothers to attend clinics regularly during which health education on nutrition including breastfeeding will be provided.

On activities planned for the week long celebration, she announced that there will be family enlightenment breastfeeding seminar of young couples, grandparents, adolescents, health workers, youth corps members, selected secondary school students and women of child bearing age.

“During the week-long celebration, maternal and child’s survival services and interventions will be provided at all primary health care facilities spread across the local government and local council development areas. These shall include counseling on exclusive breastfeeding, vitamin A administration, appropriate complementary feeding, immunization, vaccination of pregnant women with tetanus toxoid and health education on key household practices,” Adeshina explained.

http://www.vanguardngr.com/2011/08/breastfeeding-lagos-to-establish-creches-in-ministries/

Couples With Different HIV/Aids Status Can Leave Normal Lives - John Idoko

An interview conducted by: Ruby Leo
We bring you an extract below:

interview

Though a cure for HIV/AIDS is yet to be found, the Director General of NACA Professor John Idoko says couple with different status (one negative and the other positive) can marry, give birth to negative babies, live a normal life, using treatment as prevention.

Using prevention as a major tool of reducing new infections is a theme being focus on. Is this approach working for Nigeria?

Yes, treatment has helped a great deal in reducing new infections in Nigeria. When a person uses ARVs it reduces the viral load and this makes it less possible for the person to infect someone else. This principle is used in reducing transmission of the virus. We will not restrict treatment for pregnant women whose CD4 count is less than 350. We use the HAART option, meaning, we give three drugs from pregnancy, to delivery and when the woman weans the baby. In essence you protect the woman, so she does not transmit the disease during pregnancy to the baby or during delivery or during breast feeding.

The second option is to use two drugs from the time of pregnancy, from 24 weeks to one week after delivery but in addition you will give the baby neverapine syrup. All of these are to prevent transmission through treatment and we have recorded success though we are working towards doubling the success stories.

Tell us about this innovation being funded by donors, to improve prevention?

A lot of emphasis in this summit is on how treatment plays a role in prevention. There are two things recent studies have come up with. First is the Pre-Exposure Prophylaxis. These drugs work to break transmission of the virus from a HIV positive person to an HIV negative person when the latter is exposed to the virus either through sex or other means. Studies have shown that the drugs work for both Men who have Sex with Men (MSM) and sero-discordant couples. I am part of a chore team working on the use of prophylaxis and Nigeria has been chosen as one of the countries where demonstration studies will be carried out to see how it works in certain environments. If we are successful, then, we will scale up the programme.

But for a country like Nigeria where people might ask why we should be using resources on prophylaxis for uninfected persons when we need to double the number of sick people on ARVs, I would like to say that prevention should be the starting point for treatment. For us, we must prevent new infections among sero-discordant couples, the fact is that couples have the desire to live a normal life and to have children. So, once we send our proposal to this committee and we get the funds, we will commence the study in states with high prevalence rates.

Tell us of the PMTCT services in Nigeria and why Nigeria is finding it hard to scale up the services?

All our challenges can be traced to a weak health system. The natural thing is to implement PMTCT at Primary Health Centers (PHCs) during ante-natal. Most PHCs are dilapidated and not fully functional; unfortunately they are located in the rural areas where over 70 percent of Nigerians live. We are trying to introduce PMTCT services to the private hospitals in the urban areas since a large percentage of women are registered with them. For us to scale up PMTCT services, we have to rehabilitate the PHCs, re-train staff, buy new equipment and re-introduce the centers to the people.

We also need to look into the lopsided distribution of health workers. When you look at the South East, the South West, they have enough trained personnel to provide health services. This is not the same in the North. We need to train lower cadre staff to handle PMTCT services in areas where we cannot get higher cadre staff to work in PHCs. Most importantly, we have to integrate PMTCT services into core ante-natal services. Efforts are on to integrate the PMTCT into health programmes for mother and child survival. We are also stepping up intervention for the management of malaria and TB. We are mobilizing communities to key into these programmes.

But Nigeria being a large country with 774 LGAs, it is not easy to get the results we desire, though there has been a lot of improvement in the last two years with support of PEPFAR, The Global Fund and the World Bank who have just given us a grant to provide PMTCT. Due to their support our PMTCT coverage moved from 11 percent in 2009 to 30 percent this year. But we need to get to 70 percent or even 90 percent like some of the countries here at the summit.

There was a session on managing HIV, TB and Malaria. Nigeria is one of the countries which have sought to manage these three diseases holistically. How far have we gone with it?

Let me put in this way, TB is the commonest reason why a PLWHA get sick or dies. Almost 50 percent of the people diagnosed with HIV have TB. So the management of TB is very important, because it complicates the treatment of PLWHAs. Malaria is also important because research has shown that HIV prevalence is high in areas where this disease is endemic. It is a bit technical, but the simplest explanation is that once a person is down with malaria, the cells that contain the HIV virus begin to multiply and once your viral load is high, the person can easily transmit the virus. Again, PLWHA with low immunity easily go down with more complicated cases of malaria like cerebral malaria.

On our part, we don't treat malaria but we work through the AIDS, TB and Malaria (ATM) taskforce chaired by the Health minister. NACA is also fully involved in the integration of services towards maternal and infant survival.

On the control of HIV among commercial sex workers, is our national response tackling this problem?

There are three ways of implementing the combination prevention strategy. This strategy takes into cognizance, behavior, biomedical intervention and structural intervention. For structural approach, we look at those things that put people at risk from the political, socio-cultural and socio-economic perspective.

We have a big problem with commercial sex work in Nigeria. Firstly the commercial sex workers are not organized. A few commercial sex workers have organized themselves into groups but things are still patchy and this makes it difficult for us to reach them.

We have to address the problem of stigma and discrimination, so that they can go for voluntary testing and get treatment for those who test positive. We also need to create job or create the right conditions for income generation, to encourage those who want to leave the profession to do so. Government should think of getting them educated so they can be better informed on how to protect themselves from Sexually Transmitted Infections (STI). We have started the move to create a sex network but it has been difficult. Commercial sex workers are a reality in Nigeria but many people pretend that they don't exist. Those who recognize them criminalize them and this is detrimental to the national response on HIV.

You pledged to improve on research, How far have you gone?

The dearth of research is not only in the academia or in agencies like NACA but even in the media and other sections of society that could function better with it. The word research is no longer respected in Nigeria. We need to reignite interest in research. The biggest challenge has been funding and NACA is seeking means to generate funds for research that will boost the national response to HIV.

Famous universities get international funding for research but government and NGOs hardly fund research in Nigeria. We have established a research unit; last year we brought in two professors on sabbatical and the third is that we have put a research policy together outlining our priorities. A fund has been established for research and we will soon advertise for people to apply to an expert committee which will now select proposals that will be funded by NACA. Plans are underway to fund young scientists and young media scientists to do research.

What will Nigeria take away from IAS 2011?

One is bridging the gap between treatment and prevention, the second is mobilizing resources to sustain our programmes. Resources means, human, capital resources and goods and services. For example we have about 400,000 people on ARVs which is better than the world average. But when you remember that we need to put not less than 1 million people on treatment due to the recent research findings on the need to create universal access, you will agree that we still have a lot of work to do.

The good thing is that we have opportunities; we have good programmes already bought into by our partners. We have funding coming from the Federal Government, the MDG Office, PEFFAR, the Global Fund, the private sector and the World Bank and we have well marshaled plans to fully utilize these funds to make the national response even more effective.

http://allafrica.com/stories/201108021462.html

Before Mr President Signs the National Health Care Bill

Dr Aminu Magashi
These days any forum or meeting one attends, hardly will they conclude without making reference to National Health Bill which was passed on Thursday, 19th May 2011 by the last National Assembly and awaiting the signing into law by Mr President.

If signed, it becomes an act that provides a framework for the regulation, development and management of a national health system and set standards for rendering health services in the federation, and other matters connected therewith.

Health Reform Foundation of Nigeria, a non-governmental organisation has moved the advocacy beyond meeting rooms by publishing paid advertorials on the pages of newspapers notably This Day and Daily Trust newspapers requesting for the assent of President Goodluck to the National Health Bill passed by National Assembly.

The advertorial on page 42 of Daily Trust Newspaper of Friday, July, 29th, 2011, to my opinion created more questions to be pondered strategically and answered by all health advocates and of course Mr President before the bill becomes an act. It mentioned amongst others that;

The National Health Bill provides for:

• Free medical care for children under 5 years old, pregnant mothers, elderly (above 65 years) and disabled people.

• A guaranteed basic minimum health packages for all Nigerians

• Universal acceptance of accident cases by all health facilities in Nigeria (public and private)

• Ensure quality of health care services through the issuance of certificates of standard (public and private).

What is the economic implication for a country that is planning based on a health care bill to provide 'Free medical care for children under 5 years old, pregnant mothers, elderly (above 65years) and disabled people.' These categories of people are more or less the largest percentage of what constitute health facilities attendance and admissions. Can we provide free services to them in an efficient, effective, equitable and sustainable manner? Let me digress a bit to mention how the bill is planned to be funded.

Contained in the health bill, are some good innovations, such as the establishment of a National Tertiary Hospitals Commission, which already has an acting executive secretary and will surely gulp a lot of over head expenditure. The establishment of a National Primary Health Care Development Fund that will be financed directly from the consolidated fund of the Federation, with 2% of its value, with 50% earmarked for the provision of primary care via the National Health Insurance Scheme and the other 50% for drugs, infrastructure and human resources for primary health care to be managed by the National Primary Health Care Development Agency through State Primary Health Care Boards

We are also aware that a lot of critical commitments have relied on the bill . One of such is Nigeria's commitment to the United Nations Secretary General's Strategy on women's and children's health which affirms that the initiatives is in full alignment to our existing country-led efforts and strategies targeted for implementation for the period 2010 - 2015. In that regard, Nigeria has committed itself to fully funding its health programme at $31.63 per capita through increasing budgetary allocation to as much as 15% from an average of 5% by the federal, states and local government areas by 2015.

Based on available budget records, the aggregate Nigeria's expenditure for 2011 is N4.226 trillion and Health sector has taken N235.8 billion that is about 5% of the national budget. It is still not clear how we intend to move from 5% to 15% allocation from 2010 - 2015 - that's 2% increment every year until 2015. What is expected is to cost the implementation of the bill by looking at all that is proposed vis-a-vis the potential source of funding as well as the practicability of mobilizing resources to finance the bill.

'Free medical care for children under 5 years' old, pregnant mothers, elderly (above 65 years) and disabled people' requires deeper analysis. At what level of care are services going to be free; teaching hospitals/federal medical centres, secondary health facilities and/or primary health care. If user fees are withdrawn from teaching hospitals/federal medical centres which form largely their internally generated revenue that is used to take care of some overhead expenses, what will be the alternate source of funding? Will the Federal Government increase their monthly allocation? Our experience in many states providing free maternal and child health services have shown that, it is not effective, efficient and sustainable and lacks reliable records that maternal and under five mortality rates are reducing.

More questions need to be answered:

1. What is the current health budget in the 36 states as well as 774 LGAs? At the level of 5% health sector allocation, have we done an analysis to find out if there are budgets wasted, misplacement of priority as well as how the available scarce resources could be used in a strategic way of minimum input and maximum output?

2. Funding our health programme at $31.63 per capita across the 3 tiers of government is another challenge. What is the current per capita? What are the mechanisms at the states and LGAs to help them reach the desired per capita?

3. The Health Sector financing will also get additional funding based on the bill passed from the proposed 2% of the Consolidated Federal Revenue Capital. How realistic could that be in practical sense?

In conclusion, before Mr President hurriedly signs the bill into law only to have an 'Act' on paper that can't be implemented, lets support the system to do more economic analysis, evaluation, advocacy and awareness creation on how strategically the bill will be funded and implemented in a realistic way.

All comments to Dr Aminu Magashi at

http://allafrica.com/stories/201108021458.html

The Countries With The Fastest Growing Populations

The world’s population is likely to exceed 10 billion by the end of the century, up from 7 billion this year, according to research based on United Nations data. While population changes will remain flat or decline in developed countries, developing countries, notably those in Africa, will experience tremendous growth. According to David Bloom, a Harvard economist and author of the report “7 Billion and Counting,” nearly all of the growth will occur in less-developed regions.

“Already strained, many developing countries will likely face tremendous difficulties in supplying food, water, housing, and energy to their growing populations, with repercussions for health, security, and economic growth,” according to the release. The areas with the highest projected populations increases, primarily Africa and Southern Asia, are already suffering from the consequences overpopulation. These conditions will only worsen as populations in Uganda, Nigeria, and Bangladesh double and, in some cases, even triple over the next 40 years.

However, while 97% of the 2.3 billion projected increase will be in the less developed regions, the populations of developed countries will remain flat. Countries such as Japan, Germany, China, and Russia are expected to lose millions of citizens each. The only major developed nation projected to add significantly to its population is the United States.

24/7 Wall St. used data from the Population Reference Bureau’s 2011 World Population Data Sheet to identify the countries with the fastest growing populations. Based on “The World Population Prospects: The 2010 Revision of the UN Population Division,” PRB provides explanations for why the countries are growing along with what the potential long-term effects of the growth will be. Using their analysis, together with data on the local economy, health care, infant mortality rate, and fertility rate, 24/7 Wall St. identified the countries with the fastest growing populations. Some of these countries already deal with several problems, including high infant mortality, high prevalence of HIV/AIDS, and poor access to clean water. And these problems are magnified by the rapid population growth.

These are the countries with the fastest growing populations.




10. Uganda
> Population Growth 2011-2050: 71 million
> 2011 Population: 34.5 million (39th largest)
> Pct. Increase: +206% (3rd greatest)
> Pct. of Population < 15: 48% (3rd greatest) > GDP per Capita: $1,283

Uganda’s population is set to triple over the next 40 years. Compared to other countries, it is the third biggest increase as a percent of the population. By 2050, a nation that is one fortieth the size of the U.S. will add the equivalent of one fourth of the U.S. population. The country has the 31st highest death rate in the world. As a counterbalance, it has the second highest birth rate in the world. The average Ugandan woman has 6.4 children. The country is already experiencing extreme poverty and disease, and tripling the population in the next four decades could be disastrous. Uganda currently has the tenth highest rate of AIDS contraction in the world, and is already experiencing shortages of clean water and land for farming.

9. Indonesia
> Population Growth 2011-2050: 71 million
> 2011 Population: 238.4 million (4th largest)
> Pct. Increase: +30% (106th greatest)
> Pct. of Population < 15: 28% (105th greatest) > GDP per Capita: $4,651

While the island nation has the fourth largest population in the world, after the China, India, and the U.S, it is fairly small, covering slightly less land than the state of Texas. The southeast Asian country is projected to increase in population by 30% in the next three years. Despite the fact that it will be adding more than 70 million people, the country is expected to drop to sixth in overall population. According to Indonesian Statistics Association chairman, Khairil Anwar Notodiputro, Indonesia was on the brink of a serious crisis if its population growth wasn’t held in check.


8. Bangladesh
> Population Growth 2011-2050: 76 million
> 2011 Population: 150.7 million (9th largest)
> Pct. Increase: +50% (72nd greatest)
> Pct. of Population < 15: 31% (89th greatest) > GDP per Capita: $1,666

The country’s overwhelming population density of just over 1,000 people per square kilometer is the seventh highest concentration of people in the world – Bangladesh has the eighth largest population in the world, but barely ranks in the top 100 for land mass. The six that beat Bangladesh for population density are all relatively small protectorates and city-nations, like Macao, Singapore, and Bahrain. Already straining to fit its 76 million people, Bangladesh’s urban slums are some of the poorest in the world. It’s capital city, Dhaka, has a population of 15 million, nearly double the size of New York City. That population is expected to hit 20 million by 2025. Unsafe drinking water and poor sanitation are just some of the issues the country already faces. Those will likely only get worse as the population continues to grow.

7. Democratic Republic of Congo
> Population Growth 2011-2050: 81 million
> 2011 Population: 67.8 million (21st largest)
> Pct. Increase: +119% (33rd greatest)
> Pct. of Population < 15: 46% (7th greatest) > GDP per Capita: $343

The Democratic Republic of Congo is arguably the poorest country in the world. The U.S. GDP per capita is $48,665. In the DAR, that number is an unbelievable $343. That number will likely only continue to decline as the central African nation adds a projected 81 million people, more than doubling in size by 2050. Ravaged by war and disease, the country has the highest number of deaths per capita each year. Nearly half of its population is under the age of fifteen, compared to just 20% in the United States. The average life expectancy in the country is 50 for women and 47 for men.

6. Ethiopia
> Population Growth 2011-2050: 87 million
> 2011 Population: 87.1 million (15th largest)
> Pct. Increase: +100% (47th greatest)
> Pct. of Population < 15: 44% (19th greatest) > GDP per Capita: $1,089

Ethiopia’s population is set to double by 2050, moving it from the 15th most populous country in the world to the ninth. Part of the reason for this is the country’s low rate of contraceptive usage. Just 15% of women aged 15-49 report using birth control, compared to nearly 80% in the United States. 78% of the population lives on less than $2 per day, and GDP per capita is just over $1,000. Life expectancy at birth is an average of 56 years. That is more than 20 years less than the average American. Ethiopia is already struggling to feed its current population. Adding more than 20 million people will not make matters easier.

India, the world’s second largest country by population, currently accounts for just under 17.5% of the world’s population and shows no signs of slowing down. By 2025, the country is projected to surpass China as the most populous in the world — a place India is expected to hold through 2050. By that point, issues of overcrowding will be significant. Within four decades, the population will swell to 1.7 billion.


5. Tanzania
> Population Growth 2011-2050: 92 million
> 2011 Population: 46.2 million (30th largest)
> Pct. Increase: +199% (5th greatest)
> Pct. of Population < 15: 45% (15th greatest) > GDP per Capita: $1,491

Tanzania’s current population of 46.2 million is expected to triple by 2050. This is going to cause the East African country’s population density, which is currently relatively low, to skyrocket. The country’s area is roughly 350,000 square miles, approximately twice the size of California. Tanzania is expected to have over 138 million people by 2050. As of 2009, 5.6% of the country’s population lived with HIV/AIDS, the twelfth highest recorded rate in the world. Life expectancy at birth is just 57 years.

4. United States
> Population Growth 2011-2050: 111 million
> 2011 Population: 311.7 (3rd largest)
> Pct. Increase: +36% (94th greatest)
> Pct. of Population < 15: 20% (150th greatest) > GDP per Capita: $48,665

The United States is an outlier among the countries set to add the most people for many reasons. It is the only developed nation on this list, with most European populations remaining flat, and some actually losing citizens by 2050. Over the next four decades, the world is expected to add 2.6 billion people. The developed world will only account for 90 million of the projected 2.6 billion population increase by 2050. The United States is the only country that keeps the developed world growing – it is projected to add 111 million people.

3. Pakistan
> Population Growth 2011-2050: 137 million
> 2011 Population: 176.9 (6th largest)
> Pct. Increase: +77.6% (55th greatest)
> Pct. of Population < 15: 36% (60th greatest) > GDP per Capita: $2,851

Pakistan is slightly smaller than Tanzania, or nearly twice the area of California. Despite its relatively small size, the country has the sixth largest population in the world. Only 27% of women between the ages of 15 and 49 use contraception, and that percentage drops to 19% for women using modern methods of contraception. In the United States, those numbers are 79% for all methods and 73% for modern methods. Additionally, the percentage of the population that is under 15 years of age is nine times the percentage that is 65 or older.

2. Nigeria
> Population Growth 2011-2050: 271 million
> 2011 Population: 162.3 (7th largest)
> Pct. Increase: +167% (7th greatest)
> Pct. of Population < 15: 43% (25th greatest) > GDP per Capita: $2,546

Nigeria currently has the 7th largest population in the world. By 2050, the United Nations projects it will rise to 3rd, passing Brazil and the United States. Nigeria will nearly triple to 433 million people, adding the equivalent of the 30 most populous states in the U.S. Nigeria suffers from poor access to safe drinking water – just 42% of the rural population has access to clean water. As is the case in most of sub-Saharan Africa, AIDS is a serious problem in the country, as is infant mortality. Each year, 17 out of every 1,000 Nigerians die. This is the second highest rate in the world. However, low use of birth control and high fertility have counteracted these conditions to produce skyrocketing population growth.

1. India
> Population Growth 2011-2050: 450 million
> 2011 Population: 1,241.3 (2nd largest)
> Pct. Increase: +36% (93rd greatest)
> Pct. of Population < 15: 33% (77th greatest) > GDP per Capita: $3,608

India, the world’s second largest country by population, currently accounts for just under 17.5% of the world’s population and shows no signs of slowing down. By 2025, the country is projected to surpass China as the most populous in the world — a place India is expected to hold through 2050. By that point, issues of overcrowding will be significant. Within four decades, the population will swell to 1.7 billion.

Michael B. Sauter


http://247wallst.com/2011/08/02/the-countries-with-the-fastest-growing-populations/3/

Read more: The Countries With The Fastest Growing Populations - 24/7 Wall St. http://247wallst.com/2011/08/02/the-countries-with-the-fastest-growing-populations/#ixzz0hUvXdM5O

MDGs: So much done, so much more undone

Written by Sulaimon Olanrewaju

With 2015, the target year for the realisation of the Millennium Development Goals (MDGs) four years away, Sulaimon Olanrewaju reviews the efforts of the Federal Government towards the actualisation of the goals.

CONCERNED by the level of deprivation and degradation in the world, especially in developing countries, the United Nations, at its Millennium Summit in 2000, came up with the Millennium Development Goals (MDGs). The essence of the MDGs is to set a goal which governments across the globe could work towards in ensuring an improvement in the lives of their citizens over a period of 15 years between Year 2000 and 2015.

The MDGs are eight but they have 21 targets. The first goal is eradication of extreme poverty and hunger. The targets are; halve the proportion of people living on less than one dollar a day, achieve decent employment for women, men and young people and halve the proportion of people who suffer from hunger.

The second goal is to achieve universal primary education, while the target is that by 2015, all children must complete a full course of primary education.

The third goal is the promotion of gender equality and women empowerment, while the target is the elimination of gender disparity in primary and secondary education at all levels by 2015.

Reduction of child mortality rate is the fourth goal and it has just one target which is the reduction of under-five mortality rate by two-thirds by 2015.

Improved maternal health is the fifth goal. Its targets are three-quarters reduction of maternal mortality ratio by 2015 and achievement by 2015 of universal access to productive health.

Goal six is combating HIV/AIDS, malaria and other diseases. The targets are; halting the spread of HIV/AIDS by 2015 and reversing its spread; achieve by 2010, universal access to treatment for HIV/AIDS for all those who need it; and halting and reversing the incidence of malaria and other diseases by 2015.

The seventh goal is ensuring environmental sustainability. The targets are; integration of the principles of sustainable development into country policies and programmes, reversing the loss of environmental resources, reducing biodiversity loss and halving by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation and achieving a significant improvement in the lives of at least 100 million slum-dwellers.

Goal eight is the development of global partnerships for development. The targets are; developing further an open, rule-based, predictable, non-discriminatory trading and financial system; addressing the Special Needs of the Least Developed Countries (LDC); addressing the special needs of landlocked developing countries and small island developing states; and dealing comprehensively with the debt problems of developing countries through national and international measures in order to make debt sustainable in the long term.

Nigeria keyed in into the MDGs early and since Year 2000, efforts have been on to ensure that the country record great leaps in each of the goals. 11 years down the line, so much has been done with so much more yet to be done.

Eradication of extreme poverty
Poverty can be said to be the companion of most Nigerians; wherever they show up, poverty shows up. To those that fall into the category, poverty is a constant reminder of the failure of the government to provide an enabling environment for them to shake off their ravaging and deprecating companion. In the past, poverty used to be the identity of the uneducated and the unskilled but not any longer. In the current dispensation, poverty does not discriminate between the skilled or educated and those who are unskilled and educated; it is now as rampant among the lettered as it is among the unlettered. Many graduates of tertiary institutions are unemployed because the country annually produces graduates far in excess of available employment opportunities. The patient among the unemployed graduates remain hopeful that one day, they would be employed while those that lack the virtue take to crime or get involved in other unwholesome ventures.

Many skilled people cannot practise their vocations because the most essential input that they need, electrical power, is not readily available. In frustration many have become commercial motor scooter riders with the attendant danger of being involved in fatal accidents. Those who want to amass wealth at a faster rate than what the motor scooter business can offer take to crime.

All over the cities and major towns in the country, there is a growing army of beggars. In the not so distant past in this country, only physically challenged people would descend to the level of begging for alms from others. But now, it has become a business for frustrated and hungry people, both old and young, whether educated or not. It is now a common sight at almost every motor park to see neatly dressed people and those not so well dressed to regale people with cock and bull stories all for the purpose of getting some money from them.

The goal is to have poverty reduced by half, but it seems between 2000 and 2011, poverty has been in an upswing in Nigeria, rather than going down. This is despite efforts of the government to reduce poverty. The reason for this glaring failure is the inability or failure of the government to make adequate provision for the number of potential job seekers produced annually by the nation's many institutions. Every year, close to half a million graduates are produced by the nation's institutions but less than 50,000 of them are employed by both the public and private sector players. So, every year, the number of unemployed people swells. With the absence of any safety net by the state, many of them end up being entangled by the poverty web. Many who would have taken up the practice of a trade or the other are discouraged because of the high cost of doing business in the country.

Although the Federal Government, through the National Directorate of Employment (NDE) and National Poverty Eradication Programme (NAPEP), is trying to reduce unemployment and by extension poverty, the efforts are far from mitigating poverty in Nigeria. In fact the FG established the Office of the Senior Special Assistant to the President on MDGs, which came up with the virtual poverty fund that tags and tracks funds allocated to poverty reduction from debt relief; conditional cash transfer to the vulnerable for social protection; and conditional grant scheme; all of these seem like a drop of water in an ocean.

Universal primary education
The United Nations has no doubt that one way of reducing poverty and hazardous health habits is education. Therefore, part of the MDGs is the provision of quality primary education for every child on the surface of the earth.

Ordinarily, achieving this particular target should not be a problem in Nigeria, given the policy of the Federal Government which makes education of the child up till Junior Secondary 3 level free and compulsory. However, Nigeria, currently, is nowhere near achieving the goal. All over the country, the number of street children rises daily. In the South-West, many children are used by their poverty stricken parents for child labour as they are asked to hawk items on the streets. So, instead of going to school, the children hit the roads early to make money out of which they and their parents eke out a living.

It has been discovered that one of the reasons children in the South generally abandon school to hawk or work is hunger. They know that if they work as motor boys or food vendor maids, they will get something to eat at the end of the day, something that is not guaranteed by their going to school. So, they will rather go to work than go to school.

In the North, there is still a strong apathy for Western education, the major reason for the continuous growth of the number of almajiris. The Federal Government has said it will work towards integrating the almajiris into the normal school system but that is yet to become a reality.

There is also the problem of the children of the nomads who accompany their parents as they go with their flocks to different parts of the country to look for pastures for their cattle. The FG has said it would fashion out a system of education that would accommodate the peculiar nature of nomadic children so that they could also go to school.

But as it is now, achieving the universal primary education in Nigeria by 2015 seems a tall dream despite the claim of the FG in 2010 that it had recorded 88 per cent success in this regard.

Gender equality and women empowerment
This is one area in which Nigeria seems to be making some progress although the recorded progress is still a far cry from the target of the MDGs. There is still gender disparity as men are still more favoured than women in some respects. Some parents still go about with the old thinking of not educating their female children, although no school will turn back a qualified female.

Even in the area of politics, female politicians are an endangered species as many of them who stood election in the April 2011 elections lost out to their male counterpart. In many states of the federation, few women were appointed as commissioners or advisers with the men dominating appointive positions.

However, President Goodluck Jonathan has been able to increase the number of women appointed as ministers to 13. His administration is the first to have given so many slots to women. He has not only appointed women into his cabinet, he has also given them very key positions, an indication of his commitment to women empowerment.

Hajiya Amina Az-Zubair, Senior Special Assistant to the President on MDGs
For women empowerment and gender equality, though Nigeria has moved from where it was in 2000, the move is not significant enough to generate a cheer.
Reduction of child mortality

A report of the United Nations Children's Education Fund (UNICEF) Nigeria, claims that every single day, Nigeria loses about 2,300 under-five children with new born babies making up 25 per cent of the number. According to the report, the major cause of death among this category of Nigerians is malnutrition. The reports states that, “Preventable or treatable infectious diseases such as malaria, pneumonia, diarrhea, measles and HIV/AIDS account for more than 70 per cent of the estimated one million under-five deaths in Nigeria.”

However, the government in a statement by President Jonathan at the United Nations MDG + 10 High Level Summit of the United Nations General Assembly held in New York in 2010, claimed that “Infant mortality has fallen from 100 per 1,000 to 75 per 1,000 between 2003 and 2008. Similarly, in the same period, the under-five mortality rate fell from 201 per 1,000 to 157 per 1,000.”

Despite the claim of the government, infant mortality rate in many parts of the country, especially the rural areas remains frightening. As a way of stemming this trend, the Federal Ministry of Health introduced the Integrated Maternal, Newborn and Child Health (IMNCH) strategy as a way of fast-tracking the revitalization of the primary health care in every local government and considerably extend coverage of key maternal and child health interventions, thereby reducing maternal, newborn and under-five mortality.

However, the impact of the initiative is yet to drastically reduce infant mortality.

Improved maternal health
According to a UNICEF report, daily, about 145 women of child-bearing age die in Nigeria, subsequently, the country has the second highest maternal mortality rate in the world. The FG has acknowledged that it has serious a challenge in this area as it said in 2010 that, “improvement in maternal health has been most intractable and challenging. For most of the early years of the MDGs, the available, albeit scanty and doubtful, data suggested that Nigeria had one of the highest maternal mortality ratios in the world, hovering as much as 1,000 maternal deaths per 100,000 live births. Our most recent data, however, suggests our investments have recorded major progress with the maternal mortality ratio falling to 545 maternal deaths per 100,000 live births. We are committed to make even faster progress, and since 2009, we have undertaken a massive and growing innovative deployment of a Midwives Service Scheme, across the country, aimed to raise the proportion of births attended by skilled health workers. This will further accelerate progress in improving maternal health. We have also embarked upon community health insurance scheme targeted at pregnant women.”

With the effort of the FG, there is a likelihood of improvement in maternal health. But as things stand currently, the performance of the country in the area of maternal health is not exciting and every indicator points to the inability of the country to hit the 2015 target.

Combating HIV/AIDS, malaria and other diseases
This is an area of mixed blessings for Nigeria. While the country has made remarkable progress in the area of polio eradication with almost 99 per cent success rate, the same cannot be said of malaria, despite the malaria rollback campaign. Malaria is still the commonest disease in Nigeria and the cause of most deaths.

The government, however, claimed in 2010 that it had distributed over 72 million long-lasting insecticides bed nets with the hope of reducing the incidence of malaria although the scourge still remains 'the grim reaper' of Nigerians.

The situation is not different with HIV/AIDS. The government and donor agencies have spent a fortune on enlightenment campaigns but all indications still point to a high prevalent rate in the country.

Environmental sustainability
The Federal Government gave an indication of the state of the nation's environment in a presentation by the president to the United Nations in 2010. He said, “Our environment is still seriously threatened. Between 2000 and 2010 the area of forest shrank by one-third from 14.4 per cent to 9.9 per cent of the land area. Safe water and sanitation remains a challenge contributing to some of the severe perennial outbreaks of epidemics in parts of the country. Towards this end, our administration remains committed towards redressing the situation.”

Another indication is the repeated ravaging floods some parts of the country experience yearly. The floods have rendered many homeless, while some others have lost their lives.

Similarly, erosion of all kinds, environmental pollution and degradation constitute a major challenge in the country. The South-East region has become devastated by erosion, while the South-South is a victim of environmental pollution and degradation.

All of these have resulted in many Nigerians living in slums.

With the current efforts of the government in addressing these malaises, there is no indication that much ground will be covered before 2015.

Development of global partnerships for development
The country has been making some result-oriented efforts in this respect. The most important of all these was the successful debt negotiation of 2005. Since then, there has been a number of development partners that have shown interest in the country.

Everything points to the fact that the government has the intention to achieve the MDGs. However, results have shown that good intentions are inadequate to move the nation to its desired end. Therefore, the government will need to back its intention with actions that will produce the people's expectations.

http://tribune.com.ng/index.php/features/25959-mdgs-so-much-done-so-much-more-undone

Ekiti: A unique approach to health challenges

Ekiti: A unique approach to health challenges
Early this year, one of the media aides to Governor Kayode Fayemi invited journalists to the Palace of Ewi of Ado-Ekiti, Oba Ruphus Adeyemo Adejugbe to cover an event. Being an impromptu invitation virtually none of them knew what the programme was all about.

On getting to the venue, they met a team of medical personnel attending to various categories of people, right inside the palace. It was then that they realised it was the Free Health Mission initiated by the Governor.

Oba Adejugbe, who used the opportunity to be screened by ophthalmologists, commended the state government for bringing quality healthcare closer to the people of the state.

Also his wife Eyesorun of Ado-Ekiti, Olori Margaret Bosede Adejugbe, who was impressed with the state government’s gesture, described the scheme as a “welfarist policy intended to touch the lives of the people of the state”.

The Olori said she and the royal family and the palace staff were surprised at the governor’s decision to bring the free health to them urging the people of the state to pray for the success of the Fayemi-led administration.

Interestingly, the journalists who had gone to cover the event also turned out to be beneficiaries of the scheme as some of them used the opportunity to seek medication at no cost. Drug and free eye glasses were given to them. It was the first phase of the programme.

Although, free medical intervention is not alien to the people of the state as successive governments had tried in one way or the other to bring people closure to free medication, what would probably make news are how the programme is conceived and the extent to which the targeted audience access it. Even as a governorship candidate of Action Congress of Nigeria (ACN), Fayemi ensured that the people of the state had a taste of what he had in stock for them in terms of dividends of democracy by ensuring that the progamme commenced in the state before he assumed power.

The governor, also enlisted the supports of his friends and associates in the scheme. Not too long ago, his associates donated state-of-the-art medical facilities to the University Teaching Hospital (UTH), Ado-Ekiti.

The facilities worth over N60 million which was delivered by Dr. Gboyega Adesokan, a United State-based associate of the governor included physiotherapy equipment, surgical equipment, bed and mattresses.

Adesokan said the donation of the health equipment was in response to the call of the governor to all Ekiti at home and in Diaspora to join hands with his government to transform the state in key sectors when it needs development.

Available records show that no fewer than 30,000 people benefitted from the programme when Fayemi was still a candidate of his party.

The ongoing FHM is powered by the Ekiti State Government in collaboration with a Non-Governmental Organization, known as ‘Development Support Initiative’ (DSI). Its target was the people in the hinter-land for them to have access to free diagnosis. Those found to have required further treatment were referred to secondary health care centres.

The FHM was also an avenue to propagate public health enlightenment aimed at reducing infant and maternal mortality as well as reducing incidence of lifestyle diseases such as hypertension, diabetes, HIV/AIDS etc to increase health awareness and avoid health risk behavior.

The first phase of this year’s edition was taken to communities across the three senatorial districts between 3rd and 20th January, in which a total number of 123,427 people were reached and a total number of 5,500 pairs of glasses distributed.

It was discovered that about 90 per cent of those treated in the eye unit has never had access to eye check before.

During Segun Oni’s Administration in the state free health intervention was code named ‘SURGICAL FESTIVAL’ and ‘EYE CAMP.’ It should be noted that between July 2007 and December 2009, a total of about 147,794 of Ekiti benefited from the exercise. Of this number, 544 underwent eye operations while another 1,278 underwent surgery for other illness. No fewer than 4,900 insecticides-treated nets were distributed in addition to 6,139 who benefited from typhoid vaccination.

One of Oni‘s predecessors, Ayo Fayose, also distributed free eye glasses to people during his three and half-year tenure.

But Fayemi in his bid to ensure the effectiveness of the scheme structured its execution on senatorial basis started late June with Ekiti North Senatorial District. Virtually all the 16 local government areas in the state were touched during the first phase of the FMM.

There are five local government areas in Ekiti North-Ido/Osi, Ikole, Ilejemeje, Moba and Oye-with a 10 communities selected to benefit from the scheme.

Between June 20 and June 30, massive crowd of people trooped out in Ikole-Ekiti, Ayedun-Ekiti, Isan-Ekiti, Oye-Ekiti, Ilupeju-Ekiti, Ayetoro-Ekiti, Ifaki-Ekiti, Iye-Ekiti, Otun-Ekiti and Igogo-Ekiti covering the five LGAs in the senatorial district.

Fayemi, who recently flagged off the second phase of the mission, in Odo-Ayedun, told the prospective beneficiaries that those to be catered for in the new health initiative were children from ages zero to six, older people from 65 years and above, pregnant women and the physically challenged.

He explained that the programme had been restructured, saying it would now be on senatorial basis for effective coordination and to further penetrate the hinterland.

The governor noted that the next phase of the programme would hold in Ekiti Central Senatorial District in August while the last phase would be taken to Ekiti South Senatorial District in the last quarter of the year.

Describing health care as very crucial in the implementation of his administration’s eight-point agenda, Fayemi said all the health policies being implemented by his government were intended to benefit all the citizens of the state irrespective of their affiliations.

“This programme will not be limited to Ekiti North. General Free Health Programme is coming on the way because we want all segments of the state to benefit and it will not disturb the Free Health Mission being done on senatorial basis.

“The General Free Health Programme will be for the aged, pregnant women, children and retirees. If you need any medical attention from the doctors, come over and be examined. “If it is hypertension, diabetes, body pain, typhoid, come over to them because the treatment is free. You don’t have to be a card-carrying party member to benefit.

“Although I belong to the ACN and I am a Catholic by faith, this scheme is meant for all people in the state not minding the party or the faith you belong to because our government is a government for all the people of the state.

“Our Free Health Mission and all what we are doing for the people of this state have nothing to do with politics at all,” he said.

Drugs, equipment and personnel were deployed for the exercise in the towns earmarked where needy patients made up of men, women and children waited patiently to be attended to.

Undaunted by the magnitude of crowd which queued up to receive treatment, the DSI medical team led by Dr. Dolapo Fasawe, adopted an arrangement which gave all the people that came for treatment an equal opportunity to be attended to.

Medical records of all the patients were taken to assist the government in knowing the prevalent rate of some diseases in the state to adopt strategies to tackle same.

Eyeglasses were given to eye patients needing them after rigorous tests were conducted.

Many of the beneficiaries in the rural communities where the scheme was taken to, described the initiative as unprecedented and a signal that the government in Ado-Ekiti cared for those hitherto forgotten in far-flung communities.

Among those who benefited were the Olusin of Usin-Ekiti in Ikole Local Government Area of the state, Oba Oluyemi Adedeji, who was among the eye patients who received free eyeglasses at Odo-Ayedun.

One 70-year-old Mrs. Rachel Falope who was treated by doctors at Ikole said bringing quality doctors and drugs to the local communities had never happened in the history of the state.

To Mrs. Victoria Adeleye, another 70-year-old woman from Ijesa-Isu, who complained of generalised body pain expressed surprise that she was treated and given drugs without any money collected from her and other patients.

A beneficiary in Iye-Ekiti, Mr. Clement Amadi, who received drugs, described the Mission as a channel through which the grassroots were feeling the impact of the state government.

His wife, Mrs. Janet Amadi, an eye patient, urged the state government to do everything possible to ensure that the scheme was sustained as, according to her, many people in rural communities lack the resources to procure drugs to combats ailments like hypertension and diabetes.

“Some people don’t have the money to finance treatment of their health problems and this is an opportunity for them.

“I have seen the doctor and I have been given eyeglasses and no money was collected from me and other people who were treated. We are grateful to the governor for his efforts in the health sector and our prayer is that may God continue to help him,” she said.

The Iye-Ekiti outing was lit up by the presence of the wife of the governor, Mrs. Bisi Fayemi, who reiterated the commitment of the state government to commit more resources to health care delivery in the state.

A medical handbook on maternal health which was printed on her bill was distributed to beneficiaries who came to the antenatal unit of the Mission for their enlightenment and to ensure that a proper record of their treatment was kept anytime they visit health centers for treatment.

The governor’s wife used the opportunity to address women on the importance of family planning and reducing maternal mortality rate in Nigeria which has the second highest rate in the whole world.

Mrs Fayemi said: “We thank God that the light has shined in Ekiti and I want to say that free health services to our people is one of the promises made by my husband while campaigning for the governorship seat of the state.

“That is why you have voted for us and we will continue to do it for the benefit of the people of the state who deserve the very best. In Ekiti we don’t have oil like other states but our people are our wealth and everything possible must be done to take care of them. Human capital is our asset and we are going to take care of our people, what we are doing here today is for our own good and the good of our dear state.

“It is a pity that in Nigeria we have the second highest maternal mortality rate in the world after India which has the highest maternal mortality rate in the world and this is unacceptable. Some of the causes of maternal mortality are ignorance and lack of support during labour. We discover that when our women go to hospitals, there should be proper records about them and that is why we have produced this handbook.

Schooling them on the effective use of the handbook, she said: “You can take this handbook to anywhere and the doctor attending to you will know about your condition and know what to do. I want to advise our women to stop child bearing after four children because family planning will boost their health.”

Reviewing the second phase of the Mission, the Commissioner for Health, Dr. Wole Olugboji, described the second phase of the scheme held in Ekiti North Senatorial District as a huge success.

He disclosed that a total number of 23, 146 patients were treated while the exercise gulped more than N50 million.

His words: “By my own assessment and the assessment of those who participated and benefited, it was a huge success. Unlike that of January where we treated over 100,000 people in the first phase which covered all parts of the state, this time we were not after any particular target but to ensure that our people in this zone (Ekiti North) benefited.

“In the second phase held in the five local government areas in Ekiti North, we treated 23,146 citizens of the state and the whole exercise gulped over N50 million and this has to do with all aspects of the program me. And these include payment of stipends to the medical professionals engaged and in this one, 65 per cent of the medical personnel used are from Ekiti State unlike the first phase in which only 10 per cent Ekiti personnel participated.

“We are incorporating more Ekiti health workers into the scheme who had to be paid and we should not forget the purchase of medical instruments and equipment and disposables purchased for the scheme.”

Responding to questions on the quality of the personnel used, Olugboji said: “We ensured that professionals are engaged to do the job.

“Specialists in fields that are relevant are brought in. For example in the eye section, we have eye specialists, in the dental department; we have dental surgeons because you will be surprised that most of our people in the grassroots have never seen a dentist. We also have general practitioners, nurses and pharmacists. I am quite satisfied with the quality of the personnel used for the scheme. They are round pegs in the round holes.”

http://www.independentngonline.com/DailyIndependent/Article.aspx?id=38309

Nigeria health indicators call for concern, says minister

Written by Gbola Subair,

Nigeria health indicators are a source of concern to the Federal Government and should be addressed by the three tiers of government if meaningful achievement is to be recorded in relation to the Millennium Development Goals (MDGs), the Minster of Health, Professor Onyebuchi Chukwu has said.

Professor Chukwu, while addressing participants at the national seminar on the presentation of the 2006 Census priority tables organised by the National Population Commission (NPC) on Thursday in Abuja, stated that maternal mortality and infant mortality rates in Nigeria when compared to the rest of the world, were too high and did not speak well of a country desirous of achieving the MDGs.

Saying that this called for concern, the health minister, who was represented by the Director, Planning, Research and Statistics in the Federal Ministry of Health, Mr Samuel Oluwole, declared that this very serious gap in health indicators must be addressed in the shortest possible time for any development to take place.

Professor Chukwu, however, stated that the task of addressing the health problem was not that of the Federal Government alone noting that state governments and all the 774 local governments in the country must brace up to the health challenges and achieve significant success in the MDGs.

In his keynote address, the NPC chairman, Chief Samuila Makama, contented that Nigeria was confronted with numerous developmental challenges such as pervasive poverty, infrastructural inadequacies in the health, education.

Energy, water, transport sectors, a situation which he said made improvement in the standard of living difficult.

http://tribune.com.ng/index.php/news/25865-nigeria-health-indicators-call-for-concern-says-minister

Insecurity Threatens Healthcare in North-East

By:Ruby Leo

Insecurity in the North-eastern part of the country may thwart government's efforts towards checking maternal and infant mortality, reports have indicated.

The reports presented at a review meeting of the National Primary Health Care Development Agency (NPHCDA) showed that states in the North-east recorded the highest number of maternal and infant deaths.

The Director, Planning Health Care System Development of the NPHCDA, Dr Muhammed Jibril Abdullahi, said the security challenges had prevented the Midwives Services Scheme from making an impact in the affected areas, adding that many of the midwives deployed there were scared.

Earlier, the acting Executive Director of NPHDCA, Dr Emmanuel Abanida, said there would soon be a special intervention for all health institutions in the North-east to meet the Millennium Development Goals.

http://allafrica.com/stories/201107280744.html

Nigeria: Boko Haram heightens maternal, neo-natal health crisis in N-East Nigeria

Neo natal health crisis Nigeria - The Nigerian National Primary Health Care Development Agency (NPHCDA) Tuesday said that the rate of insecurity in Nigeria's North Eastern zone -- Borno, Bauchi and Yobe States -- as a result of the Boko Haram crisis has hampered the provision of maternal and neo-natal services by birth attendants under the National Midwives Service Scheme (MSS). But the Acting Executive Director, NPHCDA, Dr. Emmanuel Abadina, told the MSS review meeting in Abuja that the services of the midwives would be fully restored once the impasse was over in the challenged zones.

National statistics show that MSS sustainability was recorded in Sokoto, Bayelsa, Kebbi, Jigawa, Lagos, Rivers, Cross Rivers and Katsina states with no recorded maternal death in some of these South-South States.

But Borno and Bauchi States have about 26 and 13 maternal deaths respectively as at March, 2011 while the neo-natal deaths rose to 130 and 36 at the same period mentioned. Taraba State recorded 25 neo-natal deaths.

Abadina said that -a lot of progress has been made in the MSS across board. We realize that we have some challenges especially in the North-East. It is possible that the few health facilities in the North are clustered around just one part of the zones in which case the other parts may not have been covered.-

Dr. Abadina explained that the MSS core indicators included the MSS facilities offering 24 hours service with approximately four midwives per facility, total ante-natal care services, new visits, deliveries by skilled birth attendants, reductions of maternal mortality rate and neo-maternal rates from baselines.

Others are proportion of women aged 15 to 45 years, attending and using modern contraception and proportion of children fully immunized at one year old in MSS facilities.

Director, Primary Health Care Systems, NPHCDA, Dr. Mohammed Abdullahi, stated; “Some of the States such as Yobe, Borno, Bauchi are not doing well because of perceived security challenges.

-For example, even if Borno State is paying 100,000 naira today to midwives, many of the midwives will not stay there. The challenges are not because of the monetary aspect but because of the security challenges. But very soon these challenges will be resolved and most of the Midwives will go back to their duty-posts.-

http://www.afriquejet.com/neo-natal-health-crisis-2011072719233.html

Health workers give 24-hr ultimatum

By Olugbenga Adanikin


A group, the Coalition of Non-Governmental Organisations (NGOs) on health yesterday issued a 24-hour ultimatum to President Goodluck Jonathan to sign the National Health Bill.


At a briefing yesterday in Abuja, the Country Director of Johns Hopkins Programme for International Education in Gynaecology and Obstetrics (JHPIEGO), Prof. Emmanuel Otolorin said the bill would address health issues, particularly maternal mortality and death of under five children in the country.

Otolorin said: "Everyone knows that Nigeria is one of the countries with the highest burden of maternal mortality and mortality of under five children. In actual fact, Nigeria is second to India in the number of women who die every year from complications of pregnancy and childbirth. Nigeria is also the leader in Africa on the number of children under five who die annually.

"All that is required now is for Mr. President to sign this bill into law for implementation to commence. Now, the implication of not signing the bill in the next two days is that it will probably have to go back to the seventh National Assembly and we don’t know when this bill will come out again."

He said the bill allocates two per cent of the national budget to primary health care and 50 per cent for capacity building, health insurance and drugs.

Otolorin said: "The bill provides for two per cent of the national budget to primary health care. Primary health care is the bedrock of health in any country and it’s been shown or planned in the bill that 50 per cent of this fund will be used to provide health insurance through the national health insurance scheme to provide access to the majority of Nigerians, particularly the vulnerable, women and children, to access primary health care.

"Some of these funds will also be used to buy drugs and equipment that are critical to primary health care in Nigeria. Funds from these allocations will also be used for human resource development because we have a shortage of nurses, midwives, physicians at the primary health care level."

The Executive Director of Advocacy Nigeria, Hajiya Bilikisu Yusuf urged President Jonathan to sign the bill in the interest of Nigerian women and children, particularly the poor who cannot afford good health care.


"We all made a pledge at the global level that we will have universal access to health and six of the goals in the Millennium Development Goals (MDGs) are about life giving, they focus on health. Goal Four is about infant mortality, checking it and reducing it. Goal Five is about reduction of maternal mortality. Goal Six is about reducing HIV AIDS, tuberculosis and other diseases," she said.


http://www.thenationonlineng.net/2011/index.php/news/13845-health-workers-give-24-hr-ultimatum.html

Kwara State and WHO/Nigeria to Partner on Child and Maternal Mortality Rate Reduction

The Kwara state government and the World Health Organisation in Nigeria are set to work together towards reducing child and maternal mortality rate.

This consensus was reached at a recent meeting between Her Excellency, Mrs. Omolewa Ahmed, the First Lady of Kwara state and the Representative of the World Health Organisation in Nigeria, Dr. David Okello at the United Nations House, Abuja.

Speaking at the meeting, the First Lady said that improving the health of all citizens especially child and maternal health is a major focus of the present Kwara state administration. She said the Kwara state government is working out strategies to ensure reliable and cost-effective child and maternal health systems. “Consequently, the government has commenced a base-line study to profile a model hospital, available staff and their levels of professionalism in order to determine what resources are available and what gaps exist”, said Mrs. Omolewa.

This, according to the first lady, is being piloted in a designated hospital and all mothers who attend ante-natal care in such hospitals will receive free delivery kit in addition to free ante-natal and malaria treatment.

She explained that in the spirit of continuity of governance, the present administration of Kwara state has sustained the programme of free ante-natal care and malaria treatment for pregnant mothers.

In his response, the WHO Country Representative, Dr. David Okello said that WHO as a technical agency is ready to collaborate with Kwara state government to ensure safer motherhood and avoid unnecessary newborn deaths. “When a mother dies, it is colossal loss to the family and the nation”, he said.

Dr. Okello reaffirmed that mother-to-child-transmission of HIV is preventable and in fact can be eliminated given the abundant human and technical resources available in Nigeria. He added that it is imperative to put in place and implement favourable laws and regulations to impact positively on the lives of women and children.

He explained that WHO Nigeria will continue to provide technical support to the Kwara state government and people in the planning, implementation and evaluation of high impact interventions like Focused Antenatal Care, Intra-partum care, Emergency Obstetric and Newborn Care, Routine Postnatal Care, PMTCT, Routine immunization and Prevention of Malaria particularly in pregnant women.

http://www.afro.who.int/en/nigeria/press-materials/3069-kwara-state-and-whonigeria-to-partner-on-child-and-maternal-mortality-rate-reduction.html