Features

Lesson From Haitian Public Health Week

Published

14 years ago

April 7, 2010

Susan J. Blumenthal, M.D., Pamela Savitz, Kate Pitts, Timothy Dempsey, Julia Liebner, and Anita Verma

A series of earthquakes have recently shaken the world, taking a traumatic toll on communities globally. More than half of the 130 cities worldwide with populations of over 1 million people are built on fault lines, making them susceptible to the calamitous impact of earthquakes, as witnessed in the recent events that occurred this Easter Sunday in southern California and Mexico as well as those that struck over the past several months . With 57 deaths following the March 8th earthquake in Turkey, 531 left dead after the February 27th quake in Chile, and an estimated 250,000 dead following the January 12th Haiti disaster, vulnerably located nations must be prepared with emergency response plans and strong public health infrastructures. Unfortunately, these natural disasters often occur in settings that are already shaken by financial instability and poor health systems. Haiti, a nation now devastated, had a weak public health system as well as a fragile economy when a 7.0 magnitude earthquake struck and shook Port-au-Prince on January 12, 2010. This traumatic event required extensive short-term emergency response efforts, but has also dramatically increased the need for health services and a strong public health infrastructure for the long term. With the United Nations Donor Conference pledging $15 billion last week, $9.9 billion of which is being allocated toward long-term reconstruction with the United States committing $1.15 billion over the next two years, it appears this urgent need will eventually be met.

The extent of Haiti’s devastation can be seen not just through the rubble, but also in the economic and public health data detailing the damage from the quake. The earthquake has been more destructive than the Indonesian tsunami of 2004 and has caused five times more deaths per million inhabitants than the 1972 earthquake in Nicaragua. It has destroyed over 75 percent of Port-au-Prince, including 250,000 houses and most government buildings, injured at least 250,000 people, and displaced 1.5 million more who are now forced to live in make-shift tent camps. The Haitian government has assessed the death toll to be between 200,000 and 250,000 people with the potential to reach or surpass 300,000.Costs related to damage from the earthquake have been estimated at $13.9 billion, twice the amount of Haiti’s annual GDP.

The earthquake has all but broken parts of this frail nation, exacerbating pre-existing conditions and creating new challenges as well. Even before the earthquake, Haiti had experienced social and health challenges in addition to facing severe economic problems. In 2006, Haiti spent just $96 per capita per year on health care (compared to the United States’ annual per capita health spending rate of $8,160), and only 1 in 50 Haitians had steady employment. In a country so impoverished, where 80% of people were indigent before the quake struck, it is easy to see how the health of Haitians has also become quite poor. Infectious diseases are the leading cause of death for infants and children in this country, and HIV/AIDS is the number one killer of adolescents and adults. As people are forced to live in crowded makeshift camps with unsanitary conditions in the earthquake’s aftermath, the threat of tetanus, typhoid, gastrointestinal infections and other water-borne communicable illnesses, such as malaria, looms dangerously close as the rainy season approaches this May. Furthermore, children, who comprise 40-50 percent of the Port-au-Prince population, are among those most at risk in disaster situations. Because their immune systems are less developed than adults, they face a range of threats, including malnutrition, acute respiratory infections, diarrhea, and susceptibility to illness resulting from a lack of availability of vaccines to protect against childhood diseases. Prior to the earthquake, only 58 percent of Haitian children under age 1 were immunized against diseases such as measles and tetanus.

The earthquake and subsequent aftershocks also had a devastating impact on Haiti’s infrastructure for safe water sources. Thus, conditions will only worsen for the 250,000 left without shelter unless a public health system is developed. Sanitation is not the only concern for Haitians now residing in tent cities with limited resources. Once nightfall arrives, women face the constant fear of rape and attack. To make things worse, the earthquake destroyed many of the rape counseling centers including Haiti’s Ministry for Women’s Affairs, which was in the midst of implementing its five-year plan to reduce violence against women. Currently steps such as the distribution of solar flashlights and rape kits, along with providing better lighting and security patrols have been implemented to protect women in the camps.

While media coverage and relief efforts often focus on immediate support to provide food, water and medical aid, interventions are also needed to prevent the spread of another kind of wound caused by the wreckage — the mental health effects of this traumatic event. The mental stress of the earthquake’s victims must be emphasized and integrated into the reconstruction of Haiti’s public health infrastructure. Hopefully, these needs will be addressed when allocations of the recently pledged $15 billion from the United Nations are prioritized and distributed. In disaster situations, three groups are particularly vulnerable and deserving of aid. The first are those who suffer from pre-existing mental illnesses such as schizophrenia, autism, mood and anxiety disorders. Their illnesses may be exacerbated when access to care and medication is lost. The second and largest group is comprised of those who may develop post-traumatic stress disorder from the devastating nature of the circumstances or whose illness is exacerbated following the event. Measures must be taken to provide these people with interventions and support. The third group consists of the immediate responders who face the horror of traumatic emergency situations and suffer from the emotional consequences of these experiences. Mental health interventions are under way with the assistance of the Pan American Health Organization (PAHO) and the World Health Organization (WHO) that are forming a working group to develop a long-term strategy for a more decentralized system of service delivery, as well as training new mental health professionals.

Another major concern in rebuilding Haiti lies with the estimated 100,000 amputees and the thousands of people with serious wound infections that could lead to amputation in the future. Since an estimated 2% of the population now has an amputated limb, the demand for prosthetics outweighs the incoming supply, and rehabilitation services are limited, innovative solutions must be developed to tackle this new public health problem for the nation. Already in place to aid amputee victims are physical therapy efforts established by Handicap International, Miami University, and Healing Hands in over half of the existing 91 hospital facilities to aid the victims. Experts have suggested establishing a large-scale prosthetic industry and rehabilitation center in Haiti.

Priorities for rebuilding a stronger Haiti start with building the foundation for a modern, sustainable public health infrastructure. The Centers for Disease Control and Prevention (CDC) has described areas of long-term focus that address the need for water and sanitation, health care, food, verifying the status of health care facilities, assisting in supporting health care services, and providing health education to the people of this distressed nation. Social and economic needs, such as building schools, churches, and health facilities, must also be addressed so that aid provides both immediate relief and also establishes the foundation for rebuilding a nation that had only a marginally functioning public health system to begin with.

Since the quake’s strike in January 2010, aid and relief efforts have found their way to Haiti with the help of several countries. An estimated $2 billion had already been pledged internationally in February before last week’s United Nations Donor Conference, which promised an additional $15 billion to provide relief efforts to Haiti. With the help of volunteers from NGO’s including the Red Cross, UNICEF, Save the Children, and other partners, over 400,000 adults and children have been vaccinated against diseases such as measles, diphtheria, pertussis, and tetanus. While cases of acute respiratory infections, acute diarrheal disease, and tetanus have been reported, as of February, the numbers do not reach epidemic standards. The World Health Organization has reported that there are currently no increasing trends in disease outbreaks, and that widespread vaccination campaigns were successful in preventing them. To combat the prospect of a malaria outbreak during the upcoming rainy season, thousands of anti-malarial bed nets have been distributed in addition to programs financed by The Global Fund to Fight AIDS, Tuberculosis and Malaria that have supplied emergency anti-malaria drugs. Long-term goals are also being considered. Last week, Haiti’s Prime Minister and 300 Haitian and international experts at the United Nations Donor Conference presented a post-disaster needs assessment that requested not only food and supplies, but also called for a reconstruction of the country’s social, economic, and health systems over the next five, ten, and fifteen years.

To truly improve the health of Haitians, the social and economic drivers of disease must be addressed. This means providing educational and occupational opportunities for all, as well as establishing a sustainable, modern public health system. The public health lessons learned from this and previous disasters such as the tsunami of 2004 should be remembered and collected to inform future emergency response efforts in other nations. The creation of a web-based global resource bank that includes best practices and protocols in disaster response for all agencies of government, in collaboration with NGO’s, outlining their roles and responsibilities, is needed in order to more effectively respond to events that might occur in the months and years ahead.

As Louis Pasteur said, “Chance favors the prepared mind.” Today as we mark the beginning of National Public Health Week 2010, let us learn from the Haitian experience to help rebuild this country as well as put in place emergency preparedness and response plans to diminish the impact of natural disasters that may occur in the future around the world.

The authors are experts from various international institutions

Features

An Open Letter To FCT Minister, Chief Nyesom Wike

Published

2 weeks ago

November 27, 2023

The Tide

Dear Hon Minister,

First, a disclosure. You may not know me but we have met on two occasions in the house of our mutual respected Oga, first as a minister of state and second as a Governor, but l doubt if you can recognise me now. I am one of your admirers and critics.
As a two-term Governor of Rivers State, you did well in terms of infrastructure, for which l often commend you. I, however, sometimes disagree with you, particularly what l consider your streaks of high-handedness against those who disagreed with you politically.
I am writing this letter, with the hope that Don would send it to you, after watching your media interview with particular reference to your protégé and successor, Governor Siminalayi Fubara, a guy l have never met. No doubt, he would not have emerged as governor without your imprimatur. I do not have the details of your disagreement, and I am not even interested. What I am interested in is you to rise above the alleged offence.
Take a deep breath and have an introspective view of your political trajectory since 1999.
1999-2007: Obio/Akpor LGA Chairman
2007-2011: Chief of Staff, Rivers State
2011-2015: Education Minister (State)
2015-2023: Governor, Rivers State
2023-till date: Minister of FCT
And you are just 55!
I stand to be corrected, nobody from Rivers State has been so politically favoured and blessed by God as you are, not that you are the most politically-savvy politician from the State but it is just the Grace of God. I plead with you, do not take such grace for granted.
As governor of Lagos State in 2010, Governor Babatunde Fashola told me something that has stuck with me till today, regarding power and leadership. There was a three-month old strike by doctors in Lagos over pay increase. I stepped in to mediate between the doctors and the state, which by the grace of God, l was able to pull through after extensive negotiations with the doctors, and the strike was called off to the relief of millions of Lagosians. In the course of the mediation, Fashola told me that some people asked him to fire all the doctors but he made this profound statement: “Restraint is a powerful tool in leadership; the fact that you have the power to do something but chose to look the other way.” That statement has stuck with me till date. Why do you think American presidents, despite the temptation to press the nuclear button, when their interests are threatened, rather exercise restraint by refusing to go that route? It is leadership restraint.
Permit me to recall a story which you yourself regaled your audience with at the 70th birthday reception you held in honour of Dr Peter Odili. You said that when you wanted to contest for the Chairmanship of Obio/Akpor Local Government Council in 1998, you approached Dr Odili, whom you were meeting for the first time and sought his support. He obliged by giving you his support, and according to you, he gave you the first financial support towards your ambition, even when he himself was campaigning to run for the governorship of Rivers State. You became the chairman, and when you wanted to go for a second tenure, some political actors removed your name, and according to you, you ran to Dr Odili who was then the governor and he saved your political career by reinstating your name.
Fast forward to when you completed your tenure as the chairman of the local government, when your erstwhile friend, Rotimi Amaechi, who just became the governor, appointed you his Chief of Staff and that administration commenced a process to humiliate Dr Odili by setting up the Rivers State Truth and Reconciliation Commission, where your benefactor, Odili was the target and was put in the witness box.
Later when cracks began to emerge in your relationship with your boss, Amaechi, you ran back to your benefactor, Dr Odili to apologise for how your administration humiliated him. As a large-hearted person, he forgave you, and that began a wonderful relationship till date. Why am l making references to these incidents? If Dr Odili could forgive you and took you back, why can you not also forgive your political offenders, including Fubara, particularly since God has been so good to you?
Anyone who has traversed Ada George Road, Port Harcourt and seen the humongous, palatial estate you reside in, that takes a substantial part of that road, would know that you are not lacking materially. Coupled with that, you are a Minister in the current government and your wonderful wife is a judge. What else does any human being want?
My brother, please calm down, and let go of your ego and learn from history. Who would have thought that a whole General Shehu Yar’Adua (rtd) could die like a chicken inside prison; who would have imagined that a whole Bashorun MKO Abiola, the then richest man in Africa could spend five years in detention and die in custody, despite his international connections; who would have imagined that Major Hamza Al-Mustapher, the de facto Head of State during the junta of General Sanni Abacha, a man even Generals genuflected for, would spend 14 years in prison? Please, pause and think. This life is ephemeral. As the book of Ecclesiastes 1 states: life is vanity.
In Oyo State, there used to be the strong man of Ibadan politics, Lamidi Adedibu but his house in Molete, Ibadan is now desolate after his death. Adedibu was law as far as Ibadan politics was concerned. He was feared by all political actors across the nation. Before him, there was Busari Adelakun, otherwise known as “Eruobodo” in Ibadan politics. They have all been consigned to the dustbin of history. Learn from these because whether you like it or not, you would also pass away one day like all mortals.
God has been so good to you. Though I do not have the details of your feud with Fubara, you claim he is an ingrate, but this same “ingrate” took bullets for you as your Accountant-General when the EFCC was investigating your government. If you did not have confidence in him, you would not have put him forward to succeed you. Please, rise above political offences and be a leader. May it not be counted against you that since 1999, your successor would be the first governor of Rivers State to be impeached. No garland for such feat. It would be a pyrrhic victory and your new political masters in Abuja would even be wary of you. You are new to Bola Tinubu’s school of politics. Do not get carried away.
May God guide you right.

By: Richard Akinnola

Features

Abbas Recommends Privatisation Of Nigeria’s Refineries

Published

2 weeks ago

November 24, 2023

The Tide

Speaker of the House of Representatives, Rep. Tajudeen Abbas, has recommended the privatisation of oil refineries in the country to enable them function optimally.
Abbas gave the recommendation yesterday, while receiving the management of NNPCL led by the Group Managing Director, (GMD), Mr Mele Kyari in Abuja.
He described the state of refineries over the years as shameful, adding so much money was being spent on workers as salaries and allowances for doing very little.
“There is need to make these refineries have multi -dimensional uses, if there is no crude oil, are there other activities that can make the workers to be active so that why they earn is deserved? I need you and your management to look at how we can turn around these decades of losses.
“One way to do so is to find a way to privatise these refineries; we have spent so much money and time deceiving ourselves that some businesses can be run by government.
“In the case of the refineries, we have now realised that some sectors of NNPC business can only be handled by the private sector and our refineries are one of those.
“The inadequacies will become manifest as soon as Dangote refinery comes on board because the competition will be there and inefficiencies of the refineries will become more naked.
“I want you to put it as part of your cardinal objectives; let us find ways to privatise our refineries so that they can be active ,so that in the near future, they will be able to compete with new refineries that will come up,” he said.
Abbas said that the NNPCL is central to the economic development of Nigeria, pledging the commitment of the House of Representatives to supporting the company to succeed.
According to him ,the House is concerned about the high rate of oil theft as it is draining revenue, affecting forex availability and causing inflation in the country.
The speaker said that the House had inaugurated a special committee on oil theft,to interface with stakeholders with a view to addressing oil theft in the country.
Earlier, Kyari said that all refineries would become fully operational and Nigeria would become a net exporter of petroleum products by the end of 2024.
He noted that subsidy was responsible for poor activities at government-owned refineries over the years ,saying that the removal of subsidy was already attracting a lot of private sector investments.
“I can confirm to you that by the end of December latest, we will start the Port Harcourt Refinery; early in the first quarter of 2024, we will start the Warri Refinery and by the end of 2024, Kaduna Refinery will come into operation.
“This is the commitment we are giving today and you can hold us accountable on this.
”In 2024, many initiatives, including the rehabilitation of our refineries, and also the efforts of small- scale refiners, and the coming of the Dangote Refinery, will make Nigeria a net exporter of petroleum products.
“We will no longer be talking about fuel importation by the end 2024, I am very optimistic that this will crystalise,” he said.
Kyari said that it was not the practice of the company to publish its financial statements some years back , but that the practice had changed, and all the company’s accounts from 2018 till date were now in the public space.
Kyari put the expected government revenue from the company by the end of 2023 at N4.5 trillion, saying that NNPCL was returning value to shareholders in line with the objectives of the Petroleum Industry Act.
Kyari said that the company had a robust supply plan assuring that there would be no shortage of fuel over the Christmas season and beyond ,and that no one could hold the country to ransom.

Features

FAAC: FG, States, LGs Share N906.96bn

Published

2 weeks ago

November 24, 2023

The Tide

The Federation Account Allocation Committee says it shared N906.96billionn among the three tiers of government for October 2023.
FAAC disclosed this in a communiqué issued at the end of its latest meeting on Wednesday.
According to a statement by the Director, Press and Public Relations, Ministry of Finance, Stephen Kilebi, on Wednesday, the total figure shared for October was a slight increase of N3.48billionn compared to the N903.48billionn shared in September 2023, recovering from a decrease recorded in the previous month.
The total amount included gross statutory revenue, Value Added Tax, Augmentations from Forex and Non-oil Mineral Revenue, and electronic money transfer levy, among others.
The communique disclosed that although a gross total of N1.35trillion was generated, only N906.955billion was shared to the three tiers of government as Federation Allocation for October 2023.
The total revenue distributed for October 2023, was drawn from Statutory Revenue of N305.070 billion, VAT of N323.446billion, EMTL of N15.552billionn, Exchange Difference of N202.887billionn and Augmentation of N60.000billionn, bringing the total distributable amount for the month to N906.955billion.
From the total revenue from Gross Statutory Revenue, Value Added Tax, Electronic Money Transfer Levy, Exchange Difference, and Augmentation of N60bn, the Federal Government received N323.355bn, the States received N307.717bn, the Local Government Councils got N225.209bn, while the Oil Producing States received N50.674bnas Derivation, (13% of Mineral Revenue).
The Communique stated that “the Federation Account Allocation Committee at the end of the meeting indicated that the Gross Revenue available from the Value Added Tax for October 2023, was N347.343bn, which was an increase from the N303.550bn distributed in the preceding month, increasing to N43.793bn.
“From that amount, the sum of N10.894 billion was allocated for Cost of Collection and the sum of N10.003 billion was given for Transfers, Intervention, and Refunds. The remaining sum of N323.446 billion was distributed to the three tiers of government of which the Federal Government got N48.517 billion, the States received N161.723 billion, and Local Government Councils got N113.206 billion.
“Accordingly, the Gross Statutory Revenue of N660.090 billion received in the month was lower than the sum of N1,014.953tn received in the previous month of September 2023 by N354.863bn. From that amount, the sum of N38.942bn was allocated for the Cost of Collection and a total sum of N316.078bn for Transfers, Intervention, and Refunds. The remaining balance of N305.070bn was distributed as follows to the three tiers of government: Federal Government was allocated the sum of N147.574bn, States got N74.852bn, LGCs got N57.707bn, and Oil Derivation (13% Mineral Revenue) got N24.937bn.
“Also, the sum of N16.199bn from the Electronic Money Transfer Levy was distributed to the three tiers of government as follows: the Federal Government received N2.333bn, States got N7.776bn, Local Government Councils received N5.443bn and N0.647bn allocated for Cost of Collection.
“The Communique disclosed N262.887bn from Exchange Difference, which was shared as follows: Federal Government received N93.323bn, the States got N47.334bn, the sum of N36.493 billion allocated to Local Government Councils, and N25.737bn given to Derivation (13% of Mineral Revenue) while the sum of N60.000bn was for Transfers, Intervention and Refunds.
“It disclosed that N60.000bn Augmentation was shared as follows: the Federal Government got N31.608bn, the States received N16.032bn, while LGCs got the sum of N12.360bn.”
Also, the balance in the Excess Crude Account stayed at $473,754.57 as of November 22, 2023.
FAAC revealed that N50.674bn was given for the cost of collection, and N386.081bn was allocated for Transfers Intervention and Refunds.
Petroleum Profit Tax, Import Duty, VAT, Customs External tariff, and EMTL increased significantly.
However, Excise Duties, Oil and Gas Royalties, and Companies Income Tax recorded a decrease.