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Mediating Doctors' Strikes in Patients' Interest: What Should the Media Do Better? July-October, 2015 AfDB incoming top boss: Africa’s Regional Integration for Shared Prosperity Living with sickle cell disease in Nigeria and the UK: the big difference Learning to breathe in New Delhi: why Nerandra Modi should do more for Indian health by bringing air pollution to safe levels. Akinwumi Adesina Conquering culinary fears, one recipe at a time: how to make coconut rice with fun Sisi Jemimah Funmi Williams Health Politics & Today ...exploring the interface 1st i o c e h c Agrima Raina The politics of health workers’ strike in Nigeria: corruption, insincere government and overbearing unions NMA vs JOHESU in this issue Clinical Blues IX Dami Ajayi Art+Health Notes on Africa UK India Yummy Kitchen www.literamedianetwork.com

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  1. 1. Mediating Doctors' Strikes in Patients' Interest: What Should the Media Do Better? July-October, 2015 AfDB incoming top boss: Africas Regional Integration for Shared Prosperity Living with sickle cell disease in Nigeria and the UK: the big difference Learning to breathe in New Delhi: why Nerandra Modi should do more for Indian health by bringing air pollution to safe levels. Akinwumi Adesina Conquering culinary fears, one recipe at a time: how to make coconut rice with fun Sisi JemimahFunmi Williams Health Politics& Today...exploring the interface 1st io c eh c Agrima Raina The politics of health workers strike in Nigeria: corruption, insincere government and overbearing unions NMA vs JOHESU in this issue Clinical Blues IX Dami Ajayi Art+Health Notes on Africa UK India Yummy Kitchen
  2. 2. Making our health system work for the people uman resource is the most important factor in any He discusses those issues the media often fail to adequately institution. It is even more important in a health deal with when reporting and the way forward. Would system since it deals directly with human life and Nigerian medical doctors play the spectator on the globalHhealth. Now that the highly esteemed Buhari stagewheremedicalpracticeisadvancingbythesecond? administration has been sworn in, we ask: What is the future of health workers' strike in Nigeria? It is imperative that Olusola Orimoloye is bothered by the fact that doctors in issues affecting human resources for health in Nigeria must training waste ample time going on strike and attending once and for all be addressed by the Buhari administration if union/solidarity meetings when their colleagues in other any progress must be made in the Nigerian health system climes continue to roll back the frontiers of medicine. He under his administration. In this issue, we take on a problem describes in vivid terms the deleterious effects of strikes on that has effectively brought the Nigerian public healthcare residencytrainingofdoctors. system to its knees incessant strikes embarked upon by variousunionsinthehealthsector. We have introduced a for you via our partnership with sisijemimah.com. Do you know It is impossible to quantify losses incurred by the Nigerian howtomakecoconutfriedriceorhaveyouhaditbefore?Sisi people and government as a result of lack of effective Jemimah is a fast growing Nigerian and African recipe leadershipinNigeria'shealthsector.Frequentlethaldosesof developer,helpingwomen(andmen)conquerculinaryfears. industrial strikes are a major factor contributing to She narrates meal making in simple, clear sentences with unacceptable health outcomes in Nigeria. It is equally true to colourful and sharp pictures. You'll find out how to prepare say they are symptoms of poor governance and failure of coconutfriedricesoon. leadership within the health system. But what are the underlying causes? Who are the key players? And where is Our South Asia editor Agrima Raina tells us how doctors' thebattlefield? strike in India is often fuelled by assault on doctors by frustrated patients and their relatives. She suggests a review The key players are the Government (especially the Federal of medical curriculum to address lack of communication and State Governments); Nigerian Medical Association skillsamongIndiandoctors,amongothermeasuresthatmay (NMA), umbrella body of Nigerian medical doctors; and the be put in place to check the situation. She also warns that Joint Health Sector Union (JOHESU) which is an while Delhi is enveloped in a highly polluted air leading amalgamation of unions of health professionals such as respiratory diseases for many, the Indian government physiotherapists, pharmacists, nurses, optometrists, response is abysmal. She also discusses poor sanitation and medical laboratory scientists and other cadres of health open defecation in India, a major public health problem for a workers such as community health workers, pharmacy country that has excelled in technology, pharmaceutical and technicians, medical records etc. The public hospital is their manyotherfields. playingfield. Temitope Ojedokun says the government and health Opeyemi Akindele presents insightful analysis and professionals must act now to stop disrespectful maternal commentary which revolve around the triangle of treatment during delivery. She points out that hurtful, non- [inadequate] health funding, government insincerity, and dignifying treatment of women at child birth poses health workers unions' legitimate and unreasonable significantbarriertoaccessinghealthcareamongwomen. demands. He hopes to tackle issues on power tussle and equalopportunitiesinsubsequenteditions. There are many more interesting contents for your consumption.Wehopeyouenjoythisedition. Wole Oladapo takes the media perspective, showing how the media can better mediate doctors' strike in patients' interest. He argues that the Nigerian media should take a holistic perspective when reporting health workers' strike. Yummy! new and exciting session Submit article, comments, enquiries, advert to: [email protected] Individual authors own the copyright of their essays or pictures. Where we provide health information, it is no substitute for expert medical advice or consultation although we try hard to ensure we provide accurate information. The contents and opinions expressed in this publication belong to the contributors or various news sources we use, and not the official position of Health and Politics Today or Litera Media Network Ltd. Editors Note health & politics today, July/Oct 2015
  3. 3. our team health & politics today, July/Oct 2015 3 Temitope Ojedokun (B. Pharm) Managing Editor Wole Oladapo (B.A., M.A. Communication & Language Arts) Development Communication Olusola Orimoloye (MBBS) Contributing Editor Agrima Raina (BDS) South Asia Editor Opeyemi Akindele (B. Pharm., MPH) Editor/Publisher contents 5 8 news + updates Ebola updates, WHO, African Development Bank, Healthcare, Pharmacotherapy Coconut fried rice recipe, Diabetes and microwave, kidney health food + health tips 11 15 24 32 29 25 cover story womens health afristory interview art + health 13 16 Disrespectful maternal treatment during childbirth Dr Akinwumi Adesina: transforming Africa Olu Onyimadu Funmi Williams Olaosebikan Notes on Dami Ajayis Clinical Blues Series: The Redemption of Dr Bode Johnson Design & concept by Litera Media Network [email protected] http://www.literamedianetwork.com/got-enquiries-or-business/ https://ng.linkedin.com/in/opeyemiakindele
  4. 4. Well put you right in the hands of your customers... Want to go global? Grow your customer base? Then take this space! health & politics today, July/Oct 2015 ADVERTISE
  5. 5. health & politics today, July/Oct 2015 5 1st oich e c news + updates nfortunately, contrary to the wish of Professor Oyewale Tomori, a foremost veterinarian andUvirologist from Africa, Ebola did not wait till another 10 years before it rears its ugly,deathlyhead. leave. The African countries will be are enmeshed in other left not really knowing what has battles misuse of EVD happened to them. Like someone hit funds and the inability to them smack in the face, totally fully utilize aid and disoriented. There will be millions of resources donated by international agencies. scandals about how money was Therefore, is Africa prepared for the next misspent and so on. We will focus on epidemic? Has Africa learnt important lessons At the International Meeting on those and move on. Ten years from now, from the current EVD outbreak in West Africa? Emerging Diseases and Surveillance in people will have forgotten that there was Will Africa still be helpless and totally dependent November 2014, Tomori was Ebola and we will be back to where we on international agencies for assistance to interviewed by Kai, a contributing started. control any future epidemic? Will the scientists correspondent for Science magazine. The and governments of the developed world professor was reportedly angry at how African In May 2015, the former Regional Virologist continue to so control the processes of a leaders were unable to use their own resources for the WHO Africa Region published an sustainable global disease surveillance system, (human and capital) to contain Ebola. He hoped article in BMC Central, having patiently leaving no meaningful role for participants from that the WHO African region would not be in a laboured and waited to see the end of the thedevelopingcountries? helpless situation when/if Ebola reappears in worst Ebola outbreak in West Africa. He the future, as enough lessons should have been titled his article: Will Africa's future Unfortunately, African leaders and health learnt by African governments in the last 40 epidemic ride on forgotten lessons from authorities have not had time to reflect on the yearsofEbolaoutbreak. the Ebola epidemic? Obviously indignant, last and most devastating Ebola outbreak and in the conclusion of his thought-provoking the issues raised by Professor Tomori before a When asked if he thought the unprecedented piece, he spewed a barrage of questions all new Ebola case was confirmed in Liberia on outbreak would change things, here is what the over the continent and elsewhere at June 29 when routine surveillance detected a Professorofvirologysaid: whomeveritisthatcares. newconfirmedcase thefirstsinceMarch20. I wish I could say with confidence that in 10 So, don't let off your guard. Have a high index of years'timewewillnotbewherewearenowwith Even as agencies, foundations, governments, suspicion. Wash your hands often hand Ebola. But the countries have totally lost control and institutions outside Africa are holding washing remains the most effective way of of what is going on. If you go to Sierra Leone or meetings to assess the lessons learnt from the preventing infection generally. Aviod touching Liberia today, there must be at least 10 EVD disaster and map out strategies for the dead and direct anyone with high fever to international groups there. At the end of this better response and control of future thehospital. epidemic, everybody will pack their bags and epidemics, EVD devastated African countries Ebola is back in West African Liberia! Growing health literate kids 1 2 3 ealth & Politics Today celebrated 2015 Children's Day (May 27) with Nigerian kids. We took theHopportunitytoencourageparentstohelp their children cultivate health eating habits by providing them with adequate fruits and vegetables and teaching them the benefits of eating more fruits. Fruits contain lots of vitamins and minerals needed by children for normal growth, strong immune system, strong teeth and bonesetc. r Akinwumi Adesina has been elected President African Development Bank (AfDB) on 28th May during the development bank's 50th Annual General Meeting. He was born on February 6, 1960. Dr Adesina was Nigeria's MinisterDof Agriculture and Rural Development under former President Goodluck Jonathans administration. From September 1, 2015 Akinwumi will succeed Dr. Donald Kaberuka, Rwandan and current AfDB president who was elected in July 2005 and re-elected to second term in 2010. Dr Adesina, an alumnus of University of Ife (now Obafemi Awolowo University) holds PhD in Agricultural Economics, Purdue University, USA (1988) Awarded the Most Outstanding PhD Thesis. Masters in Agricultural Economics, Purdue University, USA (1985) Bachelor's degree (1st Class Honors) in Agricultural Economics, University of Ife, Nigeria (1981). Mr Akinwumi has made important reforms and achievement in the agricultural sector as a key player under the outgoing President Goodluck's administration and Transformation Agenda. Nigeria's President Muhammadu Buhari, who was sworn-in on Friday 29th May is key to the emergence of Adesina as AfDB top boss for the next 5 years. Buhari, in the build up to the AfDB election asked Atiku Abubakar, former vice-president of Nigeria to use his influence and contacts across Africa to ensure majority support for Dr Adesina among delegates who were going to vote at the AfDB general meeting. Dr Akinwumi Adesina emerged the winner among contestants with impressive pedigree and who are well- qualified as well: Sufian AHMED: Minister of Finance and Economic Development of Ethiopia Jaloul Ayed: Former Minister of Finance, Tunisian Republic Kordj Bedoumra: Minister of Finance and Budget, Republic of Chad Cristina Duarte: Minister of Finance and Planning, Cape Verde Samura M. W. Kamara: Minister of Foreign Affairs and International Cooperation, Sierra Leone Thomas Z. Sakala: Zimbabwean and retired Vice- President, Country and Regional Programmes, AfDB Birama Boubacar Sidib: Malian and Vice-President, Islamic Development Bank, Jeddah, Saudi Arabia. AFDB welcomes new top boss!
  6. 6. 7 6 4 news + updates WHO releases new guidelines for prevention of neural tube defects NTDs health & politics today, July/Oct 2015 6 1st oich e c HO has issued new guidelines for folate Good sources of folate concentrations for women of include: reproductive age. Each year, about AsparagusW300,000 babies worldwide are born with neural Bell peppers tube defects (NTDs), but adequate daily Broccoli consumption of folic acid before and during early Brussels sprouts pregnancy has been shown to significantly reduce Cauliflower t h e r i s k f o r N T D s . Chickpeas The new guidelines state that at the population Fortified breakfast cereals level, red blood cell (RBC) folate concentrations Liver should be greater than 400 ng/mL (906 nmol/L) Okro in women of reproductive age to achieve the Peas greatest reduction of NTDs. Suggesting that 5mg Seeds & nuts o f Fo l i c a c i d p e r d ay i s s u f f i c i e n t . Spinach Although no serum folate threshold is recommended for prevention of NTDs in women of reproductive age at the population level, In addition, microbiological assay is recommended as the most reliable choice to obtain comparable results for RBC folate c o n c e n t r a t i o n a c r o s s c o u n t r i e s . (Source: Morbidity and Mortality Weekly Report (04/24/15) Vol. 64, No. 15, P. 421 Cordero, Amy M.; Crider, Krista S.; Rogers, Lisa M.; et al.) RBC folate thresholds can be used as an indicator of folate insufficiency in women of reproductive age. t Health & Politics Today, our commitment is to put healthcare issuesandpolicyonthepoliticalagendaandmakethemamatterof public debate. A bane of poor healthcare delivery in Nigeria is theAfact health authorities and professionals are largely unaccountable to the patientsandthegeneralpublic.So,wehostedourfirste-conferencewhere weengagedthreeemergingleadersinhealthpolicyfromNigeriaandIndia to thrash out the question: How do we evolve an accountable healthcare system founded and funded to serve the patient? Seye Abimbola, Laz Ude Eze and Agrima Raina discussed the concept and practical issues of accountability focusing on primary health care. Ac c o rd i n g to S eye Abimbola, doctoral s t u d e n t i n H e a l t h S y s t e m s & P o l i c y University of Sydney, Accountability is being o b l i g e d t o a c c e p t r e s p o n s i b i l i t y & transparently disclose resourceusefor&results of health activities. A c c o u n t a b i l i t y i s patients able to d e m a n d responsibility f r o m providers and having affordable recourse to legal action for malpractice. According to Agrima, in order to fix the pervasive problem of frustrated patients and relatives assaulting and battering doctors in Indian hospitals, the medical curriculum must be revisedinordertoarmdoctorswithpertinentcommunicationskillswhile the government should also increase healthcare funding to increase doctor-patient ratio. Laz, a public health physician with wide experience in health programmes strengthening, emphasised the need for every Nigerian to take interest in how health facilities function and be aware of minimum healthcare package as stipulation in primary health care policy in order for them to be able to make demands for excellentserviceprovision. n the 8 May 2015, WHO released its biennial update of the essential medicine list to include new regime for tuberculosis (TB),Ohepatitis C and cancers. The WHO list usually serves as a model for governments and health institutions because of the established quality, drug safety, efficacy and cost-effectiveness of the medicines included. Hepatitis: 5 antivirals were added including sofosbuviranddaclatasvir; Cancers: 16 new medicines including trastuzumab forbreastcancer; Tuberculosis: 5 more including bedaquiline and delamanid to target multi-drug-resistant TB. TB remains one of the world's most deadly infectious diseases with over 95% of TB deaths occuring in low- and middle-income countries. So the hard work is not the medicine list but ensuring those medicines are actually available to patients. Some of which h i g h p r i c e s c u r re n t ly m a ke unaffordable and thus inaccessible to thepeoplewhoneedthemmost. Accountability in healthcare e-conference Biennial update of the essential medicine 5 1. The Guardian suggests that Britain recorded its hottest day in June since August 2003. Temperatures are soaring across the country and at the popular Heathrow airport it rosetoabout37degrees. 2. Since June 20th when the extremely hot weather condition lasting several days began, health officials say about 100,000 people have been affected in Pakistan, killing 1 out of every 10 affected individuals. Hundreds of causalitieswerealsorecordedinIndiaearlier. 3. The World Metrological Organization (WMO) & World Health Organisation (WHO) have also just published a global guidance t o a d d r e s s HeatHealth and development of a p p r o p r i a t e interventions or H e a t - H e a l t h W a r n i n g Systems. People have been advised to avoid working in the sun for too long, take a lot of water, make use of available coolingpointsandtakeany affected person to a health facility after giving the first aid i.e. cooling the victim. http://www.who.int/glob alchange/publications/W MO_WHO_Heat_Health_Gu idance_2015.pdf?ua=1 Heat Wave Report
  7. 7. news + updates Consultant Pharmacists Provide Enhanced Long-Term Care Services medical therapies, Dr. approach tend to play a Hardestyexplained. more administrative role within their LTC teams, These changes have working with other LTC p r o m p t e d m a n y leaders to make financial and operational c o n s u l t a n t decisions. In this capacity, strategic pharmacists to take on pharmacists have been responsible for a more operational role implementing a number of initiatives focused in LTC, expanding their on public health, such as drug reevaluation focus to include both policies and improved electronic health individual patients and record (EHR) utilization. The role of a patient populations. strategic consultant pharmacist is not only to With recent shifts in identify problems, but to develop solutions,any consultant pharmacists are long-term care, we're starting to see Dr.Hardestyexplained.t a k i n g o n n e w r o l e s a n d consultantpharmacistsplayamoreactiveroleresponsibilities in the shifting long-M in improving public health, Dr. Hardesty said. She noted these responsibilities are notterm care (LTC) landscape, allowing them to They are partnering with executive and without their complications, however,perform a number of enhanced services. regional leaders to develop and implement necessitating cooperation between strategicConsultant pharmacists are integral to LTC, solutionstobroaderhealthproblems. and tactical pharmacists. Strategicaccording to Jennifer L. Hardesty, PharmD, pharmacists can face difficulties inFASCP, the Chief Clinical Officer and Corporate Dr. Hardesty categorized these enhanced implementing their initiatives, making itComplianceOfficerforRemediSeniorCare. service as either tactical or strategic. The challenging for them to keep up with day-to- consultant pharmacists who take a more day operations, Dr. Hardesty stated. ForAmong other responsibilities, consultant tactical approach are more involved with them to be effective, they often need supportpharmacists are tasked with reviewing each direct care, treating patients on an individual fromtacticalpharmacists.patient's medications and care process, as basis. In addition to performing medicationwell as auditing the administration and regimen reviews and patient assessments, No matter which approach consultantstorage of medication. These services tactical pharmacists put a great emphasis pharmacists take, the enhanced services theyhave become particularly important on educating patients and implementing are offering point to a greater role for them toas LTC patients are increasingly cost-saving initiatives. Working on the play in the future of LTC, Dr. Hardestytreatedinoutpatientsettings ground also enables tactical pharmacists concluded. Consultant pharmacists are to forge a stronger partnership with other extremely valuable resources, she said. AsEach day, there are 1,383,700 LTC faculty members, Dr. Hardesty added. LTC continues to change, their enhancedresidents in nursing homes, and 713,300 Tactical pharmacists' on-site work allows serviceswillbecomeevenmoreessential.residents in residential care communities, Dr. them to build long-term relationships withHardesty said at the 2015 American Society of administrators, nurses, and prescribers, Dr. ByRyanMarotta,AssistantEditorConsultant Pharmacists Forum in Baltimore, Hardesty stated. Everyone works together asMaryland. There's a huge opportunity for a team, which contributes to a successful LTC Culled from Pharmacy Times. See more at:consultant pharmacists to make a difference partnership.in long-term care. Yet, consultant pharmacy services have been significantly affected by Compared with tactical pharmacists,changes in the acuity of residents, lengths of consultant pharmacists who take a strategicstay, electronic health records, and complex http://www.pharmacytimes.com/news/Con sultant-Pharmacists-Provide-Enhanced- Long-Term-Care- Services#sthash.hKXeqqeU.dpuf esearchers sought to project the Annals of Internal Medicine (04/21/15) Vol. 162, No. population effect and cost 8, P. 533 Odden, Michelle C.; Pletcher, Mark J.; Coxson, effectiveness of statin therapy in PamelaG.;etal.Radults aged 7594 years. The intervention was statins for primary The American research shows that prevention based on LDL cholesterol threshold of cholesterol lowering statins (e.g. atorvastatin - 4.91 mmol/L, 4.14 mmol/L, or 3.36 mmol/L; Lipitor brand by presence of diabetes; or 10-year risk score of at least Pfizer), if prescribed 7.5%. All adults in this age group in the National for old men and Health and Nutrition Examination women aged 75- Survey have a 10-year risk score greater 94years can prevent than 7.5%. According to the study onset of or death due results, primary prevention strategies to heart attack and with statins would prevent myocardial other heart diseases. infarctions and coronary heart disease S u c h t re a t m e n t deaths and be cost-effective, as long as would also help save cost of there is no effect on functional limitation healthcare in addition to or cognitive impairment. Treatment of t h e a f o r e m e n t i o n e d all adults aged 7594 years would prevent benefits. However, in spite 105,000 (4.3%) incident MIs and 68,000 of the potential benefits of (2.3%) CHD deaths at an incremental cost preventing heart diseases per disability-adjusted lifeyear of $25,200. using statins, adverse A small increase in geriatric-specific effects of the drug in old people (e.g. muscle adverse events could offset pain affecting mobility etc.) would make all cardiovascular benefits, the itspotentialbenefitsnotworthit. researchersnote. In lay terms: Cost Effectiveness of Statins for Primary Prevention in Older Adults health & politics today, July/Oct 2015 7 1st oich e c image credit: google.com image credit: google.com 9 8
  8. 8. food + health tips with Sisi Jemimah Jemimah Adebiyi is the author and recipe developer at sisijemimah.com, a food blog which features delicious family friendly recipes with detailed and carefully illustrated preparation methods. She is legal case researcher by day and an unbridled food enthusiast by night. She blogs at sisijemimah.com Twitter: @sisijemimah Ican't believe I'd lived almost all my life without tasting Coconut fried rice until earlier this year. I'd always had a mental image of rice and coconut milk not being a good combo so I stayed away. Anyway, I tried it out forthefirsttimeinFebruaryandIwassold! The recipe is pretty simple, very similar to traditional Nigerian fried rice. Most rice recipes require chicken or beef stock but this one doesn't and you still get the same delicious taste as with stock. To achieve this, you'll need raw chicken fillet; you'll get more details as you read on. You can use either breast or thigh though I find thigh absolutely more flavourful compared with breast. Coconut fried rice is bound to be a hit at any party. It addsclassaswellandswaysfromtheusualJollofriceandfriedricenormpopularatmostparties. Now,coconutfriedrice,let'sgetstarted! Ingredients which stands out in fried rice) 3 cups of rice 1 teaspoon minced garlic 2 cups/ 500ml coconut milk 1/2 teaspoon white pepper 1cup raw diced chicken(preferably thigh fillet) 1/2 teaspoon cumin 1/2 cup baby prawns 1/4 teaspoon black pepper 2 tablespoon Coconut oil and 1 teaspoon olive oil 1/4 teaspoon cayenne pepper 1 large carrot chopped 1/4 teaspoon mixed herbs 1/2 small green and red pepper chopped 1/2 teaspoon each Curry, thyme, 1/2 cup green peas Salt to taste 1/2 cup sweet corn 2 Knorr chicken cubes or any bouillon cubes 1/2 small chopped yellow onion you prefer. 1/2 small size red onion (you can use just one type of 1/4 cup desiccated coconut (optional) onion, I like yellow for taste and red for the colour ce ok ca on m u o t t ri w c o e h with fun! hicc kee nht .etanira m 1 2 ecirehthsa w tos ck klimtunoco cehtdda 3 o marinate, mix the olive oil, cumin, one Knorr cube, black pepper, cayenneTpepper and mixed herbs, let it refrigerate for at least an hour. The chicken can be marinated for as long as possible though I always marinate overnight to allow the chicken soak up the flavours from the spices better I'll suggest at least an hour. After it's been marinated, take it out, dice it into bits and set aside. hen, wash the rice thoroughly and leave to drain in a colander.T ext, into a heated pot, add the coconut milk stock and Nsome water. It's better to use fresh home-made coconut milk for this recipe, it tastes so much better and creamier. Also add 1/4 teaspoon curry, thyme, salt, white pepper, one Knorr cube and bring to a boil on medium heat. Stir, add the rice, cover the pot and let it boil till soft. health & politics today, July/Oct 2015 8 CONQUERING FEARS RECIPE culinary at a time ONE
  9. 9. hile that's boiling, add the coconut oil into a frying pan Won low-medium heat. Now, add the onions, saut for a minute, add the garlic and one Knorr cube, saut till fragrant. Then add the diced chicken, one Knorr cube and fry till the chicken loses its pinkness and turns brown. Add the carrot, saut for another minute, then add the chopped peppers, green peas, sweet corn, prawns and red onions. Stir for 5 minutes but be careful not to overcook your veggies. Switch off the heat when it's fully done. The natural flavours of the chicken is released and then incorporated into the veggies which then goes into the cooked rice (Nothing is wasted!). Cooking it this way creates a juice which replicates chicken stock and ends up tasting extra flavourful. heck the rice at this time, when the liquid is all dried up and the Crice soft, stir lightly to add the fried veggies and chicken. Stir till all are fully combined. Adjust seasoning and salt if necessary. Reduce the heat and steam for a further 2-3 minutes or turn off and let it steam with the residual heatand it's ready. ext, into a heated pot, add the coconut milk stock and some Nwater. It's better to use fresh home-made coconut milk for this recipe, it tastes so much better and creamier. Also add 1/4 teaspoon curry, thyme, salt, white pepper, one Knorr cube and bring to a boil on medium heat. Stir, add the rice, cover the pot and let it boil till soft. food + health tips with Sisi Jemimah 4 5 Check the rice at this time Add the coconut oil 6 health & politics today, July/Oct 2015 9 s we round off this session partcanbeusedincooking,themilk, also essential for bone formation and good on making coconut fried the water, flesh, oil, sugar. The leaves cellhealth. rice, let's talk coconut. Yes! and husks on the other hand areACoconut palm is one of the usedforfurniture,decorationandas Coconut (and its' milk) contains a type of very few trees that gives its' brooms for cleaning. Isn't that fat called Lauric acid. Unlike other entirety for living. Almost all its amazing,nothingliestowaste! saturated fats, Lauric acid is used up more rapidly by the body and are less likely to be Coconut milk, which is the key stored as fat. It is also changed in the body ingredient for this recipe is highly into a highly beneficial compound called nutritious with commendable monolaurin, an antiviral and antibacterial health benefits. It is rich in vitamin that destroys various disease causing B, vitamin C and E as well as organisms. minerals like iron, selenium, sodium,phosphorus,magnesium. Although the British Heart Foundation recommends swapping coconut oil with Now, let me explain what all that less saturated ones live olive oil, it is now means. Vitamin C helps boost your thought that consumption of coconut milk immune system by fighting against may help protect the body from infections. infections and promoting wound For this recipe we have used both coconut healing. Vitamin E promotes healthy and olive oil. So you get all the benefits skin while B and iron helps in blood however formation. The other minerals are Food is ready! Presentation Temitope Ojedokun Ensure you take your 5 portions of fruits and vegetables daily
  10. 10. health & politics today, July/Oct 2015 10 Kidney disease affects millions of people around the world. It is important for you to maintain healthy kidneys as it is such a crucial organ which helps your body remove toxic metabolic wastes e.g. urea, drug metabolites, blood pressure regulation and blood formation via the synthesis of an hormone called erythropoietin. We present to you some natural fruits/herbs that help keep your kidneys healthy. food + health tips Natural foods that help cleanse your kidneys eets contain a lot ofbetaine, antioxidants and Bnutrients that increase urine acidity. Increase in urine acidity helps the removal of calcium phosphate and struvite whichcancausekidneystones. 1 photocredit: http://www.ideadigezt.com/ et a glass of warm water. and squeeze the juice of four lemons Gintoit.Andyoucanenjoyadrink rich in citrine, a chemical which acidifies your urine thereby clearing your kidneys of substances which may causepainfulkidneystones. 2 ater is the number one and readily available kidney Wdetoxifier. For most people water is almost free and within reach. Yet many never take advantage of it to improvetheirhealth. How much water should you drink? Well, 8 glasses of water daily is generally recommended, but people living in countries with hot weather obviouslyneedmore. One sure way of knowing youve had sufficient water is when your urine is cleari.e.withoutcolour. 3 nions are every womans companion! They are household seasonings. You can eat onions Oraworcookedaspartofyourmeal. Yes, onions are rich in flavonoids notably quercetin which helps prevent cholesterol deposits in blood vessels. A powerful antioxidant, quercetin mops off free radicals from your system and protect your kidneys againstcancer.Italsopreventsheartdisease. Also, low potassium content of onions means they are kidney-friendly and your kidneys wouldnt wear outtryingtogetridofexcesspotassium. 4 Diabetes risk and how you microwave your food cientists at New York University have plasticmaterials,youincreaseyourexposure found that harmful phthalate to toxic phthalate as small amounts enters Schemicals from plastic materials get your food. It is safe to use aluminium wrap into the food we eat. Phthalates (DINP & andwaxpaper. DIDP) thought to be safe are used by industries to strengthen plastic materials, Also avoid washing plastic food containers in but have been found by Professor Leonardo the dishwasher, because phthalates can leak Trasande and his colleagues at NYU to be out. associated with insulin resistance (a risk factor for diabetes) and small increases in Also, check the recycle symbol on plastic bloodpressure. containers and avoid those labelled numbers3,6or7. Whenyoumicrowavefoodinorcoveredwith
  11. 11. Nigerian doctors had not been able to make reasonable contribution to healthcare delivery in the last two years as a result of incessant strikes. Addressing health workforce crisis and strikes in nigeria: a policy framework cover story with Opeyemi Akindele health & politics today, July/Oct 2015 11 1 H etc.sincemanydonotreporttothehospitalorhealthcentres.uman resource is the most important factor in any institution. It is even more important in a health Barely half of births are attended by skilled health personnelsystem since it deals directly with human life and (midwives,nurses),andthat'smuchworseintheNorthwesternhealth. Health workforce is the driver of health system region where only 3 out of 10 women are delivered by skilledperformance and takes the largest share of health budget. birth attendants on average. Currently, Nigeria is 40% short ofTherefore, it is imperative that issues affecting human its 2015 maternal mortality target (250 per 100,000 liveresources for health in Nigeria be once and for all be births), according to the Nigeria MDG 2013 Report. Malariaaddressed by the Buhari administration if any progress which accounts for 1 in 10 maternal deaths still remains a bigmust be made in the Nigerian health system under his issue due to poor living conditions, endemic fake antimalarialsadministration. In this essay, I take on a problem that has and the failure of the government to improve access healthcare.effectivelybroughttheNigerianpublichealthcaresystemto The only good news that has emerged from theits knees incessant strikes embarked upon by various Nigerian health system seem to be the successfulunions in the health sector. My analysis and commentary eradication of Guinearevolves around the triangle of [inadequate] health Wo r m i n 2 0 1 3 ; afunding,thegovernmentandhealthworkersunions. development which, albeit commendable inHealth system is a complex arrangement of coordinated itself suggest that we arepersonnel, departments and activities geared towards decadesbehind.disease management and health improvement. The WHO defines a health system as all the activities whose primary As observed by thepurpose is to promote, restore or maintain health. There president of Medical andare three key functions of any health system as delineated D e n t a l C o n s u l t a n t sbytheWHO: Association of Nigeria ( M D C A N ) , D r S t e veimprovingthehealthofthepopulationtheyserve Oluwole, Nigerian doctorsrespondingtopeople'sexpectations had not been able to makeproviding financial protection against the costs of ill- reasonable contribution tohealth. healthcare delivery in the last two years as a result ofUnfortunately,healthsysteminNigeriaisquitefarfromthis incessant strikes. Or whatideal. Nigeria's health outcomes are among the worst in the value could a large, butworld, and it contributes the lion's share to many of the hardly working contingentheart-rending morbidity and mortality statistics in West of health professionals canAfrica and sub-Sahara Africa. Most Nigerians who seek add to a people in need ofhealthcare in public health facilities do so because they their services? It washave no affordable and decent alternative. The level of without a shred of shamedistrust for health professionals among Nigerians is high, thatmanyhealthprofessionalsspokeafterPatrickOliverperhapslikeneverbefore. Sawyer the Liberian-American diplomat imported the deadly Ebola virus to Lagos in July 2014: Thank God we werWhile Nigeria has one of the largest health workforces in e on strike! That's how bad the Nigerian health system hasAfrica, the state of healthcare is very bad nonetheless. I gone.Wearenotpreparedtorespondtoemergencieswhetheritmean VERY BAD, at least for over 80% Nigerians who is an epidemiological threat to the country or a threat to the lifecannot afford decent, dignifying healthcare from private ofanindividual.providers. In 2000, the World Health Organisation (WHO) ranked Nigeria's health service performance 187th In the 21st century where it is unimaginable in many countriesposition among 191 countries in its publication Health that health professionals would leave the dying unattended forSystems: Improving Performance- far below many less even one hour, Nigeria's unions of health professionals haveendowed countries. Today, nothing much has changed. made an ignoble competition out of industrial strikes whileAccording to the Nigerian Bureau of Statistics, infant continuing to earn their relatively fat salaries within the civilmortality and under-5 mortality rates are still high, service. There is no other sector of the Nigerian state, howeverespecially in rural areas where 67 and 105 children die out rickety, that has witnessed inter-professional wrangling andof every 1000 born alive respectively. There is sufficient regular industrial strikes that can come close to that of theground to believe that these official child mortality figures healthsector,particularlythehospitalsector.may be less than the actual number of children who die daily of malaria, typhoid, diarrhoeal diseases, pneumonia,
  12. 12. health & politics today, July/Oct 2015 it is possible to r e v e r s e t h i s terrible trend by creating a robust health workforce p o l i c y w h i l e executing same with a sincere p o l i t i c a l w i l l across all levels of government. Y ou could count how many days Nigerian health Nigeria, was never implemented as intended or at least, not professionals were at work in the year 2014. If their seentohavebeenimplemented. national unions were not on strike, those at a particular federal or state institution would be on strike due Moreover, it is fair criticism of the document to assert that to some local issues with their chief medical nowhere is industrial strike given due attention as a major director/hospital management. Then their sister unions in militating factor improving access to health services or a other parts of the country would abandon their patients and wildaffronttopublicstewardshipandaccountability. life-saving duties in order to show solidarity for their striking colleagues. The government is indifferent. Health Since the much touted National Health Bill has been assented workers are adamant. Who cares about babies who timely by former President Goodluck's administration, it is equally surgery could have saved from permanent deformity, important for robust and sustainable national human prolonged pain or even needless death? How about tens of resources for health policy be formulated and implemented. thousandsofmotherswhorequireregularantenatalcare? Such a document may also be adopted or adapted by state ministries of health. The policy should Strikes and union/solidarity meetings address health workers' strike while constituteasignificantpercentageofthetime encompassing health workforce resident doctors are supposed to spend in performance monitoring and evaluation, their training to become medical consultants. health facility performance assessment, The gap created when pharmacists are on hospital rating/ranking based on clearly strike is happily filled by charlatans and defined criteria and a working model for quacks who help helpless patients inter-professional co-operation and complicate their conditions by giving drugs teamworkamongclinicalprofessionals. they know next to nothing about. Nurses, m e d i c a l l a b o r a t o r y s c i e n t i s t s , If the problem of industrial strike is not physiotherapists, others turn down patients addressed as a matter of urgency, the and expectant mothers who are always told much hyped National Health Bill would to access affordable antenatal care in soon join the league of policies and governmenthospitals. legislations that never made the differencetheywereintendedtomake. The tales are endless. Our health system is weak and terribly so. However, it is possible Some well-meaning Nigerians have said to reverse this terrible trend by creating a thewaytogoistomakeanyformofstrike robust health workforce policy while action by health workers illegal. Indeed, executing same with a sincere political will healthcare is an essential service which acrossalllevelsofgovernment. should not be denied anyone who needs it. However, that view would leave health National Human Resources for Health workers at the mercy of an indifferent Strategic Plan 2008 to 2012 is a key policy document drafted government or insincere politicians who often fail to meet by the Federal Ministry of Health (FMOH) under the short- legitimate demands of health workers. A workable policy lived administration of Professor Adenike Grange. The wouldbeonewhich,ononehand,compelsthegovernmentto publication was perhaps produced in response to an earlier provide excellent working conditions (not falling below publication on the state of health workforce in Nigeria set/agreed minimums) and welfare package for all cadres of published by the Africa Health Workforce Observatory. In health workers without which they may legitimately principle,thestrategicplanfortheNigerianhealthworkforce withdraw some of their services (and for no other reason); was designed for improving on access (to health services), while demanding accountability, excellent health services stewardship and accountability. Very insightful analysis of andtruecommitmenttoworkfromhealthworkers. health workforce disparities across geopolitical zones, the key challenges of recruiting and retaining health Thetimeisnowtostopplayingpoliticswithhealthcare. professionals as well as practical solutions were discussed. Sadly, but unsurprisingly, the Human Resources for Health Strategic Plan 2008 to 2012, like many other policies in Addressing health workforce crisis and strikes in nigeria: a policy framework cover story with Opeyemi Akindele 2 photo:www.lifeway.com 12
  13. 13. health & politics today, July/Oct 2015 13 cover story with Wole Oladapo A s great as the effect that HippocraticOathtakenbydoctors conflicts of interests In most of the stories, some is sure not a license to take between medical doctors sections of the Hippocratic Oath medicaldoctorsandtheirservices a n d a u t h o r i t i e s [the health of my patient shall be for granted. The Oath does not governments, ministries, my first consideration; I will provide a cheap tool for departments, agencies, and maintain the utmost respect for blackmailing doctors. Nowhere in professional bodies have on the human life] are often invoked the Oath is it stated that doctors people, public knowledge of the against the doctors' strike to should be subjected to degrading conflictsislimitedinmostcasesto describe the action as inhuman and inhuman treatment in the what the media publish. Even and insensitive to patients' name of service to humanity. If manypolicymakersarenot better plights. Only careful media do doctors' service is that critical, aware as they are often manage to condemn the strike their concerns must also be individuals drawn from fields without casting aspersion on the t r e a t e d a s s u c h b y a l l other than medicine. That is why practitioners of the noble stakeholders, most especially in the role of the media in finding a profession. From all indications, timesofindustrialcrises. lasting solution with a human face this kind of reporting has not to the nagging problem of medical yielded sufficient desirable What then should the media do doctors'incessantstrikeactionsis outcomes as the role of the media better? If the justifications crucial. No other time is this need inresolvingdoctors'strikehasnot provided by doctors for their more imperative as whatever beenrecognisedasinfluential. strike are considered insufficient concerns the health of the citizens or unjustifiable, it is not enough to isamatteroflifeanddeath. Thereisneed,therefore,formedia simply say that. Rather than adopt practitioners to evolve a reporting an episodic frame in their reports Duty calls that the responsible style that recognises the rights of (treating each strike as an media treat health independent event), issues as important media practitioners need b u t s a d l y, i t i s to provide an in-depth problematic knowing analysis of the current t h e n a t u re t h a t situation in the light of importance should history.Havethedemands take. How then can been made earlier? How the media mediate did the government medical doctors' r e s p o n d t o t h o s e strikes such that it demands then? How did will preserve the the public respond? What all the stakeholders affected bydignity and interest of the were the views of other doctors' strike. The media publicprofession and at the same time professionals in the health sector sphere must serve as a publickeep the citizens at the heart of its aboutthosedemands? forum where issues leading toreporting? d o c t o r s ' s t r i k e s a r e There is need to track how the contextualised in the light ofWhenever doctors in Nigeria situation gets to the present history, global standards inembark on a strike, the following condition. History provides us medical practice and standards inare the usual news headline: with a wealth of experience other professional practices in theCrisis Deepens, As Lagos Doctors needed to well understand the health sector. A reporting styleStrike Enters Day Six and present. If there is a persistent that pitches doctors againstNigerian Doctors' Strike Selfish, recurrence of doctors' strike, we p a t i e n t s , o t h e r h e a l t hIllegal and Unethical Say Nurses. need to know how different professionals, governments andThe media often do more to stakeholders have kept their sides the public will do nobody anydisplay social empathy in their of the promises and agreements good as it cannot by any meansreporting: they visit hospitals, that suspended the previous compel or persuade the doctors tointerview patients and caregivers, strikes. This will provide a shift their grounds when theirand keep a public record of the directionfor'progress'reporting. demands are not yet met. Thevictimsofthestrike. There is need, therefore, for media practitioners to evolve a reporting style that recognises the rights of all the stakeholders affected by doctors'strike. Mediating Doctors' Strikes in Patients' Interest: What Should the Media Do Better? photo:googleimage 1
  14. 14. A nother important angle to rivalry is responsible for many of health faculties and departments reporting doctors' strikes is thehavocsthataredonetopatients inNigeria. p r o v i d e d b y g l o b a l i n h o s p i t a l s . U n t i l t h o s e standards in medical c o n t r o v e r s i a l i s s u e s a r e This is where the patients come in. practice. In August 2014, The satisfactorily resolved, we cannot If the public is furnished with Nigerian Medical Association hope for a functional health sector. detailed and balanced information released a document enumerating Doctors' strike always triggers about doctors' strike and a proper the 24 reasons why Nigerian such issues into public discourse. context for understanding and doctors went on strike. Many The media can appropriate the interpreting the information, the media outlets made that the opportunities a crisis period offers stage is set for making issues headline of their stories about the to explore how inter-profession resulting in doctors' strike a public strike the subsequent days. Most of relationships are maintained in concern. If members of the public the media outlets that published or functional health sectors to push understand the justifiability of the aired the story simply relayed the such models to the front burner of demands made by medical doctors, reasons as hard as the NMA national health politics. For those demands become those of presented them. This approach is instance, is it the practice the public as well, since the health not very useful for properly everywhere in the world that only system is designed for the patients, understandingthosedemands. medical doctors could be CMDs? If thepublic. it is a national peculiarity, is it The media can help the If the public lend their public to understand support to the demands, how the issues raised by the demands become NMA are addressed in unavoidable for the countries with a healthy government and other health sector. If NMA stakeholders. Then, the demands that medical fight for a functional health doctors be paid a sector becomes everyone's minimum of #100,000 fight. The Ebola outbreak as monthly hazard in Nigeria reminded us allowance, the media again that the sacrifices should tell us what being made by medicalpossible that it be managed obtains in other climes just as they professionals in the delivery ofpeacefully? How do other dowiththesalariesandallowances their services are in every sensec o u n t r i e s h a n d l e s i m i l a r of political office holders. They overwhelming. That some medicalcontroversies in their health should also examine the criteria professionals had to pay thesectors? Exploring angles such as used by NMA to arrive at such highest price to save the countrythese will provide us with points of figures. How do countries with a from the scourge of terriblereference when assessing the functional health sector manage diseases like Ebola is a call to bothsituations in our health sector. All residency training for medical the government and the entireof these efforts are important doctors? Responding to the country to re-examine the honourbecause the world is gradually demands of medical doctors from a we accord the noble professions.discarding the idea of professional global perspective will provide all I n s t e a d o f p i t c h i n g t h esuperiority and embracing that of the stakeholders with clearer stakeholders against one anotherprofessionalinterdependence. lensesforviewingthedemands. when reporting doctors' strike, media practitioners should try toMost schools in developed The most sensitive aspects of find a common ground amidstcountries adopt multidisciplinary doctors' strike are the issues that conflicting interests and provide aorientation in developing their concern other professionals in the unitedfrontfordemandingabetteracademic curriculum. If this is not health sector. The Nigerian health andfunctionalhealthsectorforall.yet the practice, now is the time to sector is characterised by rivalry set it as an agenda, most especially among its constituents. Sadly, this for medical schools and other If the public lend their support to the demands, the demands become unavoidable for the government... then the fight for a functional health sector becomes everyonesfight. cover story with Wole Oladapo health & politics today, July/Oct 2015 Mediating Doctors' Strikes in Patients' Interest: What Should the Media Do Better? 2 14
  15. 15. esearch on womens experiences during pregnancy, and particularly during labour shows that women across the world receive disrespectful treatments. Disrespectful treatments range from neglect, verbal abuse to coercion (like coercive caesarean sessions) or even spanking and unwarranted episiotomy (an incision between the vagina and the anus). This disturbingRphenomenon can potentially cause a rise in maternal/child mortality from complications in labour when women begin to substitutedisrespectfulhealthcarewithunassistedorhomedeliverieswithunskilledattendants. Having served in some government hospitals myself coupled with reports from friends and families, I have witnessed first-hand how nurses in particular maltreat or neglectwomeninlabour. Manydont showempathyallinthenameofbeingmothers themselves i.e. they think if they had been through labour, why should another woman be treated specially. This is not to say that is always the situation, however disrespectful maternal care is not uncommon in Nigeria and has remained largely unexplored. Imagine someone who is paid to take care of you raining insults on you (e.g. Didnt you know it would turn out like this when you were doing the thing...) when they should be reassuring their clients. I doubt I would be able to paint the exact degree of apathy on our female labour wards in Nigeria, therefore, I have inserted a true life story in here, as Despite growing evidence and reports of poor or disrespectful maternal care, currently there is no international consensus on how disrespect and abuse should be defined and measured. We need to understand the root of this problem, could it be work stress, poor attitudes or lack of sufficient staff or lapses in health workers training? Understanding, measuring and preventing abusive and disrespectful care is a research agenda that remains unexplored. In many instances policies to promote respectful maternal care have notbeenadopted,areunspecific,andareyettobetranslatedintosignificantaction. Olutosin Oladosu-Adebowale shares her own experienceofdisrespectfulmaternalcareinNigeria. arrived just in time took the baby from When the time came for me to deliver At the hospital, there was not a single his arms. I dont know how, but by some my first daughter, my maternal doctor. The room was crowded with miracle of God he was able to revive my grandmother took me aside and told me women in various stages of delivery. We daughter.Relieved,Ifellasleep. tositdown. were forced to labor on benches, as there was only one bed. When the baby I woke in a pool of bloodthe nurses had There is no pain as that of child birth, crownedatthebirthcanal,womenwould forgotten to stitch my vagina where the she said. It is indescribable. Delivery can betransferredtotheonlyavailablebed. episiotomy had been performed. I only be done by God. Put your faith in recovered after eight days in intensive him.Asforthedoctorsforgetthem. A nurse sternly warned me not to push, care. despite my babys insistence on coming Her words made me deeply afraid for into this world. When I could not take it These horrible experiences happened in what I was to experience next, and my any further, I screamed and the nurse oneofthelargesthospitalsinLagos.Iwas motherswordsonlyconfirmedmyfears. almost hit me. "I told you not to push! No lucky to survive. My daughter, whom we spaceforyoutodeliver!" named Oluwatobiloba meaning 'God is a Has she explained everything to you? Great King', was lucky to survive. Every shesaid.Itwillbepainful. The pain of attempting to stop my labor day, women are sacrificed at the altars of mademecryoutinmorepain.Ipulledmy medicalnegligenceinNigeria. True to their words, my labor was the husband aside and gave him these most horrific experience of my life. My instructions: "If I die, ensure that you I could quote statistics of maternal relatives prepared me for the physical take me back to my village for burial. I do deaths in my country, but they would be pain, but I was not alerted to the not want to be buried in Lagos, or in your useless: official numbers do not conditions I would meet in Nigerias village."Herespondedwithahiss. represent the actual quantity of healthcarefacilities. casualties we see daily. I call on our When my baby was finally delivered, she government to commit to proper funding I went to the hospital to deliver my could not breathe. The nurse looked at and staffing for our health care system. daughter on April 25, 2002. Pain gushed me straight in the face and said, "Witch, We must all come together to reduce the out of me like the flow of a river. I you have killed your daughter." She number of women and infants buried in screamed, expecting soothing handed the baby to my husband and said, thegraveyardsofNigeria medicationstoreducemypain,oratleast "She is a still birth. Your wife killed your soothing words to help me through. child." ByOlutosinOladosu-Adebowale. Instead, one of the nurses shouted at me: Source:http://www.impatientoptimists. "Shut up! It is time for you to know that a I began to cry as my husband wrapped a org/ babys head is bigger than a mans scarf around the baby to prepare her for manhood." burial. But suddenly, a doctor who Disrespectful treatments of women during : a major barrier to utility of hospitals for baby delivery childbirth Women & Development with Temitope Ojedokun health & politics today, July/Oct 2015 15 Shut up! It is time for you to know that a babys head is bigger than a mans manhood."
  16. 16. Allocation to health dropped by 17 billion (approx. 85million USD) in 2014 to 262 billion naira. ccording to the United Nations, the ultimate have been enrolled under the National Health responsibility for healthcare lies with the Insurance Scheme in ten years of its existence government. Claiming that the Nigerian (2005-2015). However, 60 per cent coverage hasAgovernment has recorded abysmal performance in been achieved in many African countries that healthcare provision is not a matter of comparing it launched their health insurance programme after to developed countries such as Switzerland where thelargesteconomyinAfrica. health insurance coverage is 99.9%. Nigeria fails woefully even when compared to other African Conversely, politicians know how to take care of countries. Nigeria's economic prosperity does not their own health at the expense of the public. In May matchitsgovernment'sshareofhealthexpenditure, 2014, Nigerians were shocked to learn through which is a little over 20% compared to Egypt and media reports that an outgoing governor (Godswill South Africa where government spending on health Akpabio of Akwa Ibom state, now a senator of the average40%. federal republic) and his wife would be getting annual health insurance coverage to the tune of Barely a year after the United Nations launched the 100million naira (about 600,000 USD) after leaving Millennium Development Goals, African heads of office. Knowing they have not made any reasonable states converge on Abuja from April 26-27, 2001, at provision or funding for a decent healthcare service the invitation of the former President Olusegun in hospitals, Nigerian politicians almost always Obasanjo, for a conference where they affirmed chatter private jets or take the next available flight their commitment to fight HIV/AIDS, tuberculosis to Dubai, India, Germany or other medical tourism and improve healthcare delivery for their citizens. destinations. This happens in a country where The 26th point in the Abuja Declaration reads: "we children die because pledge to set a target of allocating at least 15% of their mother cannot our annual budget to the improvement of the health afford to pay for sector". Till date, the percentage of annual budget malaria treatment that goes to health in Nigeria is less than half of the which often cost less 15%thatwaspledged14yearsago. than 1500 naira (about 6USD). Governmentspendingonhealthhas,formosttimes, been around 5% of budgetary allocation since 1999 While health workers when a democratic government was ushered in. In s o m e t i m e s c i t e 2014,6%(262billionnairaor1.7billionUSD)ofthe government's failure national budget went to health, over 80% of which to provide Nigerians is meant for paying salaries and buying petrol and w i t h a d e q u a t e diesel to power hospitals, research institutes, healthcare as their health ministry, departments and agencies. Only a reason (or a main little is left for improving access to healthcare and reason) for going on a quality of care, purchase of essential medicines, strike, we know that it provision of new health facilities, diagnostic is only to give an altruistic face to their own struggle equipment, medical and surgical devices. As a for higher salaries or higher salary competition as result, the health insurance scheme only covered the case may be. In any case, if health workers' those in the formal sector mainly government unions were to fight for better healthcare for employees who are barely 4% of the entire Nigerians, denying and depriving the same people population. access to healthcare by refusing to work is not the way to go about it. It is Nigerians who should go all The vast majority of Nigerians pay for health care out protesting against an unjust, unfair and out-of-pocket, accounting for about 75% of health oppressive government while unions of health expenditure. Private health insurance is purchased professionals and civil societies should champion for a privileged few who are employed by good advocacy and mediation as they interface between companies such as multinationals. Of over 160 themassesandthegovernment. million people, only about 6 million (about 3%) cover story with Opeyemi Akindele Failure of government to finance healthcare Addressing health workforce crisis and strikes in Nigeria: some key issues health & politics today, July/Oct 2015 16 1 image:www.idssociety.org
  17. 17. The mentality is that when you work for the government, hard work isn't worth it. urthermore, Nigerian health workers go on by poor healthcare service. The poor masses continue strike because generally they do not earn as tobearthebrunt. much as they should. As a result, even whenFhealth workers are not on strike, they do not work On other hand, Nigerian senators earn about 1 million enthusiastically or put in their best. The mentality is USD a year with great healthcare packages while that when you work for the government, hard work representing a people isn't worth it. Morale is low as workers are not of whom 70% wallow motivated. in extreme poverty living on less than Many Nigerians would rather not patronise public 1.25 USD per day- hospitals because they are repulsed by the poor w i t h o u t s o c i a l attitudes of nurses and fagged out resident doctors security or health who shout at their patients. Salaries and wages earned i n s u ra n c e . Wa rd by a worker have been referred to as "hygiene factors" councillors flaunt that influence performance, morale, and motivation by their largesse before Hertzberg, Mausner, and Snyderman in their book The theirconstituencies. MotivationtoWorkpublishedin1959. Consequently, the Health workers in Nigeria earn less than their general feeling among colleagues in neighbouring countries. A physician health workers is that employed by the federal government may earn up to if politicians who $1000 at entry level, a pharmacist or physiotherapist appear to do less, and earns about $700 per month. Nurses, medical have not improved the laboratory scientists, others earn even less. Those lot of Nigerians earn employed by the state or local government generally so much, then the earn much less. Yet the cost of living -cost of decent government must accommodation, school fees, electricity etc.- continue have enough in its coffers to pay health professionals to rise. In order to improve their income, many health whoprovidehealthservicestothepublic,sometimesat professionals engage in side activities and private the risk of their own lives. Hence, for Nigerian health practice to the detriment of public service. Since workers strike is the most effective way they can practitioners are engaged in two ventures none of squeeze funds out of the pockets of an unyielding which gets their best, even private practice is plagued government cover story with Opeyemi Akindele health & politics today, July/Oct 2015 17 image:Debamboozled Remuneration lags behind rising cost of decent living Addressing health workforce crisis and strikes in Nigeria: some key issues 2
  18. 18. t is not uncommon that government's insincerity other. Key factors that will affect how much is available when it comes to implementing agreements it for the government to spend of health include but not Isignedwithhealthworkers'unionsleadstostrikes. limited to: rising internal and external debts, huge spending on fuel subsidy, skyrocketing cost of WesawhowpoliticalgimmicksplayedbyNyesomWike governance, declining demand for crude oil and (as education minister) kept university students out of reduction in flow of development assistance for health school in 2013 when the Jonathan administration (DHA). failed to execute the agreement it signed with the AcademicStaffUnionofUniversities. Onewaythegovernmentcanboosthealthfundingsoas to provide fair, robust and satisfactory Similarly in the hospital sector, in order to save its face salary/allowances package to all cadres of the health and stop public outcry, it is not unusual for the Nigerian workforce is via total removal of oil subsidy so that the government to sign an agreement to pay better salary billions of dollars saved can be invested in healthcare. packages with striking JOHESU or NMA even when it Also, ministries and agencies serving duplicate or knows it would not be able to meet the demand or similar functions should be merged while savings in sustainit. runningcostsshouldbeinvestedinhealth. Health workers' unions too, who have become However, how much of additional budgetary allocation accustomed to the cunning of politicians, would only to health should go to increasing health workers' say they suspended the strike whenever they cut any salaries rather than healthcare capital projects may promising deal with the government. So, by the time need to be debated, especially in a situation whereby the going gets tough and the promised salary packages NMA and JOHESU continue to competitively demand or due allowances are not delivered, the unions soon forhighersalariesoutofjealousy. makeafreshcallforstrikeaction. Apart from pervasive irresponsibility among Noteworthy is the fact that chances are high that the politicians, higher salary demand competition by NMA government may find it difficult to increase and sustain and JOHESU partly explains why a government bogged payment of health workers salary while investing down by salary payments may sometimes fail to meaningfully in universal health coverage at the same implement agreements it signed "under the duress" of time; and if prudent, evidence-based health economics anindustrialaction. is not applied, one might be done at the expense of the cover story with Opeyemi Akindele health & politics today, July/Oct 2015 18 Government insincerity in implementing agreement with health workers unions 3 OF CLEAR LANGUAGE IS THE GREAT ENEMY INSINCERITY George Orwell Addressing health workforce crisis and strikes in Nigeria: some key issues
  19. 19. he lion's share of government expenditure on community better are not at the forefront of striking health personnel goes into salaries and unions' agenda. And if they are, they are only used as a Tallowances earned by health workers in the pretext to give a human face to their struggles. Or how hospital sub-sector. Yet, shockingly, it is the same canyouclaimtobeonstrikeforaltruisticreasonswhen hospital sub-sector (which gets the lion's share of our you are depriving the same patients you want to be budgetary allocation on health) that also goes on strike better served of healthcare, apparently for selfish for salary related reasons most frequently. What often reasons? comes as a rude shock to patients and the general public is that health workers go on strike out of While it is true that Nigerian health workers are not jealousy. remunerated as much as their colleagues even in some African countries, it is also true that health workers in Unfortunately health professionals in Nigeria have the Nigerian government employment are better paid been pitched against each other by their union leaders relative to other civil servants. Sadly, many health and associates who do not have the interest of workers have not justified the current level of salary Nigerians at heart. Doctors under the aegis of the NMA they earn by their input into the health system, would go on strike with fresh demands should the efficiencyandworkethics. government agree to a pay rise for nurses, pharmacists, medical laboratory scientists, optometrists, To address this facet of health workers' strike, the physiotherapists and other health workers under the government may need to review the various salary JOHESUumbrella.JOHESUinturnwouldmountthreats structures in the entire civil service (i.e. all ministries, to shut down all public health facilities all over Nigeria departmentsandagencies).Apartfromusingacademic shouldthegovernmentappeartocutaperceivedbetter qualification or level of study as a yardstick to dealwithNMA-medicaldoctors'union. determine what a cadre of workforce should earn, their respective contribution to the economy should be It's the same way a kid would ask for more portions measured by experts and factored into deciding how whenever their mother adds more to the meal served muchshouldoneearnrelativetotheother. the other child/ren: one group or union contends with the government that it has agreed to an unfairly robust For instance, the contribution of teachers to improving salary and benefit package with the other group, national health outcomes has been underestimated resulting in a strike by the group which felt cheated. over the years, leading to poor remuneration of And then counter-strike by the other party should the teachers compared to others workers with same governmentaccedetotheformer'sdemand. university qualification e.g. health professionals. And within the health workforce, those whose contribution According to some government officials, the ever rising to national health and the economy has been demand for higher salaries by health workers is underestimated (hence paid much less relative to pushingthegovernmentbeyondwhatitcanreasonably othersworkersinthesamesector)e.g.midwivescanbe afford. Patients' interests and the thirst to serve the adequatelyremunerated. cover story with Opeyemi Akindele health & politics today, July/Oct 2015 19 Unhealthy igher salary among health workers competition for h4 image: www.getrealphilippines.com Addressing health workforce crisis and strikes in Nigeria: some key issues
  20. 20. SouthAsia Afestivalofstrikes Indian Medical Association study divulges ratio might become stiffer in future. he resident doctors of ten that over 75% doctors experience Moreover, frequent strikes over the issue of government hospitals in Delhi went workplace violence in India. On the other security would make the matter worse for Ton one-day strike from 10 am to 4 pm hand, literature reveals other attributing thealreadysufferingpatients. on 20th February 2015. Over hundred factors such as communication gaps, lack of nursing homes and hospitals in Panvel, presence of senior doctors and shortage of ImpactofstrikeonhealthcareinIndia Maharashtra supported by Association of doctors in the hospital. The proposals to Thousands of patents flocking the Medical Consultants called a daylong strike inculcate the communication skills module government hospital with a slight hope of on 6th April 2015. Tamil Nadu chapter of in the medical curriculum have failed to being seen by the doctors is the usual scene Indian Medical Association along with maketheirwayforward. on days of strike. Some of them might have its 33,000 members called a 24-hour travelled miles from their villages for the strike on 2nd May 2015 along with health facilities at the hospital. 3,500 members of Indian Dental These people are often forced Association by staying away from to stay back until the strike is duties. Meanwhile, Tamil Nadu Government called out as neither can they Doctors Association's 16,000 members travel back and forth again nor supported the strike by working with black they can afford it. On the other arm badges. Indian Medical Association's hand, most of the emergency Lucknow chapter called a 12-hour strike on s e r v i c e s a r e u s u a l l y 8th May 2015 crippling the services at all operative. Nevertheless, theMoreover, shortage of doctors continues to diagnostic and pathology centres, clinics, scheduled surgeries andhaunt the healthcare sector. The limited andprivatehospitals. outpatient department facilitiesavailability of doctors during night hours, often remain suspended. Althoughand multiple cases being reported in the This is a slice from cake of protests and complete shut down for all the healthemergency at the same time have led to strikes by doctors this year. However, the services for long period is an extreme rarity,brawls in the past. The unavailability of the important issue is the reason for these but shutting down the usual outpatientsenior doctors for interaction with the strikes. These different strikes were called s e r v i c e s l e a d s t o c o n s i d e r a b l efamily members of the patient is another by different groups of doctors in different inconveniencetothepatients.common source of conflict. The junior states on different incidents but for one doctors reporting the condition of the same reason, security. All these strikes were Other reasons for health workers'patient to the family are often foreseen as sparked by various incidents of attacks strikeinexperienced by the relatives and against the doctors by relatives or friends of Demands such as salary hikes, timelyconsideredassofttargets. patients for different reasons. The doctor on payment, better facilities, and living duty at Lifeline Hospital, Maharashtra was conditions, etc. have traditionally being theMeasurestostopassaultandbattery brutally beaten on death of a 65-year-old major reasons for strikes by the healthcareFrom time and again doctors have been woman patient in Intensive Care Unit (ICU) professionals. Health workers and nursesdemanding security in the hospitals to on ventilator by her relatives. A often complain about the dismal wages.prevent such acts of violence from the gastroentologist in Allahabad was admitted Whereas, doctors often protest againstgovernment authorities. Escalation in the toICUafterbeingbeatenondeathof80-year working conditions, equipments, facilitiesnumber of guards for a few days is all what oldseriouslyillpatient. and policies. However, in this scenario, itthey did manage before another such would be rather overwhelming if doctorsincidence happens. Although some state Manycauses would have been indulging in strikes forgovernments have passed protection bills, Hospital is a place for compassion, not reasons more than protecting themselvesexecution remains questionable. A blind collision. The relatives do need to and their lives. At least in those cases,approach from the government might force understand that it is impossible to assure a reasons like duty, ethical prerogatives,doctors to migrate from this daunting cent percent success in every medical saving lives could be cited as more thanprofession. With more doctors openly procedure. Studies indicate unexpected reasonablereasonstocriticisesuchstrikes.discouraging their children to take up this deaths as the major cause of violent challenging profession, the doctor patient behaviour from the relatives. An ongoing Assault on doctors by frustrated patients and relatives, a major cause of strikes embarked upon by Indian doctors. with Dr Agrima Raina health & politics today, July/Oct 2015 20 ...The doctor on duty at Lifeline Hospital, Maharashtra was brutally beaten on death of a 65-year-old woman patient Photo credit: www.thehindu.com
  21. 21. SouthAsia with Dr Agrima Raina Ending open defecation in India: long way ahead India's flaw: Agrima tells us why public health has remained a casualty despite all the progress in many of fields. Photocredit:sunuptimes.com squatting every now and then at a considerable distance from the track defecating in open. This practice is more grieve for women who simply cannot afford the luxury to openly defecate in open. We have to spot where most men are going andessimists claim that world is in a the world but a casual visit to one of the then go in the opposite direction to find amess. Optimists however differ. Their scores of slums would reveal the darker side desertedplaceinfieldstodefecate,explainscontentionisthatprogressinscience, of the picture. Indias financial capital,P Laxmi, a labourer from outskirts of Delhi.technology and communications has Mumbai offers a stark contrast to its high- The plight of women does not end at findingcomparatively made the world a better rise towers in the slums where people live suitable place, but fears of privacy andplace to live in. Optimists are right in their like sardines cramped in one shack, making sexual abuse haunt them every day.own belief. Their belief emanates from their every effort to just survive. For them caring Meanwhile dangers of snakebites and wormair-conditioned chambers located in highly about health and sanitation is a luxury they infestations remains to be quite common.developed metros in the world. Obviously, can simply not afford. Kolkata, the cultural Moreover, many teenage girls drop out ofthey are far from factual realities. The capital of India is no better nor is the IT schools when they start menstruating duegroundrealitiesareentirelydifferent. capital, Bangalore. Smaller cities are to lack of toilets taking a toll on educationobviouslyevenworse. andfutureoftheseyounggirls.The overall living conditions of a very large number of the people on the planet remain Nearly 600 million people defecate in the Prime Minister Narendra Modi launched aextremely pathetic, to say the open in India. This lack of sanitation facility massive cleaning and sanitation campaignleast. This pitiable condition of can commonly cause diarrhoea and aimed for cleaner surroundings asthe people, who cannot afford well as build sanitation facilitieseven a morsel of food, makes throughout the country. Thethe pessimists to conclude that programmetargetstobuild12millionthe world, is in a mess. Public health is Toilets in current fiscal year and morea major causality .There has been than 110 million toilets in next fiveremarkable progress in various fields years with budget of 600 billionincluding agriculture, medical IndianRupees.Anumberofbusinessresearch, diagnostic means and houses as well as NGOs have alsocommunication, to name a few that intestinal infestations and diseases like pitched in to build toilets in villagesconcern a common person, but sanitation hepatitis, cholera, typhoid among others. and school. Advertisements haveand hygiene have remained a major Every minute, more than 1 million litres started rolling on television for thedilemma demanding an imperative and humanexcremententersthelongestriverof importance of building toilets in everyimmediate solution. That is why public the country, Ganga. A WHO report claims household. Women organisations havehealth has remained a casualty despite all loss of nearly Rs.6500 (approx. $104) per initiated campaigns urging women totheprogressinavarietyoffields. person in India due to highly preventable demand constructing a toilet in the house diseases caused by lack of hygiene. If beforemarriageifitislacking.To get a clearer picture of the state of public affluent households having access to proper health, one has to travel through the dark sanitation and hygiene are excluded, this However, a more daunting task in theand dingy mud lanes of Asia, Africa, Latin figure rises to almost Rs. 12,000-15,000 per horizon is change. A change in the centuriesAmerica and other continents and reach an person. These diseases cause much more old practices of relieving themselves underobjective conclusion. Despite all the tall than poor health, which is, loss of income. the open skies. Meagre toilet building wouldtalks, sometimes doling out cash incentives Due to illness, an auto rickshaw driver may probably not solve the problem, or say yes,by international agencies and even the UN not be able to go for work causing the may be for females, but what about thoseagencies, hygiene and sanitation remains a worthy daily income, which is quite men who love their freedom in the naturalmajor concern in all under-developed, least necessary to feed children. Things get even surroundings? They would still be out there.developed, developing and even many areas worse for the lone bread earners of the Mass media campaigns on importance ofindevelopedcountries. family adding them to vicious chain of toilet use perhaps would be the next on list povertyandillhealth. for building clean and healthy surroundingsTake for instance India, the largest for the future generations. Though, road isdemocracy and a fast developing country, An early morning walk along the tracks of farahead,atleastthejourneyhasstarted.which has made marvels in space worlds fourth largest train network, Indian technology. Indian political capital New Railways will force you to notice men Delhi looks like the most developed place in Nearly 600 million people poo in the open in India...WHO says about $104 is lost per head to preventable diseases. health & politics today, July/Oct 2015 21
  22. 22. The heart of the problem Manyunansweredquestions? Indiaindenialmode Healthissues A recent WHO study of 1600 cities in the world divulges that New Delhi has the most polluted air, even worse than Beijing. The city's average annual PM2.5 level was whooping 153micrograms per metre cube of air as compared to 56 in Beijing. This figure is way above the safe limit of 25 micrograms per cubic metre of air within 24-hour time scale as demarcated by WHO. What is even more alarming is appearance However, the greatest impact on health is due to As result, Delhi Transport Department of other Indian cities on the list like Patna, long-term exposure affecting the quality of life. introduced one of the largest fleets of eco- Gwalior, and Raipur with 149, 144 and 134 These particulates can even lead to premature friendly busses in the world all running on PM2.5 levels respectively competing with Delhi deaths in people with pre-existing heart and CNG. Due to consistent law enforcement, strict for the top spot in this pollution race. These are lung conditions. PM2.5 is potentially emission norms were enforced; outlived and somewhatless-developedthanthecapitalofthe carcinogenic and may cause lung and other polluting vehicles were phased out from city country with much lesser vehicles and lesser cancers as well. Meanwhile studies also link roads. However, despite all these measures still urbanisation. excessive PM2.5 exposure to arteriosclerosis running, the pollution monster is back. Delhi is andevenprematurechildbirths. no more that 'green and clean' and yes, that is Meanwhile, the financial capital of the country, theuglyorratherpollutedtruth. Mumbai scored way less than its counterpart However, these excessively high levels of PM2.5 'greener Delhi' with 45 micrograms despite could be linked to ever increasing vehicular If one goes out of the air-conditioned cabins and being the biggest competitor of Delhiin terms of traffic in Delhi, which alone accounts for about cars to walk along a busy congested Delhi road, development and urbanisation. However, even 8% vehicles in the country. Delhi boasts of more lungs will definitely tell the reality. Same air that Mumbai fails to fall into the safe-zone category vehicles than the three metropolitan cities of sustains life has become a massive killer. A ofPM2.5levels. Mumbai, Kolkata and Chennai put together. As government of India study reveals about 2.63 of March 2015, Delhi has more than 8.8 million million people suffer from Acute Respiratory PM2.5 level refers to the fine particulate matter registered vehicles in the city, besides vehicles Diseases in the country due to air pollution. inairhavingdiameterof2.5micrometresorless fromotherneighbouringcities. Global Burden of Disease by WHO identifies air which are only visible via electron microscope. pollutionassixthmostdangerouskillerinsouth PM2.5 are generally composed of toxic organic Moreover, Five National Highways pass through Asia with India alone accounting for a quarter of compounds as well as some heavy metal the Capital, making Delhi as a major trading and its share. Moreover, 15-16% of asthma patients primarily resulting from automobile smoke or distribution centre in the north. On an estimate, in Delhi are children, which 40 years back was a burningplantsoryardwastes. 78% fruits and vegetables, 49% fuel and 47% meagre2%. food grains traded in Delhi are destined for So, why are these tiny particles important? Well, otherstates. these particles are so small that they can easily According to a study by Chittaranjan National penetrate deep into lungs and blood stream and Cancer Institute conducted in 2010, more than may reach vital organs such as brain, kidney, Amidst this, India is still in the denial mode for 40% schoolchildren in Delhi have reduced lung liverandspleen. Delhi having the most polluted air in the world; function. These figures raise many unanswered perhaps due to successful pollution control questions. Are Delhites breathing highly measures undertaken in the past. Delhi's contaminated air for years? Will they be Exposure to high concentrations of PM2.5 may compressed natural gas (CNG) revolution a compelledtodosoforyearsorevengenerations exacerbatetheheartandlungconditions.Short- decade ago along with plantation drives to come? Will most of them have respiratory term exposures can cause symptoms like cough, definitelyhaditsimpactontheenvironment.All problems sometime in lives? Are they wheezing, shortness of breath, difficulty in the public vehicles started using CNG or other susceptible to lung cancer more than others breathing and even asthmatic attacks. Children cleanerfuelssince2001. are? Clearly, cost of pollution control is much andelderlybeingtheworstaffected. cheaperthanthecostofthepollutiondamage. Death by : Delhi's killer air.breath SouthAsia with Dr Agrima Raina health & politics today, July/Oct 2015 22
  23. 23. WhatisPM2.5? Where does PM2.5 comefrom? H ow i s a i r s a f e t y measured? W h a t P M s i z e i s dangerous? greatest health risks. Particulate matter, or PM, Because of their small is the term for particles size (approximately found in the air, including 1/30th the average dust, dirt, soot, smoke, width of a human hair), and liquid droplets. fine particles can lodge P a r t i c l e s c a n b e deeplyintothelungs. suspended in the air for long periods of time. Some particles are large or dark enough to be seen Sources of fine particles as soot or smoke. Others include all types of a r e s o s m a l l t h a t combustion activities individually they can only (motor vehicles, power be detected with an plants, wood burning, electronmicroscope. e t c . ) a n d c e r t a i n industrial processes. Many manmade and Particles with diameters In addition to air quality natural sources emit PM between 2.5 and 10 data, EPA guidance on the directly or emit other micrometers are referred The PM2.5 standards are PM2.5 designations pollutants that react in toas"coarse." based on averaging air process also discusses the atmosphere to form quality measurements other important factors, PM. These solid and liquid S o u r c e s o f c o a r s e both annually and on a 24 including emissions of particles come in a wide particles include crushing hour basis. The annual pollutants that lead to rangeofsizes. or grinding operations, standard for PM2.5 is met P M 2 . 5 f o r m a t i o n , and dust from paved or whenever the 3 year population, commuting unpaved roads. Other average of the annual patterns, and expected particles may be formed m e a n P M 2 . 5 growth, that states should Particles less than 10 in the air from the c o n c e n t ra t i o n s f o r evaluate in order to micrometers in diameter chemical change of gases. designated monitoring determine whether a (PM10) pose a health They are indirectly sites in an area is less than c o u n t y i s a l i k e l y concern because they can formed when gases from or equal to 15.0 g/m3. contributor to the area's be inhaled into and burning fuels react with The 24 hour standard for airqualityproblem. a c c u m u l a t e i n t h e sunlight and water vapor. PM2.5 is met whenever respiratory system. These can result from fuel the 3 year average of the Adapted from the US Particles less than 2.5 combustion in motor annual 98th percentile of E n v i r o n m e n t a l micrometers in diameter vehicles, at power plants, values at designated P ro te c t i o n A g e n c y : (PM2.5) are referred to as and in other industrial monitoring sites in an http://www.epa.gov/pm "fine" particles and are processes. area is less than or equal designations/faq.htm#0 believed to pose the to35g/m3. Do you know the of the air in your ? Here is why you ignorant is not bliss! PM2.5 city health intelligence Most of us want our country to become an industrial hub, creating wealth. But when that happens, you may no longer take innocent breaths. Air pollution is such a threat to our health. health & politics today, July/Oct 2015 23 infographic:www.tceq.texas.gov
  24. 24. VISIO