Countdown to ANPA 3.0......

The long-awaited refresh of the ANPA Home Page will be live at noon EST on Friday April 15, 2011.

Integrated with the new site is an exclusive section for members ("Members Zone") that provides access to the new discussion board ("ANPA Forum"). Members can also update their passwords and view the profiles of other registered ANPA members.

The new site also provides access for membership renewal and online registration for the upcoming annual meeting and scientific conference.

Here is a preview:

Budgetary Allocation to Health: Shame of a Nation

The lack of commitment on the part of the federal government of Nigeria to increasing the budgetary allocation needed to improve the health of Nigerians remains a disturbing one. Recently, it was reported that Nigeria earmarks 3.5 per cent of its national budget to the health sector. With the well documented intrigues surrounding the release of budgetary allocations, no one is even sure if all the earmarked funds are ever gets released, and if released what percent is spent on services or lining pockets. With this level of allocation, Nigeria ranks just above Burundi in Africa in budgetary allocation to health. It is shameful that a nation that ten years ago hosted African Heads of State and Government at a conference in Abuja and led in the pledge for governments to allocate at least 15 per cent of their national budgets to health does not even allocate a paltry 5 percent of its budget to care for the health of its citizens. According to Ademola Olajire, a Nigerian and the Director at the Social Affairs Department at the African Union Commission, only six countries have achieved the target set in Abuja. It sure must break Mr. Olajire’s heart to provide such information that gives Nigeria a black eye. The six countries, namely Rwanda, Botswana, Republic of Niger, Malawi, Zambia and Burkina Faso that have passed the 15 per cent mark are all less endowed than Nigeria. Leader of Africa, who are you leading.

Did someone say “Cry my beloved country”, oh no I am the one who said it. As a healthcare professional, the healthcare infrastructure in Nigeria breaks my heart every time I think of it. As one of my colleagues said “because we all have parents and relatives in Nigeria who depend on this healthcare system and cannot afford to fly them out to countries with better facilities every time they fall ill, we cannot fold our hands and watch without doing anything.” The question is what can we do as non-politicians to force the hand of the government to allocate more resources to delivery of healthcare services to Nigerians? At a National Association of Resident Doctors’ roundtable in 1987, Nigerian physicians were called out for forgetting the “Hippocratic Oath” and not insisting on receiving needed resources when they become commissioners or ministers of health. It will be recalled that the late Professor Olikoye Ransome-Kuti extracted a committment from Babangida before he accepted the position of Minister of Health that the resources needed by the ministry will be provided to ensure that programs are implemented. He remains the only minister in recent memory to have done this. He got most of what he wanted albeit during a military regime.

In an interview with The Guardian after delivering a speech at the on-going Conference of African Ministers responsible for Finance, Economy, Planning and Economic Development in Addis Ababa, Ethiopia, Nigeria’s Minister of Health Professor Onyebuchi Chukwu said “funds allocated to security and the electoral system, among other competing needs in Nigeria, might have robbed the health sector of much-needed higher allocation in the budget.” The minister’s statement does not provide any succor to many Nigerians who still rely on government provided healthcare. In addition, the minister’s assertion that government's per capita expenditure on health was rising steadily and it's about $20 contradicts independent sources including the Africa Public Health Info which puts the figure at $10.

This is not surprising as anyone following the political debates and campaigns in Nigeria would have noticed that none of the candidates at the local, state, or national levels including the presidential candidates have mentioned or articulated any strategies to improve the health of Nigerians or arrest the decay that is the Nigerian health infrastructure. As the elections are conducted, winners announced, and executive councils formed, it is time for the Nigeria Medical Association that have done a good job of insisting on physicians running the ministry of health to go a step further to insist on improved allocation to the health sector and preventing its members from accepting health commissioner and minister positions as a form of protest if government allocation is not increased. Professor Olikoye did it and it still can be done if the focus is on the overall interest of Nigerians and not on holding a political position. When it is all said and done, physicians are going to be reminded that they presided over the decay of the Nigerian healthcare system.

The African Woman: A Priority in Medicine?

Researchers link preparation of smoked fish to lung diseases! For my fellow fanatics, this recent article in The Guardian will undoubtedly be a disheartening revelation of the hidden cost behind the savory goodness that is smoked fish. My initial thoughts after reading the title were admittedly, selfish. My mind skipped through the numerous pulmonopathies that I have encountered during my first year in medical school. I ranked the diseases in order of severity, hoping that the punishment for my affair with smoked fish would be selected from the bottom of the list. As I read further, I soon realized that I was not the subject of article. In this case, the unfortunate victims of lung disease are the manufacturers of smoked fish – predominantly women (“manufacturers” because the things that these women do to smoked fish are nothing short of magical). The Togo-based study suggests that these women who are “constantly exposed to smoke, heat and burns, during the process are at high risk of developing chronic chest and respiratory infections or disease."

As I sympathized with the women from the article, my thoughts led me to the broader topics of feminism and the empowerment of women. March 8, 2010 was the 100^th anniversary of International Women’s day, a global celebration of the political, economic and social achievements of women. Using the Togolese fish smokers as a take-off point, I thought about women in Africa and what I believed was an on-going struggle to empower them. My mental exercise soon turned into a “Google” exercise as I realized the inadequacies of my knowledge base about African women. In the course of my search, I stumbled upon an inspiring article: Empower Women to Realize the African Dream written by Obiageli Ezekwesili, the World Bank Vice President for the Africa region. From the piece, it’s clear that the African woman has come a long way over the last few decades. Progress is evident in the worlds of business, politics, education and medicine. However, as Mrs. Ezekwesili reminds us, “the feminization of poverty still remains acute.” Women bear the brunt of the African situation, standing at the front line in wars against malnutrition, overpopulation and discrimination. Equality and gender issues have seen some improvement, but we still have a long way to go.

Women in Nigeria proudly show a hand-painted banner for peace

Of Mrs. Ezekwesili’s points, I was struck most considerably by those that highlight the things medicine is NOT doing for our women. “One in 20 girls born today in Angola, Mozambique, Liberia and Sierra Leone will die in childbirth. An African woman is 25 times more likely to die during labor than a European woman […]; three young women are infected with HIV/AIDS for every young man in Africa; [and] girls still face genital mutilation in 28 African countries.” Like most others, the medical sector is doing a miserable job as regards protecting and providing for our women. I’m in no position to criticize the field, or to recommend things that we can do to advance women’s rights in Africa, but I do know that we can do much better. So even as we remember International Women’s Day and take our hats off to the women who make life worth it, I ask that we make it a priority to empower the women of Africa through medicine. Our mothers, wives, daughters, sisters – our women – are our “hope, strength and opportunity.” Let’s play our part to make sure they are always treated as such.

Reasssessing the Notion of a "Brain Drain"

The idea of a drain hardly ever evokes a positive reaction especially in the context of the siphoning of intellectual capital from developing countries. The impact of the “brain drain” phenomenon has been hotly debated in development circles, particularly in relationship to the flight of health care workers who emigrate from countries facing incredible public health challenges. This has been discussed previously on the ANPA blog here and here. Outside of the usual culprits – corruption, bad governance, and the like – some are wont to place the blame of Nigeria’s health care struggles on the backs of doctors and nurses who participate in destabilizing the healthcare infrastructure by abandoning the country. Nearly one in ten Nigerian physicians practices in the United States or Canada. To add insult to injury, reports surface indicating that foreign-trained health professionals in developed countries, at times, outperform their home-grown counterparts – begging the question, why have we (Nigerians) not benefited from the fruits of our labour (that is, educating such professionals)? One may come to conclusion that while developing nations invest resources into the training of its professionals, developed nations are unfairly poised to reap the benefits of such harvests. However, this line of reasoning requires a serious rethink. In full disclosure, I must admit that I am a somewhat biased, since I am a product of Nigerian intellectual refugees, and would not wish it any other way. But, I cannot help but highlight a number of incorrect assumptions made by the above argument that may debunk the notion of the brain drain as the critical destabilizing force in Nigerian healthcare.

I’ve struggled with how best to say this without being offensive, but, the idea of that the Nigerian government has and continues to lose out on its investment into the training its healthcare force, is, quite simply, laughable. Investment, ke? When overall health infrastructure spending falls at a paltry 4% of a nation’s total budget, one can only imagine that how much less is “invested” into training the healthcare force – in terms of financial assistance for education and future career support. For the overwhelming majority of Nigerian physicians practicing both in Nigeria and abroad, the heavy lifting of such support primarily rested on self, family, benevolent communities and non-governmental organizations. Furthermore, the American Medical Association reports that more than half of African born physicians practicing in the United States spent a significant portion of their educational careers at American universities and hospitals.

While doctors and nurses play an irreplaceably essential role in a nation’s overall healthcare, one must remember that the success of any national healthcare system depends on far much more than its healthcare workers. The World Health Organization identifies a number of key components of an effective healthcare system, of which, interestingly, health care staff play a merely supporting role. Of chief importance are, again, good governance and financing, but also functioning information systems, diligent public health surveillance and access (to be distinguished from availability) to essential drugs and technologies. While the desire to return home and practice medicine in Nigeria remains a strong desire for many a Nigerian physician in the US, packing up and re-inserting oneself into a virtually non-existent health system may prove frustrating to both healthcare provider and patient. It goes without saying that organizations such as ANPA have and continue to contribute to the welfare of Nigerian patients and some Nigerian physicians in America, have in small groups, given back to their homelands, whether in financial assistance, educational support, or short-term projects. Though not yet quantifiable, doctors in the West may be contributing far more than they could have while in Nigeria and a mass exodus back to Nigeria, may prove counterproductive, particularly in the absence of policies and structures. It is critical, therefore, to reassess what is actually being drained and what the consequences are of haphazardly reversing that process.

ANPA Leadership Secures Waiver of Back Payment of Licensing Fees for Nigerian Physicians Practicing Outside Nigeria

In a landmark decision, the Medical and Dental Council of Nigeria (MDCN) has agreed to waive the requirement for back payment of registration and licensing fees for Nigerian physicians who have been in practice outside Nigeria. The news of this agreement was conveyed to the ANPA members by its President, Dr. Fiemu Nwariaku today. The President said the MDCN decision was conveyed to ANPA representatives by the Registrar of the Medical and Dental Council of Nigeria during the recently concluded signing of the MOU between ANPA and Federal Government of Nigeria in Abuja.

Prof. Roger Makanjuola, Chairman MDCN

Before now, foreign-based Nigerian physicians were required to pay back registration and licensing fees whenever they requested for certificate of good standing, often needed to register or obtain licenses in their countries of practice. The fees in some instances may be for over twenty years as was the case for one of my colleagues who recently moved to Chicago and had to obtain an Illinois license. Many have condemned the payment of fees for a period during which one is not practicing in the country as exploitatory and punishing. The granting of this waiver is therefore a welcome relief. The waiver according to the Dr. Nwariaku is contingent on the Nigerian physician being able to demonstrate that they have been and continue to be in good standing (dues paying) in their current location. Practitioners who wish to renew their licenses will however be required to pay renewal fees for the current year of practice.

Former ANPA President, Dr. Julius Kpaduwa

ANPA Blog has learned that the Chairman of MDCN, Professor Roger Makanjuola, was swayed by representation made on multiple fronts by ANPA, pleading the case for thousands of diaspora Nigerian doctors who are eager to contribute to their homeland. Former ANPA President, Dr. Julius Kpaduwa, raised the matter at the the July, 2009 retreat with the Ministry of Health attended by the the health minister, Professor  Buchi Chukwu. Furthermore, ANPA Blog pestered Professor Chukwu with the issue during our interview with him in the fall of 2010, and extracted his promise to present our case to the MDCN.

 In his message, Dr. Nwariaku said: “ANPA has worked hard to secure a waiver of the requirement for back payment of medical license renewal fees for physicians and dentists who have been out of Nigeria for some time. We strongly argued that this was a major barrier to the desire of Nigerian trained physicians and dentists living outside Nigeria, to resume practice (fully or intermittently) in Nigeria, and that this regulation worsened the critical shortage of a skilled healthcare workforce within Nigeria.”

This decision by the MDCN couldn’t have come at a better time as the Nigerian government struggles to attract diaspora doctors to contribute their skills to the development of the country. In addition, the long drawn issue of whether Nigerian physicians practicing outside Nigeria need to obtain temporary licenses when they go on medical mission trips can be put to rest. With this agreement, obtaining a temporary license will be much easier for foreign-based Nigerian doctors who want to spend time back home providing care for our citizens without the back payment of fees hanging over their heads like a sword of Damocles.

I salute the hard work of the ANPA leadership in securing this waiver and join the President in applauding the current leadership of the MDCN for making right the wrong that has been perpetuated over many years.

Update from ANPA President

ANPA President, Fiemu Nwariaku

March 3, 2011
From the Office of the President

Dear Colleagues,

As promised, I would like to use this opportunity to provide you with updates on the activities of our organization. Much has happened since our strategic retreat in Houston in November. I am pleased to announce that the much awaited memorandum of understanding (MOU) with the Federal Ministry of Health in Nigeria was signed on February 14th 2011. Some of you may recall that the initial MOU signed 6 years ago did not result in any significant activity. As a result the current leadership of the FMOH assembled a meeting of stakeholders in Abuja, last July. During that meeting, the decision was made to renew the MOU, but make it active by convening a joint technical committee (JTC) which will become the effector arm for the MOU.

On February 14th 2011, the Hon. Federal Minister of Health signed the MOU and commemorated a fourteen-member JTC. Represented on the JTC, were ANPA, MANSAG, FMOH, Medical and Dental Council of Nigeria (MDCN), Nigerian Medical Association (NMA), National Institute of Medical Research (NIMR) and the Committee of Chief Medical Directors of Tertiary Hospitals. Our organization was represented by Past President Kpaduwa and myself. Also present from ANPA were Drs Igho Ofotokun, Vincent Idemyor and Abdulkareem Lateef.

Dr. Nwariaku and Hon. Min. of Health, Prof Chukwu, sign MOU 

The JTC held its first meeting that day, and began the work of identifying priorities that match the resources of ANPA and MANSAG. The next meeting is scheduled for late March 2011. ANPA proposes to focus on Maternal/Child Health and Emergency Medical Services (EMS) as the initial priorities. Our organization will then leverage our technical expertise and resources to address these priorities. We believe that this is a huge step by our government, and will rely on our members to deliver on our promises. I will continue to keep you abreast of the JTC activities as they pertain to our organization.

Secondly, ANPA has been fortunate to secure financial and logistical commitment from the Health Systems 20/20 project of the U.S. Agency for International Development (USAID). As part of this project, ANPA has offered to provide technical assistance to facilitate the revision of medical school curricula in Nigeria. With assistance from the Medical and Dental Council of Nigeria, the National Universities Commission (NUC), NIMR, the Diaspora Desk of the FMOH, and the University of Ibadan, the Hon. Minister for Health also inaugurated a committee to serve in an advisory role to the regulatory bodies in Nigeria, whose responsibility it is to revise the medical school curricula. This group also had a very successful meeting between February 15th and 18th 2011. Represented by Drs Igho Ofotokun, Vincent Idemyor and myself, our organization provided perspective on the American medical training. During that meeting, the decision was made to assemble the relevant materials to assist the NUC, MDCN and interested medical schools in Nigeria to begin the long process of curriculum reform. This process will likely take months to years; however we have been fortunate to secure the commitment from USAID and other partners for the duration of this project. We believe that this will be an important long-term investment to rebuild and strengthen the health care sector in Nigeria.

On the home front, preparations are underway for the next Annual Scientific Convention in Chicago. As usual, Professor Scott-Emuakpor and his program committee have put together a solid program. With a powerful theme of Maternal and Child Health, we will certainly attract significant attention from the public and private sectors. The projects described above will require significant financial commitment from our organization. As such, I hereby seek your assistance to begin making the calls to your friends, family, partners and acquaintances that are in the position to provide such assistance, both here and in Nigeria. Our organization will need a lot of financial support for many of these important activities that are underway. We all strongly believe in the activities of our organization to improve healthcare in Nigeria. We now need to communicate that need to our network of sponsors. I strongly believe that our organization can be a positive force for good in Nigeria. However we will need all hands on deck to accomplish this goal, and will need to convince other organizations about the importance of our work. The coming months are likely to be an exciting time for our organization. I will keep you informed as these activities evolve.

Warm Regards

Fiemu E. Nwariaku
ANPA President

Pediatric Public Health: How much are we doing for the children?

Whenever I start to think about pediatric health care in Nigeria, my thoughts quickly veer toward obstetrics, neonatal care and immunization. The host of baby formula and child immunization campaigns has seen some success, evident in the steady improvement in infant mortality rates. UNICEF statistics indicate that Under-5 mortality rates in Nigeria have declined by 35% since 1990 and by 27% since 2000. In addition, about 74% of routine vaccines were funded by the government in 2009. These numbers, although far from being perfect, suggest that we are moving in the right direction with infant health care.

The question then is what happens after infancy? What are these under-5 statistics hiding that statistics about different age groups (say under-10 or 5-15yrs) would expose? A recent interview with Dr. Efunbo Dosekun in The Guardian newspaper hints at inconsistencies in continuity of care for Nigerian pediatric patients. Dosekun, the Chief Medical Director at Outreach Children’s Hospital, Lagos believes that Nigeria has focused a little too much on immunization and neonatal care, what she describes as “public health initiative.” In her words,

“We seem to have forgotten that if you save a child from having diarrhea with an immunization, there are still other illnesses he/she has not been immunized against […] It makes more sense to prevent first and then put into place centers where the child can go when he/she falls sick.”

In the rest of the interview, Dosekun points out that even with our immunization programs, Nigeria’s overall child mortality statistics are dismal. One in six children does not make it to adulthood, putting us at par with many war torn countries. Of those who survive, the number that are significantly disabled as a result of childhood illnesses is staggering. The 48 year life expectancy of the average Nigerian is further testament to the fact that many children will not lead full, fruitful lives. Is this the best that Nigeria can do?

President Obama Taps ANPA Member, Dr. Funmi Olopade, for Key White House Post

Olufunmilayo Falusi Olopade, MD, FACP

Nigerian-born Chicagoan and ANPA member, Olufunmilayo Falusi Olopade, MD, FACP, has been appointed by President Barack Obama to the National Cancer Advisory Board. The Board advises the administration with respect to the activities of the National Cancer Institute, including reviewing and recommending for support grants and cooperative agreements, following technical and scientific peer review.

Dr. Olopade is an alumnus of the University of Ibadan College of Medicine, Ibadan, Nigeria, where she received the MBBS degree in 1980. News of her appointment has set off jubilation among ANPA members who hold her as one of the organization's shining stars. ANPA President, Dr. Fiemu Nwariaku congratulated Dr. Olopade for her great achievement and expressed gratitude to President Obama for an appointment that he said was clearly based on merit. According to Dr. Nwariaku, this is a fine example of the contribution that thousands of Nigerian-born physicians are making to improve the health of their fellow citizens.

Also, the Ibadan College of Medicine Alumni Association, (ICOMAA) through it's president, Dr. Benedictus Ajayi, released a statement praising Dr. Olopade for doing her home country proud and  for flying "an unstained Nigerian flag". Dr. Olopade, he added, "has never forgotten her roots .... and has continued to work relentlessly to ensure that our Alma Mater becomes one of the world's best".

In naming her to this top administration post, the White House released the following citation:

Olufunmilayo Falusi Olopade is the Walter L. Palmer Distinguished Service Professor of Medicine & Human Genetics, Associate Dean for Global Health, and Director of the Center for Clinical Cancer Genetics at the University of Chicago. She is also a practicing clinician and Director of the University's Cancer Risk Clinic. In her clinical work, Dr. Olopade is an authority on cancer risk assessment, prevention, and individualized treatment based on risk factors and quality of life. She also works with educators, doctors, government officials and pharmaceutical companies to improve access to quality education and medical care in low-income communities. Dr. Olopade has received numerous professional honors and awards, including the MacArthur Foundation Fellowship, the ASCO Young Investigator Award, the James S. McDonnell Foundation Scholar Award, and the Doris Duke Distinguished Clinical Scientist Award, among others. She holds an M.B.B.S. from the University of Ibadan in Nigeria, completed her residency in internal medicine at Cook County Hospital in Chicago, and completed a postdoctoral fellowship in hematology and oncology at the University of Chicago.

Rapid Recall for the Internal Medicine Boards by Dr. Chinedu Ivonye, ANPA Member

A new book, Rapid Recall for the Internal Medicine Boards, by ANPA member Chinedu Ivonye MD, FACP, billed as "a powerful tool to help you ace the boards", has just been released by CreateSpace Publishers. The book is intended for use by candidates preparing for the American Board of Internal Medicine (ABIM) certification examinations.

Dr. Ivonye is an Associate Professor of Medicine at Morehouse School of Medicine, Atlanta, Georgia. He also serves as the Associate Program Director for the Internal Medicine Residency Program, the Director of Primary Care, and the Chief of Ambulatory Services at Morehouse.

The book is the culmination of several years devoted to teaching and development of curricula for residents and medical students. Dr. Ivonye's passion for teaching has received wide recognition, including The J. Willis Hurst, M.D. Award presented by the Georgia chapter of the American College of Physicians.

Dr. Chinedu Ivonye

His motivation for writing the book, Dr. Ivonye told The ANPA Blog, was "to help the candidates preparing for the ABIM focus on the high yield materials". He added that "my experience over the years with residents has shown me that even the most intelligent candidates still need to focus on the high yield materials for the ABIM".

ABIM is one of 24 medical specialty boards that make up the American Board of Medical Specialties (ABMS). Through ABMS, the boards work together to establish common standards for physicians to achieve and maintain board certification. ABIM certification is regarded as evidence that that internists have demonstrated – to their peers and to the public – that they have the clinical judgment, skills and attitudes essential for the delivery of excellent patient care.

The book is available here on Amazon.

Minister of State for Health Indicted?

Minister of State for Health Alhaji Sulaiman Bello

We were alarmed by this morning's scandalous headline from The Daily Trust, but were quickly reassured that the financial shenanigans being reported has nothing to do with the Federal Ministry of Health. Not again!

The newspaper reported that the Minister of State for Health, Alhaji Sulaiman Bello has been indicted by the Independent Corrupt Practices and Other Related Offences Commission (ICPC) over an alleged N11.2 million bribe.

However, the alleged offense was purportedly committed during Alhaji Bello's previous post as Resident Electoral Commissioner (REC) with the Independent National Electoral Commission (INEC). The minister was alleged to have unlawfully solicited the sum of N11.2m from the governor of Adamawa State and given a N0.5 million bribe to an official of INEC. Court hearing has been set for January 31st, 2011.

We should point out that this is merely an allegation and the Minister may be entirely innocent of these charges. After all, the ICPC does not have a stellar record of winning convictions against those public officials it has taken to trial.

Reflections on Brain Drain and Brain Gain in Nigeria

Over the holidays, a colleague of mine who has a thriving practice here in the United States shocked me and many of our friends when he said he was planning on returning home to Nigeria to set up a private clinical practice. In fact, he said he has shipped personal belongings and medical equipments to Nigeria. He said he believes he has learned all there is to learn in advances in medical science having undergone training in the United Kingdom and the United States. He said it is time to return to Nigeria and give Nigerians the benefit of the expertise he has acquired over the almost twenty five years since left the shores of Nigeria in search of greener pastures. One of our colleagues jokingly asked if the pastures were no longer and that he hoped he was making the right decision.

Today as I reflect on this conversation with our friend, I am once again drawn into the ever contentious exchanges on “Brain drain” and Brain gain”. Many have argued that my Nigerian professionals including physicians would not have reached full potentials and achieved professional expertise and competence if they had remained in Nigeria. May be and may be not. Others argue that even if this was the case, Nigerian professionals should return home after their training to contribute to the development of the country; after all to whom much is given much is expected. This is so much so when one remembers that most individuals in my generation were literally paid to go school. We all received bursaries, scholarships, and all kinds of grant to attend universities in Nigeria, and did not pay tuition.

So my friend is turning brain drain into brain gain by returning to Nigeria to contribute his expertise to health care delivery. Returning home to Nigeria is one way of turning brain drain into brain gain. Unfortunately, many Nigerian professionals can not take such giant leaps for fear of failure, insecurity, and an unfriendly practice environment that does not engender professional satisfaction and fulfillment. For the majority for whom returning home is not feasible, there should be other ways to give back to Nigeria and contribute to her development. Nigerian professional organizations in the Diaspora need to develop constructive, long-term sustainable strategies to develop particularly the education and health sector in Nigeria. The Diaspora Commission set up over a year ago is still bugged down with bureaucracy and has no tangible achievements to date. During my days in academia, I had Indian colleagues who go to India every summer to teach in medical schools and provide development workshops to practicing physicians. Such arrangements are done through their professional associations, are not done sporadically for self-recognition, develop clout, or for personal or political gains, but regularly in the overall interest of Indians.

Wherever you stand, or whatever your believes, “Brain drain” or “Brain gain” one thing is clear; Nigerians in diaspora particularly professionals need to be more involved in the rebuilding of the Nigerian state.

Partners in (Nigerian) Health

A report from the Federal Ministry of Health (FMOH) highlights a new initiative – the Data Inventory and Documentation Initiative (DIDI) – that aims to better align Nigeria’s health survey database with international standards. The report argues that such data “are invaluable resources for statisticians, researchers and analysts”, a statement that could very easily be extended to include benefits for health care professionals. After all, proper cataloging of health information could mean the difference between treating 200 patients today (preventing the spread of a disease) and treating 20,000 patients tomorrow in a full blown epidemic. I admit that this is an extreme example, but then again, health care is all about extremes. We can’t expect any less when we’re dealing so intimately with human life.

In any case, the report identifies the International Household Survey Network (IHSN), the World Bank, *PARIS21, the International Health Facility Assessment Network and USAID, as organizations that will help the FMOH with this transition. **MEASURE Evaluation will provide much of the technical support. In addition, the ministry has requested that data from private surveys (conducted by individuals and organizations) be contributed to the program. In all, it seems like a multi-faceted effort that is well poised to do wonders for the health situation in Nigeria.

It’s an incredibly fortunate coincidence that the FMOH would launch such a program shortly after the appointment of ex-minister of health, Babatunde Osotimehin to the position of Executive Director at the United Nations Population Fund (UNFPA). From such a position, Osotimehin can contribute greatly to programs like DIDI and thankfully, he seems ready to do just that. In a visit to his successor at the ministry (Prof. Onyebuchi Chukwu), Osotimehin re-affirmed his dedication to the health sector, promising to “provide more for Nigeria than ever before.” Embracing the sentiment, Chukwu praised the efforts of the ex-minister, asserting that his appointment at the UNFPA was a clear indicator of his exemplary leadership during his tenure.

Photo courtesy of the UNFPA (https://www.unfpa.org/public/home/news/pid/7103)

This alliance is encouraging on multiple levels. Most clearly, it holds great promise for the development of epidemiology and heath care management in Nigeria. In addition, it legitimizes Nigeria’s position as a country that has the potential to be a forerunner in global health. Very importantly, it’s a great example of a smooth hand-over in a leadership position, something that Nigeria doesn’t see very often. Let’s hope that the Nigeria-UNFPA relationship will live up to expectation and ultimately, help programs like DIDI reach their full potential.

* PARIS 21 - Partnership in Statistics for Development in the 21st Century (Founded in November 1999 by the United Nations)

** MEASURE Evaluation - Monitoring and Evaluation to Assess and Use Results (Program sponsored by USAID)

Health Minister Gives Progress Report on the First Six Months

Nigeria's Health Minister, Professor C.O. Chukwu came into office just over six months ago, at a time of great political turmoil, and following a rapid turnover at the helm of the health ministry. Prior to his appointment, he was Chief Medical Director at the Ebonyi State University Teaching Hospital, and then Professor of Orthopaedic Surgery and Deputy Provost of the College of Health Sciences, Ebonyi State University at Abakaliki. He had just taken a sabbatical as Visiting Professor of Surgery at the College of Medicine, University of Nigeria but before he could settle in Enugu, he received the fateful call from President Goodluck Jonathan that would thrust the health of Nigeria's 150 million people into his hands.

President Goodluck Jonathan 

So what progress, if any, has been made in Nigeria's health care under President Jonathan and Minister Chukwu? In an exclusive interview given to The ANPA Blog, the Minister made his case directly and rendered a progress report on the activities of the ministry during his first six months in office. We asked: "You have been in office for less than 6 months, so it may be too early to discuss your achievements. However, are there some things you are particularly proud to have accomplished?".

Professor Chukwu opened by touting the "new sense of urgency and responsiveness at the Federal Ministry of Health" and his drive to establish "trust and confidence-building" as his guiding principles. Also, he revealed that President Jonathan has been singularly focused on health policy and has invested enormous political capital to pass the Health Bill that will facilitate the development of a functional health system for the country.

But, what specifically has he achieved, we asked. First he recalled that during his Senate confirmation hearings, the entire healthcare sector was in crisis over the wage dispute between the ministry and several groups of health workers. He had swiftly quelled the crisis, he said, by implementing "payment of the new wage structure for health workers and the arrears thereof". To produce transformational changes in the health system, however, the Minister said that he is focused on passing the National Health Bill and the implementation of the National Strategic Health Development Plan. The Health Bill has passed both chambers of the National assembly and is awaiting harmonization. President Jonathan recently expressed confidence that he will sign the bill before the New Year.

A top priority of his ministry, said Professor Chukwu, is to ensure that Nigeria meets the health-related Millennium Development Goals (MDGs) by 2015. However, he recognized from the outset that little will be achieved without fostering a sense of collegiality among all health workers. Notably, during his Senate confirmation, Professor Chukwu was embroiled in a controversy over whether only doctors should be appointed to the top job. Then, he had forcefully emphasized the important role of all ranks of health workers, saying: "The bottom line is that without team work nobody can do it alone." To this end, he said, he went on to create the "Committee on Harmonious Working Relationship among Health Workers/Professionals" charged with  instilling a sense of common purpose among physician and non-physician health workers. Professor Chukwu said he is working at full speed to fully implement his “Action Push Agenda for Health” plan before a new government is sworn in in May 2011. He reiterated what he had told The Guardian about his plan:

‘The Action Push Agenda’ is a compass for the period from April 2010 to May 2011. During this period, our top priorities will be on governance and stewardship, team work and industrial harmony, keeping on track the realisation of the MDGs especially the Health MDGs, disease prevention, surveillance and control, provision of affordable but world-class healthcare services at our public and private tertiary health institutions, and the establishment of a reliable referral system.”

Regarding dissatisfaction among resident doctors, the Minister said he was determined to address them comprehensively and has therefore established a "Committee to Review the Residency Training Programme". He noted that he has invited a broad coalition of medical experts to serve on this committee, including ANPA, which is represented by the Chair of the Education Committee, Dr Dotun Ogunyemi. The Minister said that ensuring quality training and meeting the MDG goals were part of his push to "inspire international confidence in the Health Sector". He pointed out the vital role that diaspora organizations such as ANPA can play in this regard, noting his full personal engagement during the "Retreat for Health Professionals in the Diaspora" held by the health ministry in July 2010.

Other achievements listed by the Minister include: audit/mapping of skills and facilities in the federal tertiary health institutions; providing support for first ever ATLS course in Nigeria; deployment of 2488 midwives across 652 primary health facilities; update of health data and statistics update; convening an inter-country inter-ministerial meeting with Nigeria’s neighbours to discuss and sign an agreement on cross-border health issues; and hosting of the 2nd International Cancer Week.

Health Minister: Increased Government Funding and Inter-Sectoral Cooperation Vital To Improving Health of Nigerians

Nigeria's Health Minister, Professor Onyebuchi Chukwu

For watchers of healthcare delivery in Nigeria, it did not come as a surprise when the country was ranked among the worst countries with weak national health systems; ranking 197 out of 200 in a recent World Bank survey. This poor ranking was attributed to inequitable distribution of healthcare resources between urban and rural areas; and lack of functional referral system due to poor funding. To refresh our minds, only 39 percent of births are assisted by skilled health professionals, just as only 23 percent of children between12 and 23 months receive full course of immunization against childhood killer diseases.

Against this backdrop, the ANPA Blog sought the audience of the Nigeria’s Minister of Health Prof. C.O.Onyebuchi Chukwu on these and other issues related to healthcare delivery in Nigeria during his visit to the United Nations in New York. It is a fact that most diseases responsible for mortality and morbidity in Nigeria are preventable and tied to areas outside of the ministry of health's purview (water supply, sanitation, environmental pollution). The ANPA Blog posed this to the minister and wanted to know what the ministry of health was doing to educate the leadership of the ministries involved and mobilize them for a common purpose of improving the nation’s health.

The minister agreed with facts as posed by the Blog and said that inter-sectoral cooperation was vital to improving the health and health outcomes for Nigerians. He said: “We have engaged those ministries (particularly Education, Water Resources, Environment, Interior and Finance) in bilateral discussions but intend to establish the inter-ministerial/inter-sectoral committee meeting on health.” He maintained that the better educated the leaders of these sectors are, the better will be the health of Nigerians.

The minister touted the great strides made in polio prevention in Nigeria saying “From January 2010 to October 2010 only 10 cases (2 awaiting confirmation) of Wild Polio Virus transmission has occurred in Nigeria.” and that WHO acknowledges that Nigeria has reduced transmission by 98%. The ANPA Blog congratulated the minister on this achievement but reminded him that successes are directly the result of immunization campaigns that are largely driven by external agencies and that there are still pockets of morbidity to vaccine preventable diseases, for example the 100 cases of polio paralysis reported from Jan to Sept 2009 in Kano alone. The ANPA Blog was concerned about the over-reliance on outside funding agencies and minimal national resources devoted to vaccine preventable diseases. The minister acknowledged that foreign donors are helping in the polio eradication program in Nigeria, but that more domestic funds have been committed to the operational cost (about 80%) of polio eradication effort in Nigeria than from external sources. He said: "External donor funds have been used to bridge funding gaps. This is not peculiar to Nigeria.” With regard to polio vaccine procurement, the minister said that domestic funding accounts for 50% while external funding accounts for the balance of 50%.

It is our hope that the minister will follow up on his promise to forge true inter-sectoral cooperation to improve the health of Nigerians particularly the poor and disadvantaged.

LUTH to boost medical tourism: Lessons from Colleagues Who have Gone Home

Since I left Nigeria after completing medical school, I have been back several times and have been in contact with my school mates both inside and outside Nigeria. I have been involved in both soft and heated discussions on the path forward for health care in Nigeria. In some cases, people have blamed physicians like me who received medical education in Nigeria then left Nigeria. In other cases, people see physicians like me as a potential to help pull Nigeria forward by collaborating with our colleagues in Nigeria.

I have had several opportunities to speak with Nigerian physicians in Diaspora that have gone home “successfully”, others who had to rush out after going home and many others who want to yield to calls from both the Nigerian government and people of Nigeria to return home to help.

Although I believe all physicians do not have to go back to Nigeria to help, I think a critical mass may need to go home to develop a collaborative atmosphere that currently is lacking in many medical schools in Nigeria, and which inhibits the potentials of working across the Atlantic.

Prof. Akin Osibogun, CMD of LUTH 

In a recent report that appeared in The Guardian, the Chief Medical Director (CMD) of the Lagos University Teaching Hospital (LUTH), Prof. Akin Osibogun, announced an initiative to "boost medical tourism" through a "public -private initiative arrangement". After reading this story, I wondered if it would be helpful for physicians who have gone home successfully and those who had to return to share their experiences with ANPA members as there might be a lesson or two they can give those thinking of returning home on the “dos” and “don’ts”.

The Indian government successfully attracted its citizens in diaspora back to their country by working with them to answer the question: what do you need for the government to have in place (policy) for you to come back?

Will Nigeria do the same?

Meet Our Bloggers: Nneoma Nwachuku, MPH

We are pleased to announce a new addition to our blogging team. Ms. Nneoma Nwachuku is a member of our partner organization, the Distinguished Nigerian Physicians of Tomorrow (DNPT).

Ms. Nwachuku is a medical student at the University of Connecticut School of Medicine (class of 2013). She received her undergraduate degree from Yale University where she also subsequently completed a Master in Public Health degree.

A proud Ohuhu native, Ms. Nwachuku calls Umuahia in Abia State home. She co-edits a group blog, NigeriansTalk.org, writes a personal blog and is an avid tweeter. Ms. Nwachuku brings to this blog a valuable perspective from the next generation of Nigerian physicians, on how to address the challenges facing health care in Nigeria.

Meet Our Bloggers: Asishana (Shana) Osho

We are pleased to announce the addition of new bloggers from our sister organization, the Distinguished Nigerian Physicians of Tomorrow (DNPT). The DNPT, which is sponsored by ANPA, is a coalition of Nigerian Medical students all over the world with the mission to help find solutions to Nigeria’s health care problems.

The first of our DNPT bloggers is Mr. Asishana (Shana) Avo Osho, a medical student at the Duke University School of Medicine (class of 2014). Mr. Osho is a native of Edo State and grew up in Lagos. He attended secondary school at Loyola Jesuit College, Abuja and subsequently graduated from Oberlin College, Oberlin, OH where he studied biochemistry and French literature.

Mr. Osho is dedicated to the empowerment of marginalized and deprived groups. He is also interested in the delivery of care and in the implementation of health policy in Nigeria and will reflect these interests in his writings.

Reversing the Brain Drain Phenomenon

The subject of brain drain or professional intellectual loss from underdeveloped to developed countries remains a hot topic.This phenomenon is not unique to medicine and, in fact, encompasses many professional fields including other areas of science, humanities and professional sports.

To elaborate on the brain drain attributable to the medical profession, let me start by saying that many people choose to go into the medical field for various reasons. Most physicians have the gift of knowledge, forming the core of intellectual elites that elect to delay their gratifications from many years of educational torture that might eventually result in a comfortable life style.While many choose the profession to help others, some believe they do so because of the respect or prestige bestowed by the society at large. Others do so for money and yet others pursue the art of medicine because of their special gifts.

Whatever the reasons for choosing this noble profession, the fundamental act of practicing medicine must be supported by the right environment, offering adequate nurturing , security and diagnostic equipments to treat the sick and the injured. Any imbalance in this unique medical equilibrium will create an uncomfortable force that shifts the effort of the professional giver to look elsewhere and transport their expertise to a more favorable environment. Large scale migration of trained medical professionals whether from Nigeria, India or any other place seems to have the common denominators of poverty, lack of adequate medical infrastructures, poor security and inadequate allocation of health care funding. Thus the same brain that is been drained from one area can easily be filled elsewhere with the right environment. The transformation of acquired skill from a country with poor health structures is therefore not because of incompetent professionals or pure monetary seeking behavior, but rather because the new environment offers the right climate of innovation, improved experience, competency and well equipped facilities to entertain favorable and humane health care practices.

Nigeria's Health Minister, Professor Onyebuchi Chukwu, Speaks to The ANPA Blog

Several weeks ago, Professor Onyebuchi Chukwu, Minister of Health of Nigeria, was at the United Nations headquarters in New York where he addressed a summit on the Millennium Development Goals (MDGs). With only five years left until the 2015 deadline, there is a renewed sense of urgency among under-performing countries such as Nigeria to accelerate progress towards achieving the MDGs.

Soon after Chukwu took office six months ago, he lamented that Nigeria faced unique problems that made attainment of the MDGs very difficult. Within a few months, however, he was more optimistic, touting the National Health Strategic Development Plan before the Commonwealth Health Ministers meeting in Geneva, a plan which Chukwu said specifically addresses core health-specific MDG targets for infant mortality, maternal mortality, HIV and AIDS, tuberculosis and malaria.

Taking the podium at the UN, Chukwu while acknowledging the difficulties ahead was also exuding confidence, reeling off statistics to show recent progress:

"Nigeria is reasonably on course to achieve the target of MDGs on reducing child mortality with a fall from 100 per 1,000 to 75 per 1,000 live births between 2003 and 2008. Similarly, in the same period, the under-5 mortality rate fell from 201 per 1,000 to 157 per 1,000 live births .... and a drop in the maternal mortality ratio of 545 maternal deaths per 100,000 live births........a fall in the prevalence of HIV/AIDS from 5.8% in 2001 to 4.24% in 2008; doubled treatment of patients from 16.7% in 2007 to 34.49% in 2008." 

During his UN visit, the Honorable Minister who revealed that he reads The ANPA Blog, agreed to take questions from Deji Adefuye and Ben Nwomeh, in the first of a periodic feature in which we will interview stakeholders in Nigeria's health system. In subsequent posts, The Blog will report the Minister's views on a wide-range of issues, particularly those of concern to ANPA members.

Is ANPA a Social Club ?

I have been debating this question for the past few weeks. I typically try to take stock when the year begins to come to a close and one of the thoughts that came across my mind was what exactly does ANPA mean to me or in what ways does it impact Nigeria as a whole in the Health care sector.

I reviewed the different posts by members on the group emails, blogs etc. and the comments reflected issues of concern to Nigeria i.e. safety, kidnapping, state of the economy, healthcare delivery, criticisms of the government , discussions about dues, membership issues etc. We celebrated the successes of our members and their families and commiserated with the families of those that passed away (may God Bless their souls). But really, how do these conversations differ from the conversations we have in other fora or gatherings? When we meet at parties and other occasions where 2 or 3 are gathered in the name of Nigeria, the same conversations take place.

So what is the value of ANPA?