8 January 2013

Nigeria: 2013 - Stitching in Time to Save Lives

Nigeria has benchmarks in its health sector. But how far it moves from those benchmarks in the next 12 months is uncertain. What could make a difference?

2013 has rolled in, and the country is looking to pick up where it left off last year: how far will row over the National Health Bill go? What will dabbling in assisted reproductive technology yield? Will Nigeria bring medical tourism under control or get on the bandwagon? At home, will standards of healthcare tick upward or nosedive?

As 2012 rolled out, Nigeria was still wondering what to do with a blitz of crashes that claim lives every day.

The crashes and resulting deaths point to a painful lack of what health experts call a "trauma system"--a triage culture that allows doctors to act quickly in emergencies, sifting through patients caught in carnage and saving as many lives as quickly as possible.

But of course, they have to be backed by equipment, which they say aren't just available at worst or inadequate at best.

The presence of at least three state governors absent from their seats on account of ongoing medical treatment abroad points to the worse case. But the deaths of ADCs and aides in fatal crashes points to the worst.

Among milestones Nigeria is considering is to establish a culture of dealing with trauma. A few trauma centres are ongoing--one at National Hospital, Abuja (first or second port of call for high-profile public officials in emergencies) is hoped to be completed this year, and a second at University of Abuja Teaching Hospital, Gwagwalada.

Whether trauma handling changes will depend much on public will and support--the same resources being seriously tasked in other areas of the health sector.

Take the demands of primary health and public health. The line between both is likely to blur as Nigeria rises from having its nose rather bloodied. It took a beating in 2012--a year it vowed to end transmission of wild polio virus.

A couple of states still reported cases in December. In the same month, private sector doctors stepped in to offer help. Doctors of Rotary International in India and Nigeria provided free surgery to correct deformities brought on by polio in up to 400 children.

The surgery was seen as a spark to reignite support for polio vaccination among populations growing increasingly sceptical and rejecting vaccinators. Seeds of the project are to grow on as doctors continue to correct deformities in hopes of strengthening interest. Dr Deepak Purohit, who headed the free-surgery project on the Indian side, said the formula worked to pull India out from among polio-endemic countries--where Nigeria, Pakistan and Afghanistan are still firmly seated.

Blurred lines

A step further and the line between primary and public health is likely to blur in 2013--if a plan for nationwide larvicide and mass vaccination against yellow fever kicks in.

Larvicide is only a next step to battling malaria--coupled with increasing treatment, faster diagnosis and widening prevention measures--which affects millions of Nigerians. If that is not scary enough, then yellow fever should be--this time, far from causing tension between Nigeria and South Africa over international travel.

2013, and yellow fever will be bad news, according to epidemiologists, and here's why: Nigeria as a country just isn't immune to the disease. Shots have been scarce, so children aren't getting vaccines; last mass vaccination was more than a decade ago. The result is herd immunity has weakened, and the outbreak of yellow fever in neighbouring countries is cause for alarm.

The World Health Organisation said last year that even a single case amounts to an outbreak. More than 101 million could be at risk.

Working on models, epidemiologists projects millions of cases of infections and hundreds of thousands of deaths.

National Primary Health Care Development Agency is pushing for mass vaccination in hopes of heading off catastrophe that could overwhelm the health system.

Buckling under strain

And of course ever-present battle with HIV is still ongoing. While efforts continue to keep prevalence under control, the number of cases coming to light may not fall off. Awareness and testing means new cases, but now necessarily new infections, and will undoubtedly task the country's ability to cope with treatment. At present, therapy using antiretroviral drugs is only available to around half a million people. Patients who need the treatment exceed 1.5 million.

Prevention is still a strong card in the suit Nigeria has against HIV. The launch of Truvada, which heads of infection if taken before exposure, is still fresh, but how deeply Truvada and other drugs penetrate supply will be known later.

Only one true Nigerian?

There are lots of issues to consider in health, but the government take is that while it labours to put things up and working, perhaps it could start saving one million lives by 2015 if it ensures basic drugs and health services are available to women and children.

A binding memorandum under the auspices of the World Health Organisation compels Nigeria to do this. Concern about mortality among children and women also prompted the expansion of the Midwives Service Scheme--financed from bits of SURE-P funding.

This year, Nkechi, Habiba and Bola will be expected to take their health in their hands--by getting themselves health coverage. More than 70% of spending on health comes from Nigerians' personal pockets already. But the National Health Insurance Scheme is looking for states to pick up insurance and make it a priority, get employers to buy cover for their workers, and communities to cover their poor.

The rationale is that not everyone can afford insurance. So those who can should buy cover for those who can't. Federal government is buying for its workers. But there is only much it can do.

The way NHIS executive secretary Abdulrahman Sambo explains it, in a sense there is only one Nigerian--the president. Everybody else has to come from a state or the other, and those states--in addition to local governments--should be paying premium for health coverage.

To give the thought some teeth, it would be the only way of ensuring better health, and 2013 might also be the year legislation is amended to make health insurance cover compulsory in Nigeria.

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