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The acting Executive Director of the National Primary Health Care
Development Agency, NPHCDA, Emmanuel Odu, in this interview
with PREMIUM TIMES’ Nike Adebowale, spoke extensively on the activities of the
agency, and developments in Nigeria’s health sector in the outgoing year.
He also spoke on what to expect in 2017.
nytimes.com
PT: What
were the key developments in the health sector in Nigeria in 2016,
especially pertaining to the activities of your agency?
Odu: Let me begin with the polio eradication project of the
Federal Government. We can remember that
Polio, which is a highly infectious disease that mainly afflicts children under the
age of 5 years and targets especially the nervous system, has been ravaging Nigerian children for
many years, to the extent that in 2008, a total
of 798 children were paralyzed in Nigeria.
The government, through the National Primary Healthcare Development Agency and
other stakeholders, including development partners, state and local governments worked together seriously, with
the federal government in the lead providing the needed vaccines and technical support in state and local government areas, and brought down the number of children paralyzed from 798 in 2008 to 4 in 2016.
As a matter of fact, for the whole of 2015, no child was paralyzed.
For much of 2016, there were no children paralyzed.
But in August, 4 children were paralyzed in 3 local government areas in Borno State.
The main reason behind this was the fact that, in the security-compromised area as a result insurgency, access
of immunisation programme implementation and access by team members was highly compromised.
So the children there were not reached with vaccines because of the activities
of the insurgents. Because of the gallant effort of the Federal Government under the leadership of President Muhammadu Buhari, the military did
a lot of work and began to liberate communities. With the liberation of this communities, access was
improved for both the surveillance activities with which we detected cases as well as programme implementation. This was how we were able to detect
those number of people.
And the Federal Government mounted a very rapid response, to the
extent that immediately, interventions were implemented not only
in the 3 local government areas, but in other local government areas where we vaccinated a total of 820,000
children under the age of five. That scope of implementation was expanded in the following two weeks
to five states where over five million children were vaccinated in a bid to ensure
that the virus that causes it does not spread beyond that place, and indeed is restricted in that environment.
We also took the intervention to halt the spread of the virus beyond the 5 states to 18 states in the North, including the
Federal Capital Territory where, repeatedly, we vaccinated 31 million children on a number of occasions.
We are confident that with this activities, the spread of the virus has been contained.
As a matter of fact, from that time in August till now,
no other child in Nigeria has been reported paralysed.
And this is attributable to the gallant effort of not just the
vaccination team, but also of state and the federal governments.
I will not forget to mention the role of the military.
They were involved in the planning processes with us,
both at the federal level here in Abuja as well as
in our operations in Borno State. And even on ground in those security-compromised areas,
they provided support not only by accompanying our vaccination team members for physical protection, they also used the members for
their medical call to extend medical services to those security-compromised areas.
And as we make more inroads through the support of the military activities and the vaccination campaign activities, deeper
and deeper, we believe very much that the status which we have achieved now in terms of no paralysis since August will be sustained over time.
IMMUNISATION
Another key programme of the Federal Government is routine immunization.
It is common knowledge that vaccine preventable diseases are responsible for a majority number of deaths that occur in children under
the age of five years. Now, the Federal Government, through the NPHCDA, was able to make available all
the vaccines needed throughout the year 2016. We have been able to
distribute the vaccines needed by all the
states, including the Federal Capital Territory. So throughout this year, we did not lack vaccine in all the states.
And using this vaccine as a matter of fact, our children under
the age of one were vaccinated and I can confess that the coverage
level of the vaccination, based on administrative data, remains above 90 per cent.
Performance was one of the key areas that
we needed to strengthen and in that regard, we trained 11,800 health workers in those areas, in addition to the provision of the needed vaccines.
In addition to that, we provided support to all the states and the FCT in terms of strengthening of the
coaching system. Because the system is a strategy for ensuring the retention of the vaccines to make them
effective. We achieved that first at the zonal and national
level by ensuring that we have effective cold rooms that
are functioning 24 hours. Cold rooms that contain vaccines and these are the ones we distribute to all the states.
All our zonal offices also have cold stores located in Kano for north-west, in Bauchi for north-east, in Minna
for north-central, in Lagos for south-west, in Enugu for south-east, and in Warri
for south-south. We ensured that they remained functional throughout the year and remained effective to be
able to maintain all our vaccines in those states. We also provided support to all the states and FCT to ensure that their cold stores are
in good condition towards ensuring that vaccines remain good for effective administration.
Another component of vaccination has to do with non polio supplemental immunisation.
In this category, we implemented maternal neonatal
tetanus elimination project, whereby we vaccinate women of child-bearing ages in a way of preventing the occurrence of tetanus in the new born as well as in the
mother. Tetanus is a very serious disease condition with high mortality.
In other words, those infected by this disease condition, a very high
proportion of them die. And fortunately, it is preventable,
using the administration of tetanus vaccine. On the routine
system, women who are pregnant go to clinics and get administered with the tetanus
vaccine. It is required that four doses of the tetanus vaccine is
administered to pregnant women. But in the locations where people are at high-risk of this disease, we then employ a supplementary and vaccinate women of childbearing ages.
As a matter of fact, a total of 2 million, five hundred thousand women of childbearing ages
were vaccinated in high-risk states. The
states include Imo, Ebonyi, Enugu, Ondo and some other states.
MEASLES
Now, we also know that measles is one of the causes of death among children under the age of five.
In that regard, for the southern part of the country, we have vaccinated 19.1 million children in the age category of 9 to 59 months; in order
to fill the gap that may be left in the coverage of
measles vaccine. With that, we hope to decrease the incident and
therefore deaths among children under the age of
five from measles disease.
MATERNAL AND CHILD HEALTH WEEK
Another initiative I would like to speak about is the Maternal and Child Health
Week. If you recall, the National Council of
Health approved that essential and life-saving intervention and other
care and services are delivered twice in a year, precisely
May and November every year, to children under the
age of five as well as women.
For the main round, we were able to reach 41 million, 287,000 children under
the age of five with essential intervention, which include Vitamin A, routine vaccine and measures to prevent
women from having malaria. Women were given vitamins, children were de-wormed
by using tablets such as Albendazole. For women, we were able to reach 7,708,000 women of childbearing age across the country.
BASIC MIDWIVES SERVICE SCHEME
We have another project known as Basic Midwives Service Scheme.
You can recall that in the past, we had a Midwifery Service Scheme whereby we deployed in a period of 3 years approximately 4,000 midwives,
nurses as well as health workers. That project came to an end last year.
The Federal Government has been able to clear the allowances arrears
of all the midwives. So as of today, the Federal Government is not owing midwives anymore.
And we are happy to indicate many of them have become permanent employees in the various states as well as the FCT.
The succession programme to that is the Basic Midwives Service
Scheme, whereby we enter into an understanding which has become a national policy that
the Nursing and Medical Council of Nigeria will award completion certificate to basic midwives
who qualify on annual basis. This certificate is
after they had undergone the one year mandatory community service programme.
And that is in partnership with NPHCDA. So the midwives who graduate, we deploy them to various
primary health care centres across the country in a bid to improve services at the community level and to achieve improved
maternal care. So far, we have done orientation session for them in 3 locations, in Abuja, Kaduna and
Benin, whereby we trained a total 1450 basic midwives and deployed them to various health facilities across the
country.
When this batch finishes, next year, we will take a new batch and ongoing basis, will be available
to provide services at the community level.
PRIMARY HEALTH CARE REVITALIZATION
At the centre of the primary health care policy of
the present administration is the National Primary Healthcare Revitalization Initiative.
It is an initiative whereby the Federal Government, through the NPHCDA
and the Federal Ministry of Health, set out to ensure that at least one primary
health care centre in each of the wards across the
country is made fully functional to deliver a number of services to the
people in that ward.
You may wonder how it will be selected. We consider that each of the
senatorial districts would have one. The first phase is
to ensure that 109 plus one are made functional in the first phase of the exercise and the
selection process for this first phase is to select one primary healthcare centre per senatorial district, which means every state has
three for the first batch.
And the FCT which has only one senatorial zone has one
primary healthcare facility, which is located at Kunchigoro,
Gwarimpa ward of FCT. Work on that is ongoing and, as matter of
fact, the infrastructure component of it has been fully done.
Medical equipment are in place and, as a matter of fact,
an ambulance is already on ground for referral services if the need arises.
So by and large, we have commenced with the implementation of that initiative now.
And the state governments are also prepared to partner with us
in that regard, especially in relation to providing the human resources for health.
By the time this is finalised, we expect comprehensive services
to be delivered by way of the world health service package.
The package includes control of communicable diseases, which include HIV/AIDS, malaria and sexually transmitted diseases, improved immunization in all locations across the country.
maternal and newborn care is also part of the package, nutrition is also part of it, so that comprehensive package of services are delivered
towards ensuring universal health coverage for all Nigerians.
To ensure that this package works well, there
are support elements as well. Provision of essential drugs, infrastructure rehabilitation are also
part of it, as well as human resources of health, to ensure that adequate human resources are present to run 24 hours services in those facilities.
PRIMARY HEALTH CARE UNDER ONE ROOF
Finally, we have an initiative known as the ‘Primary Health Care Under One Roof.’ It is an initiative that is meant
to overcome the structural and operational constraints at the sub-national level, especially at
the state level.
Before now, the primary healthcare function is interrogated at
the state level, whereby the ministry for local government
plays some roles in terms of managing human resources or health workers.
And the local government councils that are in charge
of the health facility, they are the junior officers from
level one to six.
The ministry of health at the state level is known for coordinating roles in terms of managing human resources as well as other resources.
We are providing support to the state to have a single unit, a
single agency at the state level that has control over human resources, that will coordinate
primary healthcare activities throughout the state and that structure is known as the State Primary Healthcare Board.
Now, approximately 30 states have established this board.
And the key element of it is that all primary healthcare workers, either the regional workers of local government councils
or state ministry for local government, would be transferred
to the Board. So that the Board assumes responsibility for
the implementation as well as general management of all primary healthcare programmes at the state level.
Efforts is on going to make sure that all states establish this board.
HEALTH ACT
Some progress has been made towards the implementation of the Health Act, which we cannot conclude without speaking
about. The Health Act makes provision for the Basic Health Care Provision Fund, which will be managed by both
the NPHCDA and the NHIS, in terms of providing support to the state towards projects that are defined by the state and local government areas, provided the state or
local government areas provide 25 per cent of the cost of such projects.
The Fund will be used to supplement that so that in partnership
with the state, the resources will be available for implementation of the primary healthcare and then will go further in improving the achievement of
the universal health coverage.
The Act requires that the NPHCDA develops the
guideline for implementation of the Act, with regards to its component of basic healthcare provision fund.
That guideline is being developed and discussions are ongoing at high levels towards operationalising the Act in a time
that won’t be too long.
Now, for polio synchronization, yes the neighbouring countries of Cameroon, Central Africa Republic, Niger and Chad will implement the rounds at the same time with us.
That is the essence of synchronization, so that it will have a wide geographical coverage as well as impact.
As a matter of fact, there is an international committee, the
Lake Chad Basin Committee with representatives from all the five countries.
Our representative from Nigeria is from this agency,
working and ensuring that the government of the countries in the Lake Chad basin implement
in a coordinated way and that has been happening.
As a matter of fact, given that some of our displaced persons
are also across the border, that synchronisation also helped to enrich on the other side of the border by the neighbouring countries; so it’s a great thing.
PT: How are you filling the funding gap in the immunisation programme?
Odu: Yes, there are funding gaps, especially for 2017.
We are working with development partners and other organisations,
not only bilateral governments but also private sector organisations like Bill and
Melinda Gates Foundation, CDC, WHO, towards ensuring that
the funding gaps are filled. And we are optimistic because, for many years, there have been potential
funding gaps. And as the years came by, through the committed
efforts of the Federal Government of Nigeria, those gaps have always been filled, year in year
out. We do believe that, with the commitment of the present administration, working together
with partners, the funding gap is likely to be filled.
The government of Nigeria has not failed in terms of
securing vaccines for children each year and we believe that 2017 will not be different, especially with the commitment
of the present government.
I will also like to say the fund budgeted for polio eradication initiative for 2016,
the federal government of Nigeria released that 100 per cent and that is why we
are making the progress we have made. We have reached so many children to protect them from this disease condition.
PT: How do you intend to source funds for revitalisation of the Primary Healthcare Centres, PHCs?
Odu: You know there are different stakeholders in this.
The Federal Government provided the guideline as well
as support, including financial resources. But we also have development partners who are committed to the initiative.
By the programmes they implement in support of the various states, we
know that they are willing to work with the government to ensure that this initiative is implemented
in the states where they are working. A number of
state governments are also committed to providing funding
support to ensure that it is also implemented in their states under the
general coordination of the Federal Government.
UNICEF is also supporting some states. I know that UNICEF has a programme that supports the government
of Kebbi, Bauchi, as well as Adamawa states. The World Bank is already supporting
Nasarawa, Ondo as well as Adamawa states. That programme is also
going to expand to five additional states in the north-east.
They have a good degree of commitment towards the achievement of this PHC revitalisation,
ensuring that at least one healthcare centre is functional in a ward.
With Federal Government taking the bulk of the support, and with collaboration of these development partners,
the Federal Government will be able to achieve it and support the state governments.
PT: Is there a plan for manufacturing vaccines in Nigeria?
Odu: I will like to mention to you that the Federal Government
of Nigeria is one of the very few governments in Africa that put funds largely
into vaccines and we must applaud the effort of the government in this regards.
Routine vaccines are largely procured by the Federal Government of Nigeria, with strong support by the Global Alliance for Vaccines and Immunization, GAVI.
In terms of manufacturing, yes discussions are ongoing and it is
one of the priorities of the Federal Government now to initiate the processes
and set up the mechanisms for local production of
vaccines. If we are able to do that, it will also help not only Nigeria, but other neighbouring
countries of West Africa and even beyond. Because the logistics
of them getting vaccines from Nigeria will be less capital intensive,
compared to when they get it from somewhere far and other continents of the world.
So as a matter of fact, the business case
for establishing the facilities and initiating the local vaccine manufacturing is already ongoing.
The business case is being developed, the process has begun,
consultants are in place. And not only the NPHCDA and the Ministry of Health, but the Ministry of Science and Technology are also in partnership with us in this regard.
We look forward to achieving that status of local production of vaccines that our children need across the country.
PT: Is there any introduction of new vaccines
in the country?
Odu: Yes. The Federal Government of Nigeria through the NPHCDA has introduced
new vaccines, pneumococcal conjugate vaccine (PCV), and
that targets one of the living causes of death among children under the age
of five, which is pneumonia or respiratory infection. That is also being scaled up across the
country now.
Another one is inactivated polio vaccine, which is the injectable version of polio vaccine.
That is also being introduced. As a matter of fact, in the rounds of polio campaign that I mentioned earlier, millions of dozens
of the inactivated polio vaccine have been used already in the north-east of the country.
In sustaining the case of Borno State, the Federal Government is committed
to ensuring that polio is wiped out of Nigeria. In a similar way, the Borno state government is also committed.
Other stakeholders working in partnership with the Federal
Government through NPHCDA are also committed, and one of the ways of ensuring
the sustainability is in the part of funding.
The Federal Government of Nigeria is prepared to provide adequate funding, judging
by the provision of the executive submission of the 2017 budget or appropriation.
PT: Apart from the Boko Haram insurgents, what other challenges do you face
in eradicating polio?
Odu: The principal challenge in eradicating polio from Nigeria is the security-compromised area.
Otherwise, the technical teams are prepared to work, our partners
are supporting us, the Federal Government has mobilised resources and is mobilising resources for continued
implementation of this very important initiative.
go.com
And by and large, I will also remember to tell you that from 2008 where I mentioned that 798 children are paralysed, from that time till now, we have been able to prevent approximately 5700 children from being paralysed.
And how that was arrived at is, taking the 798 children paralysed in 2008
as a baseline. If that trend had continued up till date, and
then considering the progress we have made by reducing that number, when that comparison and analysis are made, we arrived at the fact that we have protected
at least 5700 children across Nigeria from being paralyzed.
That is the ultimate outcome or impact of the polio eradication initiative in Nigeria.
In addition to that, the infrastructure for polio was also used to control
Ebola. When there was Ebola outbreak in Lagos, the
whole world was panicking. The country was in the state
of panic, but the infrastructure for polio was used.
Here is my blog post: Yohaig
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Sonntag, 7. Juli 2024, 12:47
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