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Health For All Rivers People, A Mirage?

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“The principal objective of a health system is to improve people’s health, and the chief function a system needs to perform is to deliver health services using money, staff, equipment and drugs in different combinations to allow appropriate delivery of health interventions.

“Improving and scaling up service delivery depends on having key resources and on how those resources are organised and managed.”

This, in part, is the preamble of the Rivers State Ministry of Health (RSMOH) in its second anniversary account of stewardship in the health sector from October 2007 to October 2009.

The key question, therefore, is to what extent has the people’s health improved? And to what extent have health services been delivered using money, staff, equipment and drugs.

There is also the question of how much key resources are available? And how these resources are organised and managed in the 43 years of existence of Rivers State.

Shortly after the creation of Rivers State on May 27 1967, the only known state-owned Hospital, was General hospital Port Harcourt, which later became the  University of Port Harcourt Teaching Hospital (UPTH). The present Braithwaite Memorial Specialist Hospital (BMSH), then, was Braithwaite Nursing Home.

During this period, which, could be up to the late seventies, health care providers were known to render their services selflessly in accordance with the ethics of their profession.

Then, the emphasis visibly was not just on service delivery, but on effective service delivery.

Though the equipment used then is not comparable to what is used today, and common illnesses then cannot equate what holds today, it was rare for a patient to leave an hospital unsatisfied in terms of services rendered to him/her.

Apart from Port Harcourt General Hospital, there were also General Hospitals in the then Local Government Headquarters, though they were less equipped. However, they also rendered effective service delivery at that level.

At the level of communities also, the federal government in collaboration with state governments established health care centres which were also less equipped, and merely served as dispensaries.

By the beginning of the eighties, the emphasis on effective service delivery on the part of providers gradually diminished alongside the provision of equipment, while the quest for economic empowerment among health care providers increased.

The result, by the nineties, was an array of dilapidated health facilities, and mostly embittered health care providers. Even such laudable programmes as the “Flying Doctors Scheme” under late Dr Dima Deni-Fiberisima (the then health commissioner) could not improve the health sector.

Solace, however, came to the health sector in Rivers State with the return of democracy in 1999 under the governorship of Dr Peter Odili.

The Governor, who ruled the state for eight years, brought life into the health sector by building health centres in various communities and also modernised the BMSH.

However, while he built the physical structures, most of them, including BMSH, were not properly equipped, and adequate emphasis was not placed on human resources development in the health sector, hence the situation did not help the decay in the health sector. This was the inheritance, of the incumbent Governor, Rt. Hon. Chibuike Rotimi Amaechi.

On assumption of office on the 26th of October, 2007, the state government first held an health summit for all stakeholders in health on the 5th and 6th of February, 2008. The essence of the summit was to highlight the way forward in the health sector and also to determine the best option in its implementation process.

To ensure proper integration among all levels of health care, as was agreed in the summit, a bill for the establishment of Primary Health Care Board was introduced in the State House of Assembly and is at an advanced stage.

“The State Government first embarked on the construction of 160 New Primary Health Care centres as a step towards replacing the existing dilapidated ones and rebuilding the entire health system.

Out of the 160, the major contractors for the execution of the projects, Brunell Engineering Construction Company undertook the constructing of 105.

As at last October, 29 of the 105 were completed and were fully equipped, 18 were above 90 per cent complete, while 42 were above 70 per cent completion. The rest of the 160 are at various stages of completion.

In Secondary Healthcare, one of the major reasons for the failure of  Professor Olukoye Ransome-Kuti Primary health Care model was the non-availability of proper referral systems and centres.

The Health commissioner, Dr Sampson Parker said in order for Governor Amaechi’s vision not to have the same pitfalls, simultaneous arrangements have commenced to ensure massive renovations or complete rebuilding and equipping of the General Hospitals thus the Niger hospital (now Professor Kelsey Harrison’s Hospital) and Dental Hospital have been completely rebuilt.

In a bid to provide effective, efficient and affordable health service, he said, the radiology department and the chemical laboratories have undergone massive retooling, with Clinotech Group of Canada acting as technical partners.

The state government has also set up a surgical theatre unit, sterilising unit and an oxygen manufacturing plant, with an adjoining intensive care unit with state of the art equipment.

According to a document made available to The Tide, about 145 Rivers people benefited from Emergency Medical Service (EMS) on Road Traffic Accident Care, while about 489 non-indigenes also benefited from the scheme in November to April 2008.

Under man power development, the government said post graduate training of doctors in family medicine is in full swing as the BMSH is fully accredited to do so.

In the Ancillary Services, the drug stock level went from N12 million in 2007 to over N40 million as at May 2009.

“Monthly sale of drugs increased from N3million in 2007 to over N10 million as at May 2009, while the Central Medical Store has taken over the procurement of drugs for HIV/AIDS and Malaria Control Programmes.

An auto disabled syringe factory, which will manufacture intravenous fluids has also been completed and commissioned with technical partnership from Pan Africa Health Foundation.

In a bid to check the trend of malaria in the state, the Rivers State Government distributed one million long lasting insecticide nets from December 2007 to December 2008.

About 314,942 doses of anti-malaria drugs were bought and distributed from April 2007 to April 2009, just as the sum of N300 million was budgeted and expended for malaria treatment in 2009.

In HIV/ADIS programme, a total of N95 million was released in 2009, while about N23 million was given to the Rivers State Agency for the Control of AIDS (RIVSACA) for HIV/AIDS control and about N83 million was spent on Anti-Retroviral drugs for people living with HIV/AIDS.

Inspite of these achievements, however, the answer to the question of what extent has people’s health improved is not that favourable.

This is because even as there are modern health facilities, there are no doctors at several health centres and hospitals, especially in the rural areas because doctors posted often refuse to be in their duty post after honouring such posting.

Another worrisome issue is that while the government has spent huge amounts on drugs and other deliverables, there are no strict monitoring or supervision of government health projects.

The answer to the question of how much key resources are available and how these resources are organised and managed is nothing to talk about. This is because the rush for free medical care services and free anti-retroviral programmes has seen people from outside the state come to access the facilities. Often times, these deliverables are not properly utilised or given free to the appropriate beneficiaries. Health care providers now use the opportunity to sell the products.

It is hoped that with recent announcement by the Governor of the state, collaboration with the United Nations Development Programme (UNDP), government projects, including those in the health sector, will be  monitored in a bid to ensure that the projects are executed to the letter. However, this also depends on whether subsequent governments will continue the process.

 

Sogbeba Dokubo

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…Creates Two New Offices In Govt House

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The Rivers State Governor, Chief Nyesom Wike has announced the creation of two new executive offices to guarantee efficiency and effectiveness of activities at the Government House, in Port Harcourt.
The governor’s action was made known in a statement signed by the Special Assistant on Media to the Rivers State Governor, Kelvin Ebiri in Government House, Port Harcourt, last Monday.
The terse statement reads, “To ensure activities are functioning efficiently and effectively, the Rivers State Governor, Chief Nyesom Wike has announced the creation of the Office of the Deputy Chief of Staff, Government House, Port Harcourt.
“The Deputy Chief of Staff will be in charge of the Logistics, Correspondence of the Governor and Legal Matters.
“Similarly, he has also announced the creation of the Office of the Special Adviser on Aviation”.

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Accelerating Gender Parity In Nigeria

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In virtually all societies, women are in an inferior position to men. Sex or gender determines  more rights and dignity for men in legal, social and cultural situations, These are reflected on unequal access to or enjoyment of rights in favour of men.
There are also the assumption of stereotype social and cultural roles.
In Nigeria, gender inequality has been for decades in spite of modernization and the fact that many females have done better than men in many spheres.
Analysts are convinced that gender inequality is largely influenced by religious and cultural beliefs, as some cultures and religions still hold strongly that women are the weaker vessels created mainly to be home keepers and child bearers.
Analysts are also worried that gender inequality negatively affects status in all areas of life in society, whether public or private, in the family or labour market.
Although the Global Gender Gap Report 2018 by the World Economic Forum (WEF) shows some progress amongst the 149 countries that were indexed, the progress toward closing the gender gap is slow, because it will take 108 years to close the gender gap and another 202 years to achieve parity in the workforce, according to the report.
The report benchmarks the 149 countries on their progress toward gender parity across four dimensions – economic participation and opportunity, educational attainment, health and survival, and political empowerment.
A number of initiatives have been made by corporate organisations and governmental and non-governmental organisations  to address gender imbalance in Nigeria.
One of the latest is the launch of First Women Network  (FWN) by the First Bank of Nigeria Ltd., in commemoration of the 2019 International Women’s Day (IWD).
IWD is celebrated globally every March 8 to recognise social, economic, cultural and political achievements of women.
The celebration is also a call to action for accelerating gender parity.
The global theme for the 2019 celebration is “Think Equal, Build Smart, Innovate for Change” while the theme for the social media campaign is “#BalanceforBetter”.
According to the bank, the FWN initiative is an avenue for career management and mentoring for women to enable them to balance their career with private endeavours.
The aim,  according to the bank, is to address gender gap and increase women representation in its senior and executive levels, as well as encourage women to tap into opportunities and contribute to nation-building.
The bank’s Chief Executive Officer (CEO), Dr Adesola Adeduntan,  explains that First Women Network is targeted at the banks’ staff and customers, among others.
He believes that women can achieve more if given the necessary strategic support, hoping that the initiative
will increase the bank’s productivity and profitability.
Adeduntan notes that the initiative is  also a demonstration of First Bank’s adherence to the Central Bank of Nigeria’s Sustainable Development Goals which mandate increased women representation in all banks.
The sustainable goals require that the financial services sector should adopt a quota system to increase women representation on boards to 30 per cent and that of senior management level to 40 per cent by 2014.
Adeduntan is optimistic that the FWN will address six key area –  career management, personal branding, mentoring, welfare, financial planning and empowerment.
He is convinced that the initiative will address gender disparity at the workplace.
“It is commonly agreed that gender parity is an essential factor influencing the advancement of institutions, economies and societies.
“Studies have shown that gender parity in corporations promotes increased performance and returns on investment.
“The need to invest in composite women empowerment and enhance their contributions at senior management levels to achieve organisational goals cannot be over-emphasised,” the CEO says.
For him,  it is paradoxical that the presence of women in paid employments continues to increase, yet the progression of professional women to positions of leadership and management remains slow.
“Gender gaps persist in economic opportunities and political participation in many countries.
“This is part of the reasons for this women network initiative,” he notes.
The chief executive officer wants employers of labour and the entire society to encourage women to advance, excel and contribute optimally in  workplaces and communities.
Mr Abiodun  Famuyiwa, group head, Products and Marketing Support, promises that First Bank  will continue to promote female entrepreneurship for national growth and development.
“We recognise that promoting female entrepreneurship and independence is key to economic viability of every home in the country,” he says.
 According to him, FWN is a further demonstration of the bank’s commitment to women empowerment after the launch  of FirstGem in 2016.
He is satisfied that FirstGem is providing opportunities for women to achieve their financial goals and aspirations through with access to support funds, free business advice, specialised trainings on business development and insight on business development.
For Mr Lampe Omoyele, managing director, Nitro 121, an integrated marketing communications agency,  points out that courage is important in addressing gender imbalance.
“For gender imbalance to be resolved, there has to be courage, vision, values and character,” he says.
He is convinced that women should  have courage and confidence in taking risks within  organisations.
Omoyele advises that women must not play the victims.
“Ultimately, whether you are a female or male, what is going to sustain you is your character and values.
“You need to have values; character is important in the balance that we live to, and it sustains you as you move into the future,” he adds.
The Chief Executive Officer,  Standard  Chartered Bank, Mrs Bola Adesola, wants women to take advantage of FWN to make their lives better.
 She urges women to aspire to grow in their endeavours and refuse be limited because of their gender, stressing that they should use all resources at their disposal to grow.
 For the bank chief, FWN is not a silver bullet to creating the first female chief executive officer of First Bank, but  about opportunity.
“So, it is important that as women, we take advantage of it,” she urges.
 Ms Cecilia Akintomide, independent non-executive director, FBN Holdings Plc, is dissatisfied that Nigeria is still far in gender balancing.
Akintomide says Nigerian  women are still being restricted from working in some places and owning some property.
According to her, restrictions are rendering 50 per cent of Nigeria’s population –  mainly women –  economically unviable.
 A First Bank customer,  Mrs Ifeyinwa Okoye, lauds the FWN, and urges the bank to ensure that its customers – the secondary target of FWN –  benefit from it.
Okoye describes women as critical to economic growth and development but regrets that many women were lagging behind in their endeavours because of gender inequality.
She wants the banks to enlighten its customers on FWN for maximum results.
 “If you empower a woman, you empower a nation.
“Empowering women is especially effective because the benefits are felt throughout the whole community,” she argues.
Analysts call for more strategic support for Nigerian women to  enhance gender parity.


By: Chinyere Joel-Nwokeoma
Joel-Nwokeoma is of the News Agency of Nigeria.

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Covid-19 Vaccination: Role Of Local Leaders

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It was a matter of time, but Covid-19 vaccination has already started to generate heated arguments following a hint that the Federal Government could start sanctioning anybody who refused to be vaccinated.
Dr Faisal Shuaib, Executive Director,  National Primary Health Care Development Agency, NPHCDA, disclosed this at a recent press conference in Abuja. He, however, said that implementation was dependent on availability of the vaccines.
“The Presidential Steering Committee and the Federal Ministry of Health are exploring ways of making vaccines more available to all Nigerians, including federal civil servants and corporate entities.
“Once these vaccines are made equitably available to all Nigerians, then we will need to have a frank discussion about justice, fairness and liberty that exist around vaccine hesitancy.
“So, you have a right to refuse vaccines, but you do not have the right to endanger the health of others,” he said.
Already, attempts have been made by two states – Ondo and Edo – to make Covid-19 vaccination compulsory, especially for public servants and members of the public who wish to gain access to certain places.
These places include religious worship centres, banks and public buildings.
However, those attempts and the suggestion that the Federal Government might sanction those who refuse vaccination have been criticised by some trade, professional and religious associations.
 The Nigeria Medical Association (NMA) and Joint Health Sector Union (JOHESU) that kicked against the compulsory vaccination, said that government should rather embark on advocacy and persuasion, than coerce citizens into getting vaccinated.
The spokesman for JOHESU, Mr Olumide Akintayo, said the policy would only be sensible if there were enough vaccines to inoculate eligible citizens.
Akintayo stated: “If you are thinking of it in terms of responsibility, it makes sense; but practically, we all know it is an impossible task.
“ If all the doses that have been sent to Nigeria since this outbreak is less than 10 million, how do you enforce that kind of policy in a country of over 200 million people?
“You don’t just come up with policies that are not backed by common sense; you don’t just say things because you want to talk. It would have made some sense if the vaccines are available for everyone.”
The General Secretary of the NMA, Philips Ekpe, said citizens could not be forced to be vaccinated against Covid-19 the same way they had the right to reject medical treatment.
Rather than being forced, he said Nigerians should be made to understand the need to be vaccinated. 
According to him, although they cannot be forced, citizens who refuse vaccination should stay in their houses so that they don’t endanger others.
He said: “The Federal Government needs to make people understand the reason why they need to be vaccinated. They have the right to say no. You cannot force people. People have the right to say no to medical treatment.
“But you should let them understand the dangers of not getting vaccinated.
“For example, if you want to travel out of the country, if you are not vaccinated, you will not be let in. The reason is because the other country you are going to won’t want to endanger the lives of its citizens.
“Let them understand the importance, but then if they refuse, they should stay in their houses and not go out and endanger others.”
Experts believe that properly communicating the advantages of being vaccinated, through the use of existing structures, such as religious and cultural institutions, would yield better results than subtle threats.
Communication connotes persuasion, even on occasions when the purpose of a piece of communication is not to persuade, there is still the need to win over the audience to accept the message.
In this era of fake news, and when the social media is awash with conspiracy theories against vaccination, persuasion must first be deployed to get the attention of citizens.
The burden increases tremendously when there are cultural and religious stereotypes which could prevent many adherents from accepting that being vaccinated is safe.
This challenge is not peculiar to Nigeria. In the U.S. for instance, vaccine hesitancy is responsible for over 90 per cent of all Covid-19 related hospitalisation.
Getting some Americans vaccinated has been so challenging that many people have been offered monetary incentives to convince them to get vaccinated in an unusual case of persuasion.
In Nigeria, where religious and traditional leaders are custodians of faith and culture respectively, they wield great influence on devotees and those institutions can be deployed to boost vaccination drive.
Historically, religious and traditional rulers often employ the cognitive process of persuasive communication to change an entrenched social perception or public opinion hindering required public support for relevant people-oriented policies.
Leaders have the influence to subtly appeal to the target to listen, accept, comprehend and act.
Therefore, before considering the stick, government should first explore the use of carrot.
Religious and traditional leaders can help in giving correct messages on vaccination as well as being role models, making sure that they and their loved ones too are vaccinated.
Faith-based and culture-based organisations can also collaborate with other leaders to sensitise communities on the benefits of vaccination and to also dispel the many myths and disinformation about it.
King Bubaraye Dakolo of Epetiama Kingdom in Bayelsa has been putting this practice to use, since vaccination was first rolled out in Nigeria in March.
“The arrival of the vaccine brought a huge relief to our kingdom. I mobilised my people to carry out awareness campaigns in the various communities to guard against apathy.
“My council chiefs and I led by example in being vaccinated early. When the people saw that, they were fully convinced that the vaccine is not harmful.
“We made it clear to our people through town hall meetings that the vaccine is safe and is designed to save humanity.
“We equally reminded them how some persons who refused to be vaccinated for poliomyelitis in the past are suffering the consequences of their actions today,” the traditional ruler said. 
According to the WHO Covid-19 Dashboard, Nigeria had administered 4.4 million Covid-19 vaccine doses as at Aug. 31, 2021. Out of that number, 2.9 million Nigerians have been fully vaccinated, according to the NPHCDA.
With a fairly efficient vaccination structure, owing to many years of immunisation against polio, the Nigerian government should activate collaboration with religious and traditional bodies in its vaccination drive.
Experts, including health professionals and public administrators, believe that involving these leaders in advocacy and public enlightenment will lead to more people accepting to voluntarily get Covid-19 vaccination.
Of course, with just a paltry 0.7 per cent of the population vaccinated, the key indicator for any punitive measure for avoiding vaccination will be subject to availability of the vaccines.
However, to achieve the goal of vaccinating 40 per cent of its 200 million population before the end of 2021 and 70 per cent by the end of 2022, Nigeria will need more than availability of vaccines.
There has to be the acceptance and willingness of the majority of its population to be vaccinated.
One of the crucial and effective way to achieve that is to work with religious and traditional leaders.

By: Kayode Adebiyi

Adebiyi writes for News Agency of Nigeria.

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