Abuja — Do you think the government is doing much in the area of health to improve the quality of life for children?

I think the government is segmented. So you have some responsibility on the part of the federal government, state government and the local government.

But I feel the real question to ask is, are they doing it the right way? Is it being put together properly, so that primary health care seems to be functioning. In other words, do people get proper health care, proper nutrition and proper immunization. Its unlikely to get a disease if better precautions are put in place at the primary health care level. So the primary health care system must include everything from good practices in child bearing, to basic sanitation including water. All these need to be provided for, but I am not sure if the whole system is being built on the Primary health care. I know that preventive care saves you money .I think the government is trying hard. I will be very honest about it. We have seen a tremendous commitment at every level of government we met. I think they are looking for what works, in terms of the best health practices, and how to get that to the community level.

Is Nigeria close to achieving the health-related Millennium Development Goals?

I would like to say that all the Millennium Development Goals relate to children, and children are at the heart of the Millennium Development Goals. Number one deals with poverty and hunger. We have seen malnutrition in quite a number of children, and quite a number of children are living in poverty. Gender equality is very important in terms of people having the same equal opportunity. So they have better chance later on, by providing for their families. Other areas of interest include primary education, HIV/AIDS, malaria, tuberculosis, water and sanitation which are the environment-MDGs, maternal and child health. Children are a part of the Millennium Development Goals. So I say Nigeria can make it , though it has only six years to go. We will make tremendous progress in achieving the MDGs. We have not seen much progress in Nigeria like we have seen in some other countries. We have seen a 40% drop in child mortality since 1990 in countries like Eritrea, Ethiopia, Mozambique. You know these are not easy country's either. I truly believe that this country should charge more resources in terms of developing people. People have to think that they can be done. This is the technology, the way we communicate. The tools that we have are changing, and I truly believe that though Nigeria has a long way to go, progress can be made very quickly, if people are aware of the role each and every person could play.

What is your impression of the malnourished children we saw in Argungu, and here in Sokoto? What type of intervention can be provided to suit the situation.

I was not amazed because I have seen the numbers. You know about 29% of children in Nigeria under-five are underweight, while in Africa, the average is about 24%. In India , the country where the green revolution started, the under-five mortality rate is only three per cent. So what does this mean? It means not just that there is lack of adequate food, but lack of knowledge on the part of the people on how to feed their children in some places. I have actually been to a lot of countries, but sometimes giving water instead of breastfeeding, which may not be clean will cause diarrhea which can make the child to be malnourished.

Often times, it is not just children suffering because of lack of food, it is children starving because of lack of clean water, sanitation and knowledge on the part of the parents on what to feed the child. So I was not really surprised because I know that the numbers are there, and I know that one of the things that we need to do through this community-based approach, is really to help families understand what it means to have proper nutrition for the children. The problem is that there is no one based approach. You know one community may have one factor, and another community may have another factor about how to feed their children. But I think it is really important for communities to have the right kind of information, and have education programmes at every community level. But that can be done through the media as well. One of the things I have been told is that in this country, a lot of people listen to the radio, so we need to work on the type of messages which will collectively educate communities on good practices that will benefit our children.

What is your impression of the health centres you visited?

Let me just say that it has been a most interesting visit. This is my first visit ever to Nigeria. It is a country that is critical if the world is going to reach the Millennium Development Goals. Notice that I say the world, and I do not say Africa or Nigeria, but if Nigeria, Africa or indeed, the world is going to reach the Millennium Development Goals, this is a key country. I say that because there are two countries in the world that make up one third of our under-five mortality and one third of our maternal mortality, India and Nigeria put together. Just these two countries make up one third of what has to be done globally on the MDGs. So as I said in my initial press release, Nigeria is the country that has two per cent of the worlds population, and the other has 12 per cent of the worlds under-five mortality, and it has 11 per cent of the worlds maternal mortality. So you see there is a disproportionate impact of the most physical country indicator here in Nigeria. So I think what we have seen here these last couple of days, is the commitment by stakeholders to try to change the situation, and begin to turn the country around with regard to the indicator. For example, the community we just visited is coming together to provide exactly what UNICEF has been anticipating for. That is a community-based integrated approach to community healthcare for women and children. What we saw here is that at the community level, people are coming together to create that kind of community-based integrated approach, to providing pre-natal care for women.

They are looking at who is likely to have a difficult pregnancy, and therefore would need to be at the hospital. They may be getting their pregnancy tetanus vaccination. You know the pregnancy tetanus vaccination is the first vaccination a child gets. It should be done when a child is still in the womb. The other thing is the nutrition of the mother, because the child is much more likely to have a healthy start in life, if that mother is properly nourished. So that needs to be a part of this integrated approach and training of women. Then of course, once the baby is born, immediate breast feeding within the first hour, and within the first six months of the childs life, is essential. You saw the baby I was holding, she was four months old and she was always being breast fed. She was in very good health and had plenty of weight, and it just shows that if you do exclusive breastfeeding, it will make the difference.

Sometimes, people think that when they are breast feeding, they should give the baby water and that it could be very dangerous, particularly if you do not have adequate clean water. You have to look at this as part of the whole nutrition issue, particularly clean water and sanitation. Then you need to look at the package a child gets early in life. The vaccination, what you call the DPT 3 and then measles. You heard that community say they have had one case of measles this year since May, I think. That's quite amazing, because they are doing the vaccination. There are two special cases in Nigeria, polio in particular, because polio is endemic now. It is only in four countries in the world and the only one endemic in Africa is Nigeria. We are worried about spreading the virus to other states. It is in northern Nigeria, but it is spreading to other countries in Africa. So polio vaccination is critical.

There are millions of dollars invested in polio over the years. If we can get the last link, the last inch of this polio and eradicate it like small pox, imagine the money that we will free up to eradicate other diseases. I think thats one way we need to think about it. Malaria in this country, unlike in most countries where the leading cause of child death is pneumonia and diarrhoea. But in this country, it is malaria and yet we have bed nets. Bed nets can be effectively used to protect the children and family. There will be a campaign over the next two years to distribute 60 million bed nets in this country, and that is an unprecedented effort that has never been made before. So I think that you in the media actually can really help to get some of these messages out. For instance, are you keeping bed nets in the home? You know what happens to your children if you are not using the nets or you do not take this vaccination on protecting your children in the home. The second thing is, are you getting your child vaccinated for polio? I must say, one of the things that impressed me during the community visit was when I saw those polio boys together. This showed mothers and fathers that they need to take the lead and have their children immunized to save them from polio.

This is why people need to have every child vaccinated and have a commitment to have every child vaccinated against polio. I think this commitment is really key to the country achieving the Millennium Development Goals.

UNICEF is supporting Nigeria to fight the scourge of polio endemic in the country...

There have been huge sums of money put in place to fight polio in this country. We gave funding from Rotary International, UNICEF, WHO. Much of this money goes into trying to get the final interruption going. If you have not seen the movie, the Final Entry, I will recommend you to see it. This money we have been allocated, will provide support in Nigeria to publish educational materials on information and polio vaccination. We have important things to do before that. The money we allocated is specifically for accelerated efforts to try to get the children vaccinated against polio.

One extremely important point is, if we really need to see the numbers go down. You see the numbers are better this year than they were last year. One of the big fears is that whether in India, or Pakistan or here or Afghanistan, the four endemic countries, if you do not maintain at least for two to three years, the level of that commitment, even when you think you have seen a lot less cases, it will come back again .So what we really have to understand is to keep the picture of those polio victims in mind, so that we do not lose track of the fact that it takes some time for that polio eradication to be truly eradicated.