Alex Stories: Medical missions to the rescue in Nigeria’s health...

Alex Stories: Medical missions to the rescue in Nigeria’s health...: "..Offers affordable care to people in the grassroots The sustainability and viability of a nation’s ..."

Medical missions to the rescue in Nigeria’s healthcare

..Offers affordable care to people in the grassroots

The sustainability and viability of a nation’s economic and social growth depend largely on vibrant healthcare sector of that nation. However, no nation can maintain a steady economic growth in the absence of an adequate healthcare system. 

Over the years, providing adequate health care to Nigerians has remained a daunting challenge previous administrations in the past have devised several means to address. While infant mortality has dropped to single digits per thousand births in countries with adequate and efficient healthcare systems, mortality indices in Nigeria is close to 100 per thousand.

As improving Nigeria’s life expectancy is still seen as a tall dream, unsatisfactory and inadequate access to essential drugs and other healthcare services, has painted the nation in bad light. Individuals who throng primary healthcare centres, which is the entry point into the nation’s health services are more often than not are greeted with either inadequate access to essential drugs or empty building without medical personnel to administer medicare.

The worst hit are indigent individuals who cannot be able to afford the cost of medicare. They however resort to one form of divine favour or resign to fate. In view of these challenges, providing free quality medical care to the indigent and under-privileged in rural areas-since they form a large bulk of the population-to those who could not afford it through medical missions has been seen by health experts as a succor towards improving the health of these individuals.

An organisation that have taken the bull by the horn to ensure that the poor and needy Nigerians have access to quality healthcare without them having to pay a dime carry is ‘We care missions’. The organisation which focus on managing missionary works in health care as well as educating the poor and vulnerable population in rural communities since 2007 has impacted positively on the lives of more than 12, 000 during its yearly medical missions.

In an interview with Fatima Madus, coordinator, We care Missions, Madus revealed that medical care is scarce in some parts of the country, especially in the rural areas where large numbers of people die needlessly for lack of basic medical care.

While acknowledging the fact that abject poverty is a contributory factor, Madus disclosed that many of these people have never been to a doctor’s clinic for wellness screening or for diagnosis of their ailments, there is a trade-off between purchase of basic necessity and making a visit to the doctor’s office.

She maintained that its yearly medical missions which provide an opportunity for people to access healthcare doesn’t stop at providing consultation but also surgical interventions such as cataract, etc. when needed.

According to her “We Care Mission’s health care team provides diagnosis and treatment for diabetes and hypertension. As part of long term goals for the health screening, the volunteer team will continue to provide medical education on prevention, management of diabetes, hypertension and malaria.

“Don’t forget that we have conducted monthly screenings for five villages in Etsakor local government area of 

Edo State –Nigeria. Medical services rendered include wellness screening for diabetes, hypertension, malaria and health care education. Others include free medication to manage both acute and chronic conditions, eye examinations, minor and major surgery (including cataract surgery). These health services we intend to provide as from Monday 30^th May to June 3^rd 2011.

“We were successful in recruiting dedicated volunteers for our medical outreach; we significantly exceeded our 2007 record as indicated by attached statistics. Our relationship with the community is growing and we have laid foundation for a sustainable health care provision for the poor and disadvantaged,” Madus stated.

There is no gain saying that medical mission is a comprehensive health care initiative that covers primary, secondary and tertiary levels of prevention, introduced in a quest to find ways to take health care to the grassroots and under-served areas of the state.

For stakeholders in the health sector, health mission is particularly significant because it assists the government in its efforts at bringing, to the minimum, the number of untimely deaths experienced in the country at a time the target for achieving the MDG is just four years away.

For Madus “It is believed that the current medical mission embarked upon by ‘We Care Mission’ will go a long way in complimenting the normal health delivery services with the objective of addressing the pressing health issues of the rural communities as part of an overall effort geared towards tackling the challenges in the health sector.

“Beneficiaries of the medical mission include the most vulnerable members of the population at the grassroots such as the elderly, children, youth and pregnant women who are prone to infections and other maternal and child health-related diseases,” Madus concluded.

Though questions as to how much medical missions could accomplish beyond providing temporary intervention is the more reason why the provision of permanent structures and enduring medical practices in Nigeria is key in ensuring that everyone have access to healthcare no matter the terrain.

Perhaps the best path to follow in achieving this goal is to work with private partners – oil companies, multinational corporations, banking institutions, funding agencies, and philanthropists – to build, equip, and staff one hospital at a time. Such a hospital or hospitals could function as the base for future medical missions, until such a time when such missions are no longer necessary.

It will be recalled that various natural disasters around the globe have highlighted the need and utility of medical missions and brought to the forefront, prevailing challenges. The earthquake disaster in Haiti was massive, but smaller disasters also happen daily. We need to put a functional healthcare system in place, no matter how small.

In the views of Jide Idris, Commissioner for Health Lagos state, while on a recent Eko Free Health Mission “medical mission Mission will also supplement government's formal health structures at the grassroots level as well as provide alternative avenues of providing secondary medical care to the ailing within the time frame of operation.

“Since government cannot wait until infrastructure, equipment and manpower championed by the health reform are ready before people have access to qualitative and affordable healthcare service, free medical missions will serve as alternative source of healthcare delivery access especially to the people at the grassroots,” he concluded.

Alex Stories: UN drafts plan to improve maternal and child healt...

Alex Stories: UN drafts plan to improve maternal and child healt...: "… Task countries to scale up effective actions to combat nutrition problems The United Nations World..."

UN drafts plan to improve maternal and child health through better nutrition

… Task countries to scale up effective actions to combat nutrition problems

The United Nations World Health Organization (WHO) has drafted a plan committing member states and development partners to implement priority nutrition interventions and policies on health care, education and agriculture to improve the health of mothers and children.

The measures, which was included in a WHO report entitled “Maternal, infant and young child nutrition: implementation plan,” at the just concluded 64th World Health Assembly (WHA) in Geneva, Switzerland outlined priorities to confront child under-nutrition, low birth weight, growing rates of child overweight, both maternal under-nutrition and overweight, and the consequences of vitamin and mineral deficiencies for mothers and children.

Sadly, recent figures from the global health body reveal that more than 100 million children under the age of five were underweight in 2010, and at least 170 million were stunted. The report further stated that micronutrient deficiencies, including anaemia and vitamin A, are of increasing concern globally. Malnutrition, which is one of the most significant causes of infant and under-five mortalities in Nigeria, accounts for series of childhood deaths annually (i.e. before their fifth birthday).

In view of these preventable deaths, calls have been made for countries to scale up effective actions to combat nutrition problems even as education of the populace will further reduce the incidence of malnutrition in the country.

In a recent interview with newsmen, Ignatius Onimawo, president, Nutrition Society of Nigeria, described malnutrition as a major silent killer in Nigeria, which is responsible for over 60 percent avoidable maternal and infant mortality, especially those under-five.

Onimawo stated that this figure makes Nigeria one of the countries in the world with the worst maternal and infant morbidity rate recorded among the comity of nations. He, however, called for the review of the current national food and nutrition policy to accommodate the emergence of severe to moderate acute malnutrition as well as upsurge of metabolic syndromes which was not envisaged in the current policy.

According to him “Issues of nutrition will continue to be of great concern to every well-meaning Nigerian considering the abysmal statistics of infants, under-five and maternal mortality rates in Nigeria. It has been proven and demonstrated that malnutrition contributes approximately 60 percent of the underlying causes of these avoidable deaths that paint Nigeria in bad light among comity of nations. Food manufacturers in Nigeria should become nutrition-conscious in order to minimise the current upsurge of metabolic syndrome.”

For his part, George Ekeh, Chief Executive Officer, Justy Food Confectionaries, malnutrition, in all its forms, impairs health, cognitive and physical development, reproductive health and immune systems. Ekeh noted that this anomaly not only threatens child and infant survival, it also leads to growing rates of overweight.

“Our traditional foods are rich in all the required nutrients and can contribute over 90 percent of energy, protein, thiamin, niacin and ascorbic acid if they are well prepared and taken adequately. There is the need to improve on nutrition education on consumption patterns. This will go a long way in improving our nutritional needs,” Ekeh stated.

It will be recalled that Nigeria launched its National Policy on Food and Nutrition in 2002, with the overall goal of improving the nutritional status of all Nigerians. With the policy setting specific targets, such as reducing severe and moderate malnutrition among children under five by 30 percent and reduction of micronutrient deficiencies (principally of vitamin A, iodine and iron) by 50 percent by 2010, it is expected that cases of malnutrition among children in the country will nosedive.

Even as different development partners have different mandates, competences and resources required, a strategic partnership is required to harness these resources for effective actualisation of the Millennium Development Goals (MDGs).

While Nigeria still faces many challenges in its efforts at improving the nutrition situation of under-five children despite the availability of a National Food and Nutrition Policy and a National Plan of Action for Food and Nutrition in the Country, there is the need to implement high-impact low-cost and effective interventions like early initiation of breastfeeding, exclusive breast feeding and appropriate complementary feeding in addressing nutrition insecurity among children. This, no doubt, would halt the unacceptable infant and under-five mortalities in the country.

To various stakeholders in the health industry, it is obvious that education remains the key to any progress in the fight against malnutrition. It was also established that all stakeholders must enter a strategic partnership to make a success of any attempt to properly educate the populace on malnutrition. With the right campaigns, awareness would be created which will not only lead to better nutrition practices but also lead to the much desired nutrition security.

It wail be recalled that at the 63rd World Health Assembly which held last year, member states were called upon to increase their political commitment to better nutrition even as the world health body provide countries with support and strategic advice.

The draft implementation plan for maternal, young child and infant nutrition was presented to member States for their comments at the just concluded Assembly as part of a two-year consultative process to finalise the measures.

Alex Stories: Improving healthcare standards key in medical inte...

Alex Stories: Improving healthcare standards key in medical inte...: "…as Lagoon Hospitals bags JCI accreditation in quality healthcare The safety of patients that throng..."

Improving healthcare standards key in medical intervention

…as Lagoon Hospitals bags JCI accreditation in quality healthcare

The safety of patients that throng healthcare institutions for medicare is an issue which affects health systems in both developed and developing countries. The reason is simple. Health personnel can unintentionally harm patients when they take inappropriate decisions, a situation which results in patient disability, additional healthcare expenditure and deaths.

In a bid to stem this tide, the Joint Commissions International (JCI) focuses on improving the safety of patients through quantifiable benchmarks and certifications for patient care, driving positive changes that get noticed by clinical staff, patients and management.

Taking the driver’s seat on patient safety and management, Lagoon Hospitals has earned accreditation from JCI, which has been working with health care organisations, ministries of health and global organisations in over 80 countries since 1994.

The commission whose mission is to improve the quality of care has accredited over 200 organisations around the world; with its sister organisation, Joint Commission on Accreditation of Healthcare Organisation (JCAHO) awarding the Gold Standards for Hospitals in the United States of America (USA).

Presenting the certificate of accreditation at its Apapa office, Paula Wilson, President and Chief Executive Officer, JCI disclosed that healthcare organisations around the world want to create environments that focus on quality, safety and continuous improvements.

According to Wilson “JCI’s accreditation meets this demand by stimulating continuous, systemic improvements in an organisation’s performance and the outcomes of patient care. Our focus is on health care quality improvement and patient safety with expertise in infection control, medication safety, facility safety, and accreditation preparation. The citizens of Nigeria should be proud that Lagoon Hospitals has made a commitment to quality and safety.

Lending her view, Fola Laoye, Managing Director, Hygeia Group, revealed that Lagoon Hospitals, been the first hospital in Sub-Saharan Africa said to bag accreditation from JCI, have placed the health institution among a global community of hospitals that have achieved international standard practice for hospital management.

The Managing Director stated that limiting human errors by medical personnel involves working towards standards. She noted that checklist in the medical circles prior to any medical intervention is of paramount importance given the fact that any wrong decision on the part of the physician can lead to the death of the patient.

In her words “maintaining a regular checklist is important prior to any medical intervention like surgery. This is because when things go wrong due to human error, the patient and their families are the victims of the harm induced. There is the need to place patients at the centre of efforts to improve patient safety. This is why safety is paramount all the time and must be made a culture in hospitals within the country.

“This certificate of accreditation is for a three-year period after which JCI would be back to reappraise the hospitals again against the set guidelines. Some of the examinations include; how well we are maintaining and using our medical facilities, fire and safety standards, environmental standards, clinical standard that is how we treat and monitor our patients, how we make sure that we prevent infection, etc.  We have a lot to look up to maintain the level of healthcare and a major role to play in the community around us by making them ensure they maintain standards while dispensing care to patients,” Laoye concluded.

Taking a cursory look, surgical mistakes are often caused by surgeons in a hurry. In addition, the highest rates of errors are pharmacy errors, either in the hospital or through a neighborhood pharmacy. The problem is that many of the drugs have similar names, and many of the containers look like each other, including similarly colored labels and logos. Lousy doctor handwriting is a well-known problem, too.

Pharmacists and their technicians - in a hurry- mistake those similar drugs for each other, or will simply misread a doctor's handwriting. Patients, like elderly persons who may have trouble with their sight, or anyone who isn't familiar with what drug he/she is supposed to be taking, may not even realize they have been given the wrong drug.

There is no gain saying that ensuring the safety of everyone who comes into contact with health services is one of the most important challenges facing health care today. With no current organisation measuring patients’ safety in the nation’s healthcare institutions, in the United States of America, hospitals cannot operate unless they have JCI certification and over time, this standard has extended to some Arab nations like Saudi Arabia, United Arab Emirates, etc.

No doubt, improving patient safety involves assessing how patients may be harmed, preventing or managing risks, reporting and analysing incidents, learning from such incidents and implementing solutions to minimise the likelihood of them reoccurring.

For Adeyemo Elebute, Chairman, Hygeia Nigeria Limited, “Although human error remains inevitable in medicine, hospitals must work towards ensuring standards in healthcare delivery. This will go a long way in reducing cases of human error in healthcare services, thereby ensuring patients safety. There is the need to develop and implement national policies for patient safety in the country.

“Don’t forget that improving knowledge of medical personnel on issues relating to patient safety is critical towards addressing the issue of patients’ safety. In addition, there is also the need to ensure health-care waste management, and strengthen surveillance and capacity for research” Elebute concluded.

Alex Stories: Bumpy Road to a cashless economy

Alex Stories: Bumpy Road to a cashless economy: "In a bid to fast track the transition from a cash to cashless economy, the Central Bank of Nigeria (C..."

Bumpy Road to a cashless economy

In a bid to fast track the transition from a cash to cashless economy, the Central Bank of Nigeria (CBN) recently announced a new policy on cash withdrawal limits which may have a profound effect on banking operations. Ikechukwu Eze and Alexander Chiejina x-ray this development and the challenges which may bog it down

Kelechi Anaeke, Director, Kelly Computers owns a shop at the popular ‘Computer Village’ located at Ikeja, Lagos. Anaeke deals in all kinds of computer accessories, and supplies laptops as well as other telecommunication gadgets to clients from within and outside the state. His business is worth over a million naira, and is essentially cash-based.

Like him, Rose Okoh, a baker, owns a shop at Oshodi, Lagos. Her business is worth several thousands of naira. But unlike Okafor who maintains a personal savings account with one of the banks at Ikeja, Okoh did not have any account until last month when a bank marketer convinced her on the need to open an account with his bank.

However, Okafor, who pays between N200, 000 and N450, 000 into his bank account on a good day, has been wondering how his business will cope following recent announcement by the Apex Bank limiting daily cash withdrawals and deposits to N150, 000.

A look at recent improvements in the nation’s banking culture and growth of e-payment platforms, suggests that people move huge volume of cash around giving the instant value and finality it brings to financial transactions they embark on. For the informal sector where most cash transactions occur, it is huge and largely unsophisticated.

In a bid to reduce the increasing use of cash-in transactions which according to analysts, has dire consequences on the overall economy, particularly concerning cost of cash management to the banking industry, security, and money laundering, the Central Bank of Nigeria (CBN) directed all commercial banks, savings and loans institutions, mortgage and microfinance banks in the country to ensure that, effective June 1, 2012, daily cumulative free cash withdrawals and lodgements by individual and corporate customers do not exceed a maximum ceiling of N150, 000 and N1 million respectively.

Sanusi Lamido Sanusi, CBN Governor

In a circular entitled: “Industry Policy on Retail Cash Collection and Lodgement,” which was signed by Director of Currency Operations, CBN, Muhammad Nda, revealed that the CBN has imposed a penalty of N100 per N1000 on all individual cash transactions in excess of the limit, while corporate customers that go contrary to the new policy are to pay a fee of N200 per N1000 withdrawn above the stipulated cumulative limit.

The circular added that, “Contravention of this policy shall attract a fine of five (5) times the amount that the bank waives as a first offender, while the bank shall, subsequently, pay ten (10) times the charges waived.”

Following this developmåent, concerns about the implementation of this new policy, especially as it means transiting from a cash-based economy to a near cashless one in just one month have since sparked off another round of controversy in the banking industry.

For people like Anaeke and Okoh who make significant sales and do not operate corporate accounts, where would they keep their extra cash if they can only make a cumulative lodgment of N150, 000 in a day? Many believe that even if they resolve the problem by keeping the remaining cash for lodgment till the following day, they would still have to contend with the issue of safety of their money. This is not their only worries.

Most business transactions in the country are still cash-based, which means, businessmen would need to withdraw huge sums of money to purchase their produce or goods and pay for transportation to Lagos. The traders in the hinterland, from whom they buy their goods know of no other form of payment except cash. They would thus be confronted with a bigger dilemma if this policy if eventually implemented as it is.

In an interview with newsmen, Ade Martins Odigie, President, National Union of Banks, Insurance and other Financial Institutions Employees (NUBIFIE) warned against implementing such monetary policy in Nigeria.

According to him “The current CBN’s management should be called to order. For instance, if you compel an entrepreneur who is transacting a daily business of buying and sell for about N400, 000 to limited his cash lodgements and withdrawals to just N150, 000, it means his operations would be reduced by 60 percent. This is unimaginable and should not be accepted in any form.”

Austin Airobomian , a medical equipment supplier also believes that the policy would cause some distortions in the economy in the short term. According to him, “some of my customers always insist on cash payment before they would release their goods. How do we make these changes in a short time?” Airobomian however stated that the CBN ought to have carried out sensistisation programme to prepare Nigerians for the transition.

Central Bank of Nigeria Head Office at Abuja

 Not everybody sees it as a wrong policy. Ogho Okiti, Business Day’s chief economist believes that Sanusi is right on matters of first principle which is seeking to limit the amount of cash in circulation. “Nigeria is one of the only few big countries where people move huge amounts of cash around. When cash is not in the banking system it means banks cannot lend that cash. That simply means that the cash is not working for the economy.

“ The second thing is if he is right on first principle what are the things he wants to correct? But there are underlying principles; there is the issue of efficiency, there is issue of corruption and issue of waste.”

Okiti however admitted that the policy is not sufficient for the implementation of the new measure. For instance, he wants CBN as a matter of urgency to commence policies that would encourage people to open bank accounts as well as embrace other means of payment outside cash.

“The point is that people are inclined to argue from the angle that favours them. There is too much cash circulating in the system and we don’t have to wait until everything is right before we embark on corrective measures. Experience has shown that economic behaviour will change once the right policy is in place,” Okiti said.

In his own view, Boniface Chizea, Managing Consultant and Chief Executive Officer, BIC Consultancy Services argued banks in developed economies do not accept cash lodgements beyond a specified amount. He however added that if one must do so, some satisfactory explanations would be demanded (about) the source of such proceeds.

Chizea, who is also an economist, recommended the policy from the perspectives of attaining greater operational efficiency, as it would enable the apex bank reduce the cost of currency management, and fight the battle against money laundering.

The financial consultant advocated for a raise in the set limit initially in a bid to mitigate opposition to the policy, promote its acceptability, adding that commencement of the policy from such high cash density locations will allow time for the message of the policy to permeate the nooks and crannies of the economy and make for better implementation. The concern of the CBN is said to be that Nigeria may not realise its vision of transforming into one of the 20 most advanced economies in the world by the year 2020, which is just nine years from now, if a large segment of the population is unbanked and payment system remains undeveloped.

In a 2010 report presented last November, Enhancing Financial Innovation and Access, EFIA, a professional and non-governmental organisation sponsored by the United Kingdom’s Department for International Development, put the population of banked Nigerians at 25.4 million, representing only 30 per cent of the adult population, leaving 39 million adults outside the banking system.

Due to the vast number of Nigerians outside the banking system, this situation may result in having billions of naira circulate through the informal sector, which has a negative impact on the country’s economic growth and development. This no doubt poses a great challenge to the banking sector, particularly the regulatory agencies, saddled with the responsibility of driving the country’s transformation into a cashless society.

However, despite the fears expressed over the new policy and its possible repercussions, particularly because of the unpreparedness of the apex bank, some Nigerians see it as a good omen for the economy.

To these Nigerians, the policy is seen as an extension of various electronic products of banks, which have made life more comfortable for elite Nigerians. For instance, the use of credit card is gaining ground and is believed to be beneficial to the user, the issuer and the economy. This explains why experts believe that electronic payment (otherwise known as e-payment platforms) must form the bedrock of all financial transactions for Nigeria to achieve Vision 20:20-20.

Austin Oche, a banker, a belongs to a very small percentage of Nigerians who have embraced the e-business culture, noted that the challenge for the banks and other financial service providers is to vigorously promote e-payment or e-business with innovative products.

For Remi Babalola, former Minister of State for Finance, belongs to the class that wants Africa quicken its appreciation of the e-platforms in business transactions. In a recent lecture on the imperative of a cashless economy in Nigeria, he said:“The immense benefits associated with the use of electronic payments both to the individuals and the country are not in doubt. But while tremendous progress is being made on card system in developed countries, the African continent appears to have been left significantly behind.”

According to Babalola, the inclination, in developed countries is to move more towards electronic payment than any other form of payment for convenient, fast and easy business transactions.

”For Nigeria to join this league of developed economies by 2020, e-payment must form the bedrock of all financial transactions,” he said.

While many Nigerians may not readily use cards in paying for goods over the counter, doing so for the purposes of recharging their telephones and paying for television subscriptions may be more likely.

Currently, of all electronic payment channels, the use of the Automated Teller Machine (ATM) is more widespread as it allows the card holders to obtain cash 24 hours. To encourage its use, some banks had to issue ATM cards to their account holders and debited them. They have also imposed a cash limit that should be withdrawn with the ATM machines and customers who wish to be paid over the counter would have to pay some charges, all in an effort to encourage its use.

Going further, the Electronic Payment Providers Association of Nigeria has estimated the e-card industry to be worth about N24 trillion monthly, with ATM transactions constituting N80 billion and Point of sale (PoS) terminals only N1.4 billion.

With over 30 million e-cards, 10,000 ATMs, 15,000 PoS terminals deployed across the country, the prospect of developing a cashless economy can be said to be on course. However, some of the channels do not accept some other cards, which is why CBN’s order to the service providers to harmonise all e-payment cards in the country by next month is seen as a step in the right direction.

The new CBN directive setting limits on cash withdrawal for individual and corporate customers of banks may not be a bad policy after all. However many analysts have expressed concern on the preparedness of the apex bank, giving that many policies in the past like the banning of spraying of naira currencies at parties has only been implemented on paper.