Polio eradication: Nigeria in endless battle to eliminate the disease

…World Bank’s commitment to Nigeria for polio totals $195 million in 9 years

Alexander Chiejina

The Global Polio Eradication (GPEI)-led by the World Health Organisation (WHO), Rotary International, the US Centre for Disease Control and Prevention (CDC) and United Nations Children Fund (UNICEF) was launched in 1988 when the World Health Assembly adopted a resolution to eradicate polio.

At that time, more than 350,000 children were paralyzed by polio annually as the disease was endemic in more than 250 countries.

Sixteen years down the road since Nigeria started serious activities towards achieving the initiative in 1996, the country remains one of four countries globally-along with Pakistan, India and Afghanistan-where polio is still a major health risk.

The GPEI report released last week revealed two new cases (Wild polio Virus-WPV1 and WPV3) from Jigawa and Kano respectively bringing the total number of cases for 2012 to 54 as against 62 cases in 2011.

The most recent case was one of the newly reported cases from Jigawa with onset of paralysis on 10 June 2012 even as Immunization Plus Days (IPDs) were postponed in Kaduna, Yobe and Borno until 21th to 23th July 2012 for security reasons.

With the Presidential Task Force on Polio set up by President Jonathan in March 2012, meeting this week to evaluate progress towards fully implementing the National Polio Emergency Action Plan, health experts have tasked health authorities in the country to strengthen routine immunization, which is the bedrock of all other polio eradication, as well as carry out supplemental immunization and mop-up campaign periodically to nip the disease in the bud.

Tukur Dahiru, Department of Community Medicine, Faculty of Medicine, Ahmadu Bello University, Zaria, revealed that if the country is willing to eradicate polio, it must strengthen the Primary Healthcare system (PHC).

While stating that at the request of the Director General, WHO, an independent evaluation team was sent to Nigeria in 2009 to identify the critical barriers that prevent polio eradication, Dahiru stated that a major conclusion of the team was that, ‘The strongest and the weakest link of polio eradication programme in the country is the Local Government Area (LGA) level’.

According to Dahiru “The LGA level is the dormitory of PHC system that is generally characterized by inadequate qualified personnel, with distributed skewed between the rural and urban areas, lack of basic equipment  including the backbone of routine immunization – cold chain system – and commodity especially vaccines.

“Over the years, the neglect of this critical healthcare level has eroded public trust and therefore any public health programme championed at this level raises suspicion, lack of trust and confidence in the activities.  Without a functional, strong and reliable PHC system, the routine immunization programme that is required to maintain community immunity at such a high level after being certified as polio-free may not be able to maintain such tempo. The result will be re-emergence of wild polio.”

Lending his view, Oyewole Tomori, a virologist and former Vice Chancellor, University of Ibadan, declared that polio could be eradicated if the leaders do the proper things. While noting that poliomyelitis is a viral disease transmitted via faecal-oral route, Tomori stated that indiscriminate faecal disposal and poor sewage propels the transmission.

“Polio virus is found in water (that is, not treated adequately) and subsequently finds its way through the mouth to the intestines. The viruses are then excreted in faeces and the cycle continues.   While the GPEI is a 4-prong approach consisting of strengthening routine immunization, surveillance acute flaccid paralysis (AFP), supplemental immunization and mop-up campaign, the routine immunization needs to be strengthened.

Only recently, the World Bank’s Board approved an International Development Association (IDA) credit of N15.2 billion (US$95 million) for Nigeria’s Polio Eradication Support Project, which will help the country to achieve and sustain at least 80 percent polio immunization across all states of the Federation.

According to the website of the Bank, “the project will finance roughly 655 million doses of oral polio vaccine for children under age five across Nigeria, with a special focus on the Northern states where polio is more prevalent.”

The World Bank polio project continues a “buy-down” arrangement by which the Gates Foundation, the US CDC and Rotary International (via the UN Foundation), will repay the loan’s present value when pre-agreed results are met.

Of the World Bank’s lending commitments to Nigeria for polio from 2003 to 2012—a total of $195 million—Nigeria has already qualified for a 70 percent buy-down. This funding is coming on the heels of the FG in March 2012 to release $60million in two years for the eradication of poliomyelitis in Nigeria. This is in addition to the $17million and the existing funds in the battle against polio.

With calls for increased financial commitment to polio eradication, it is believed that eradicating polio would be won  through improving outreach and closely involving communities will help build a stronger national health system.

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Nigeria loses $500million annually to foreign medical trips

…unlocking nation’s Private health sector crucial for medical tourism

Alexander Chiejina

Following inequality in access to healthcare and dearth of medical facilities which has remained a major upset to Nigeria’s healthcare indices, Nigeria loses $500millon annually in the form of foreign treatment by Nigerians to India, United States of America and the United Kingdom, BusinessDay findings reveal.

While the trend of referring ailing patients from health institutions in Nigeria to similar institutions in other parts of the world been a common practice, this development has made many Nigerians lose confidence in the nation’s healthcare institutions to deliver quality healthcare.

In an interview with BusinessDay, Muhammad Ali Pate, Minister of State for Health, revealed that unlocking the market potential for health services in the country will create an enabling environment for the private sector to grow, thereby ensuring Nigeria becomes the destination for medical tourism.

Pate stated that most Nigerians visit foreign private hospitals for medicare, hence improving access to finance as well as developing and enforcing regulation and policies that stimulate the health sector will reduce the bottlenecks for effective private sector engagement in Nigeria.

“Imagine if we created an enabling environment for local vaccine manufacturing, pharmaceutical companies, hospital chains, and diagnostic centres of repute. This would enable us better harness the resources and expertise of our medical diaspora,” Pate hinted.

Pate pointed out that as a first step, the Federal Ministry of Health (FMOH) will in short term interventions, address regulations (such as fund transfer charges) that encourage the growth of medical tourism out of the country and review fiscal policies (economic incentives, tax, foreign exchange, import tariffs) that affects healthcare commodities, services and medical devices markets in order to create more favourable economic incentives for doing business in the healthcare sector.

“The private health sector has a significant role to play in addressing these challenges and accelerating progress in meeting the health-related MDGs. It currently accounts for at least half of healthcare service provision and has the potential to expand access to health services, improve the quality of care, contribute to job creation, and the country’s Gross Domestic Product (GDP),” Pate added.

For her part, Fola Laoye, Chairman, Hygeia Group, pointed out that lack of consumer trust in local health system, lack of quality and governance, significant gaps in human resources-both clinical and managerial, and the slow progress in integrating the private sector into the policy enforcement has affected private sector effective participation in changing the dynamics of service delivery in the health sector.

Laoye disclosed that there is need to rapidly implement the integration of the Private health sector into the National Health Strategic Framework. In this way, Laoye hinted, will make the country have a fair share of revenue accruing from medical tourism globally.

BusinessDay findings show that in 2011 alone, about 20,000 Nigerians were in India purely for medical care, with each spending about $30,000 and above on transportation, hotel accommodation, feeding and hospital bills.

Beside this, a recent Business World report reveal that while a heart bypass operation cost approximately USD $8,500 in India, additional costs of travel, accommodation, feeding and other charges constitute a high total cost which Nigerian medical tourists are less concerned about if guaranteed to receive world-class quality treatment and care.

For Muntaqa Umar-Sadiq, Technical Adviser to the Honourable Minister of State for Health “We would identify a landmark pilot Public-Private Partnership (PPP) transaction in the health sector that the FMOH and the private sector can work towards executing.

“We would also ensure that regulations that would ensure the development and enforcement of quality of care standards (and quality improvement framework) at all levels in the country will be in place. This in turn would make us a destination for medical tourism, thereby generating foreign exchange to the country,” Umar-Sadiq noted.

Stakeholders in the health sector believe that the Federal Government should commit itself to effective development of the potential still available within the tertiary hospitals, and make them true centres of excellence – for manpower development, research and services.

In the United States and across Europe are thousands of Nigerian medical experts and specialists, playing leading roles in the very hospitals patronised by Nigeria’s political elite. Most of them want to return home, but they want a working environment – with equipment, facilities and good pay

They also believe that primary and secondary health care centres, particularly, general hospitals, also need to be properly equipped and managed to minimise the migration of patients (who could be handled at those levels) to tertiary hospitals that ought to be for purely referral cases.