Hpt july-oct

Mediating Doctors' Strikes
in Patients' Interest: What
Should the Media
Do Better?
July-October, 2015
AfDB incoming
top boss: Africa’s
Regional
Integration for
Shared
Prosperity
Living with sickle
cell disease in
Nigeria and the
UK: the big
difference
Learning to breathe
in New Delhi: why
Nerandra Modi
should do more for
Indian health by
bringing air pollution
to safe levels.
Akinwumi Adesina
Conquering
culinary fears,
one recipe at a
time: how
to make
coconut
rice with
fun
Sisi JemimahFunmi Williams
Health Politics&
Today...exploring the interface
1st
io c
eh
c
Agrima Raina
The politics of health workers’ strike in Nigeria: corruption, insincere government and overbearing unions
NMA vs JOHESU
in this issue
Clinical Blues IX
Dami Ajayi
Art+Health
Notes on
Africa
UK
India
Yummy Kitchen

Making our health system
work for the people
uman resource is the most important factor in any He discusses those issues the media often fail to adequately
institution. It is even more important in a health deal with when reporting and the way forward. Would
system since it deals directly with human life and Nigerian medical doctors play the spectator on the globalHhealth. Now that the highly esteemed Buhari stagewheremedicalpracticeisadvancingbythesecond?
administration has been sworn in, we ask: What is the future
of health workers' strike in Nigeria? It is imperative that Olusola Orimoloye is bothered by the fact that doctors in
issues affecting human resources for health in Nigeria must training waste ample time going on strike and attending
once and for all be addressed by the Buhari administration if union/solidarity meetings when their colleagues in other
any progress must be made in the Nigerian health system climes continue to roll back the frontiers of medicine. He
under his administration. In this issue, we take on a problem describes in vivid terms the deleterious effects of strikes on
that has effectively brought the Nigerian public healthcare residencytrainingofdoctors.
system to its knees –incessant strikes embarked upon by
variousunionsinthehealthsector. We have introduced a for
you via our partnership with sisijemimah.com. Do you know
It is impossible to quantify losses incurred by the Nigerian howtomakecoconutfriedriceorhaveyouhaditbefore?Sisi
people and government as a result of lack of effective Jemimah is a fast growing Nigerian and African recipe
leadershipinNigeria'shealthsector.Frequentlethaldosesof developer,helpingwomen(andmen)conquerculinaryfears.
industrial strikes are a major factor contributing to She narrates meal making in simple, clear sentences with
unacceptable health outcomes in Nigeria. It is equally true to colourful and sharp pictures. You'll find out how to prepare
say they are symptoms of poor governance and failure of coconutfriedricesoon.
leadership within the health system. But what are the
underlying causes? Who are the key players? And where is Our South Asia editor Agrima Raina tells us how doctors'
thebattlefield? strike in India is often fuelled by assault on doctors by
frustrated patients and their relatives. She suggests a review
The key players are the Government (especially the Federal of medical curriculum to address lack of communication
and State Governments); Nigerian Medical Association skillsamongIndiandoctors,amongothermeasuresthatmay
(NMA), umbrella body of Nigerian medical doctors; and the be put in place to check the situation. She also warns that
Joint Health Sector Union (JOHESU) which is an while Delhi is enveloped in a highly polluted air leading
amalgamation of unions of health professionals such as respiratory diseases for many, the Indian government
physiotherapists, pharmacists, nurses, optometrists, response is abysmal. She also discusses poor sanitation and
medical laboratory scientists and other cadres of health open defecation in India, a major public health problem for a
workers such as community health workers, pharmacy country that has excelled in technology, pharmaceutical and
technicians, medical records etc. The public hospital is their manyotherfields.
playingfield.
Temitope Ojedokun says the government and health
Opeyemi Akindele presents insightful analysis and professionals must act now to stop disrespectful maternal
commentary which revolve around the triangle of treatment during delivery. She points out that hurtful, non-
[inadequate] health funding, government insincerity, and dignifying treatment of women at child birth poses
health workers unions' legitimate and unreasonable significantbarriertoaccessinghealthcareamongwomen.
demands. He hopes to tackle issues on power tussle and
equalopportunitiesinsubsequenteditions. There are many more interesting contents for your
consumption.Wehopeyouenjoythisedition.
Wole Oladapo takes the media perspective, showing how
the media can better mediate doctors' strike in patients'
interest. He argues that the Nigerian media should take a
holistic perspective when reporting health workers' strike.
Yummy! new and exciting session
Submit article, comments, enquiries, advert to:
editor@literamedianetwork.com
Individual authors own the copyright of their essays or pictures. Where we provide health
information, it is no substitute for expert medical advice or consultation although we try hard to
ensure we provide accurate information. The contents and opinions expressed in this publication
belong to the contributors or various news sources we use, and not the official position of Health
and Politics Today or Litera Media Network Ltd.
Editor’s Note
health & politics today, July/Oct 2015

our team
3
Temitope Ojedokun (B. Pharm)
Managing Editor
Wole Oladapo (B.A., M.A.
Communication & Language Arts)
Development Communication
Olusola Orimoloye (MBBS)
Contributing Editor
Agrima Raina (BDS)
South Asia Editor
Opeyemi Akindele (B. Pharm., MPH)
Editor/Publisher
contents
5
8
news + updates
Ebola updates, WHO, African
Development Bank, Healthcare,
Pharmacotherapy
Coconut fried rice recipe,
Diabetes and microwave,
kidney health
food + health tips
11
15
24
32
29
25
cover story
women’s health
afristory
interview
art + health
13
16
Disrespectful maternal treatment
during childbirth
Dr Akinwumi Adesina:
transforming Africa
Olu Onyimadu
Funmi Williams Olaosebikan
Notes on Dami Ajayi’s Clinical Blues
Series: The Redemption of Dr Bode Johnson
Design & concept by Litera Media Network
info@literamedianetwork.com
http://www.literamedianetwork.com/got-enquiries-or-business/
https://ng.linkedin.com/in/opeyemiakindele

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5
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news + updates
nfortunately, contrary to the wish
of Professor Oyewale Tomori, a
foremost veterinarian andUvirologist from Africa, Ebola did not wait
till another “10 years” before it rears its
ugly,deathlyhead.
leave. The African countries will be are enmeshed in other
left not really knowing what has battles – misuse of EVD
happened to them. Like someone hit funds and the inability to
them smack in the face, totally fully utilize aid and
disoriented. There will be millions of resources donated by international agencies.
scandals about how money was Therefore, is Africa prepared for the next
misspent and so on. We will focus on epidemic? Has Africa learnt important lessons
At the International Meeting on those and move on. Ten years from now, from the current EVD outbreak in West Africa?
Emerging Diseases and Surveillance in people will have forgotten that there was Will Africa still be helpless and totally dependent
November 2014, Tomori was Ebola and we will be back to where we on international agencies for assistance to
interviewed by Kai, a contributing started. control any future epidemic? Will the scientists
correspondent for Science magazine. The and governments of the developed world
professor was reportedly angry at how African In May 2015, the former Regional Virologist continue to so control the processes of a
leaders were unable to use their own resources for the WHO Africa Region published an sustainable global disease surveillance system,
(human and capital) to contain Ebola. He hoped article in BMC Central, having patiently leaving no meaningful role for participants from
that the WHO African region would not be in a laboured and waited to see the end of the thedevelopingcountries?”
helpless situation when/if Ebola reappears in worst Ebola outbreak in West Africa. He
the future, as enough lessons should have been titled his article: Will Africa's future Unfortunately, African leaders and health
learnt by African governments in the last 40 epidemic ride on forgotten lessons from authorities have not had time to reflect on the
yearsofEbolaoutbreak. the Ebola epidemic? Obviously indignant, last and most devastating Ebola outbreak and
in the conclusion of his thought-provoking the issues raised by Professor Tomori before a
When asked if he thought the unprecedented piece, he spewed a barrage of questions all new Ebola case was confirmed in Liberia on
outbreak would change things, here is what the over the continent and elsewhere –at June 29 when routine surveillance detected a
Professorofvirologysaid: whomeveritisthatcares. newconfirmedcase –thefirstsinceMarch20.
I wish I could say with confidence that in 10 So, don't let off your guard. Have a high index of
years'timewewillnotbewherewearenowwith “Even as agencies, foundations, governments, suspicion. Wash your hands often –hand
Ebola. But the countries have totally lost control and institutions outside Africa are holding washing remains the most effective way of
of what is going on. If you go to Sierra Leone or meetings to assess the lessons learnt from the preventing infection generally. Aviod touching
Liberia today, there must be at least 10 EVD disaster and map out strategies for the dead and direct anyone with high fever to
international groups there. At the end of this better response and control of future thehospital.
epidemic, everybody will pack their bags and epidemics, EVD devastated African countries
Ebola is back in West African Liberia!
Growing health literate kids
1
2
3
ealth & Politics Today celebrated
2015 Children's Day (May 27)
with Nigerian kids. We took theHopportunitytoencourageparentstohelp
their children cultivate health eating
habits by providing them with adequate
fruits and vegetables and teaching them
the benefits of eating more fruits. Fruits
contain lots of vitamins and minerals
needed by children for normal
growth, strong immune
system, strong teeth and
bonesetc.
r Akinwumi Adesina has been elected President African Development Bank
(AfDB) on 28th May during the development bank's 50th Annual General
Meeting. He was born on February 6, 1960. Dr Adesina was Nigeria's MinisterDof Agriculture and Rural Development under former President Goodluck Jonathan’s
administration. From September 1, 2015 Akinwumi will succeed Dr. Donald Kaberuka,
Rwandan and current AfDB president who was elected in July 2005 and re-elected to
second term in 2010.
Dr Adesina, an alumnus of University of Ife (now Obafemi Awolowo University) holds PhD in
Agricultural Economics, Purdue University, USA (1988) – Awarded the Most Outstanding PhD Thesis.
Masters in Agricultural Economics, Purdue University, USA (1985)
Bachelor's degree (1st Class Honors) in Agricultural Economics, University of Ife, Nigeria (1981).
Mr Akinwumi has made important reforms and achievement in the agricultural sector as a key player
under the outgoing President Goodluck's administration and Transformation Agenda. Nigeria's
President Muhammadu Buhari, who was sworn-in on Friday 29th May is key to the emergence of
Adesina as AfDB top boss for the next 5 years.
Buhari, in the build up to the AfDB election asked Atiku
Abubakar, former vice-president of Nigeria to use his
influence and contacts across Africa to ensure majority
support for Dr Adesina among delegates who were going to
vote at the AfDB general meeting.
Dr Akinwumi Adesina emerged the winner among
contestants with impressive pedigree and who are well-
qualified as well:
Sufian AHMED: Minister of Finance and Economic
Development of Ethiopia
Jaloul Ayed: Former Minister of Finance, Tunisian Republic
Kordjé Bedoumra: Minister of Finance and Budget,
Republic of Chad
Cristina Duarte: Minister of Finance and Planning, Cape
Verde
Samura M. W. Kamara: Minister of Foreign Affairs and
International Cooperation, Sierra Leone
Thomas Z. Sakala: Zimbabwean and retired Vice-
President, Country and Regional Programmes, AfDB
Birama Boubacar Sidibé: Malian and Vice-President,
Islamic Development Bank, Jeddah, Saudi Arabia.
AFDB welcomes new top boss!

7
6
4
news + updates
WHO releases new guidelines for
prevention of neural tube defects NTDs
6
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HO has issued new guidelines for folate Good sources of folate
concentrations for women of include:
reproductive age. Each year, about AsparagusW300,000 babies worldwide are born with neural Bell peppers
tube defects (NTDs), but adequate daily Broccoli
consumption of folic acid before and during early Brussels sprouts
pregnancy has been shown to significantly reduce Cauliflower
t h e r i s k f o r N T D s . Chickpeas
The new guidelines state that at the population Fortified breakfast cereals
level, red blood cell (RBC) folate concentrations Liver
should be greater than 400 ng/mL (906 nmol/L) Okro
in women of reproductive age to achieve the Peas
greatest reduction of NTDs. Suggesting that 5mg Seeds & nuts
o f Fo l i c a c i d p e r d ay i s s u f f i c i e n t . Spinach
Although no serum folate threshold is
recommended for prevention of NTDs in women
of reproductive age at the population level,
In addition, microbiological assay is
recommended as the most reliable choice to
obtain comparable results for RBC folate
c o n c e n t r a t i o n a c r o s s c o u n t r i e s .
(Source: Morbidity and Mortality Weekly Report
(04/24/15) Vol. 64, No. 15, P. 421 Cordero, Amy M.;
Crider, Krista S.; Rogers, Lisa M.; et al.)
RBC
folate thresholds can be used as an indicator of
folate insufficiency in women of reproductive age.
t Health & Politics Today, our commitment is to put healthcare
issuesandpolicyonthepoliticalagendaandmakethemamatterof
public debate. A bane of poor healthcare delivery in Nigeria is theAfact health authorities and professionals are largely unaccountable to the
patientsandthegeneralpublic.So,wehostedourfirste-conferencewhere
weengagedthreeemergingleadersinhealthpolicyfromNigeriaandIndia
to thrash out the question: “How do we evolve an accountable healthcare
system founded and funded to serve the patient?” Seye Abimbola, Laz Ude
Eze and Agrima Raina
discussed the concept
and practical issues of
accountability focusing
on primary health care.
Ac c o rd i n g to S eye
Abimbola, doctoral
s t u d e n t i n H e a l t h
S y s t e m s & P o l i c y
University of Sydney,
“Accountability is being
o b l i g e d t o a c c e p t
r e s p o n s i b i l i t y &
transparently disclose
resourceusefor&results
of health activities.
A c c o u n t a b i l i t y i s
patients able to
d e m a n d
responsibility
f r o m
providers and having affordable recourse to legal action for
malpractice.” According to Agrima, in order to fix the pervasive
problem of frustrated patients and relatives assaulting and
battering doctors in Indian hospitals, the medical curriculum must be
revisedinordertoarmdoctorswithpertinentcommunicationskillswhile
the government should also increase healthcare funding to increase
doctor-patient ratio. Laz, a public health physician with wide experience
in health programmes strengthening, emphasised the need for every
Nigerian to take interest in how health facilities function and be
aware of minimum healthcare package as stipulation in primary
health care policy in order for them to be able to make demands for
excellentserviceprovision.
n the 8 May 2015, WHO released its biennial
update of the essential medicine list to
include new regime for tuberculosis (TB),Ohepatitis C and cancers. The WHO list usually serves
as a model for governments and health institutions
because of the established quality, drug safety,
efficacy and cost-effectiveness of the medicines
included.
Hepatitis: 5 antivirals were added including
sofosbuviranddaclatasvir;
Cancers: 16 new medicines including trastuzumab
forbreastcancer;
Tuberculosis: 5 more including bedaquiline and
delamanid to target multi-drug-resistant TB.
TB remains one of the world's most deadly
infectious diseases with over 95% of TB deaths
occuring in low- and middle-income countries. So
the hard work is not the medicine list but
ensuring those medicines are actually
available to patients. Some of which
h i g h p r i c e s c u r re n t ly m a ke
unaffordable and thus inaccessible to
thepeoplewhoneedthemmost.
Accountability in healthcare e-conference
Biennial update of the
essential medicine
5
1. The Guardian suggests that Britain recorded its hottest
day in June since August 2003. Temperatures are soaring
across the country and at the popular Heathrow airport it
rosetoabout37degrees.
2. Since June 20th when the extremely hot weather
condition lasting several days began, health officials say
about 100,000 people have been affected in Pakistan,
killing 1 out of every 10 affected individuals. Hundreds of
causalitieswerealsorecordedinIndiaearlier.
3. The World Metrological Organization (WMO) & World
Health Organisation (WHO) have also just published a
global guidance
t o a d d r e s s
Heat–Health and
development of
a p p r o p r i a t e
interventions or
H e a t - H e a l t h
W a r n i n g
Systems. People
have been advised to avoid
working in the sun for too
long, take a lot of water,
make use of available
coolingpointsandtakeany
affected person to a health
facility after giving the first
aid i.e. cooling the victim.
http://www.who.int/glob
alchange/publications/W
MO_WHO_Heat_Health_Gu
idance_2015.pdf?ua=1
Heat Wave Report

news + updates
Consultant Pharmacists Provide Enhanced Long-Term Care Services
medical therapies, Dr. approach tend to play a
Hardestyexplained. more administrative role
within their LTC teams,
These changes have working with other LTC
p r o m p t e d m a n y leaders to make financial and operational
c o n s u l t a n t decisions. In this capacity, strategic
pharmacists to take on pharmacists have been responsible for
a more operational role implementing a number of initiatives focused
in LTC, expanding their on public health, such as drug reevaluation
focus to include both policies and improved electronic health
individual patients and record (EHR) utilization. “The role of a
patient populations. strategic consultant pharmacist is not only to
“With recent shifts in identify problems, but to develop solutions,”any consultant pharmacists are
long-term care, we're starting to see Dr.Hardestyexplained.t a k i n g o n n e w r o l e s a n d
consultantpharmacistsplayamoreactiveroleresponsibilities in the shifting long-M in improving public health,” Dr. Hardesty said. She noted these responsibilities are notterm care (LTC) landscape, allowing them to
“They are partnering with executive and without their complications, however,perform a number of enhanced services.
regional leaders to develop and implement necessitating cooperation between strategicConsultant pharmacists are integral to LTC,
solutionstobroaderhealthproblems.” and tactical pharmacists. “Strategicaccording to Jennifer L. Hardesty, PharmD,
pharmacists can face difficulties inFASCP, the Chief Clinical Officer and Corporate
Dr. Hardesty categorized these enhanced implementing their initiatives, making itComplianceOfficerforRemediSeniorCare.
service as either tactical or strategic. The challenging for them to keep up with day-to-
consultant pharmacists who take a more day operations,” Dr. Hardesty stated. “ForAmong other responsibilities, consultant
tactical approach are more involved with them to be effective, they often need supportpharmacists are tasked with reviewing each
direct care, treating patients on an individual fromtacticalpharmacists.”patient's medications and care process, as
basis. In addition to performing medicationwell as auditing the administration and
regimen reviews and patient assessments, No matter which approach consultantstorage of medication. These services
tactical pharmacists put a great emphasis pharmacists take, the enhanced services theyhave become particularly important
on educating patients and implementing are offering point to a greater role for them toas LTC patients are increasingly
cost-saving initiatives. Working “on the play in the future of LTC, Dr. Hardestytreatedinoutpatientsettings
ground” also enables tactical pharmacists concluded. “Consultant pharmacists are
to forge a stronger partnership with other extremely valuable resources,” she said. “As“Each day, there are 1,383,700
LTC faculty members, Dr. Hardesty added. LTC continues to change, their enhancedresidents in nursing homes, and 713,300
“Tactical pharmacists' on-site work allows serviceswillbecomeevenmoreessential.”residents in residential care communities,” Dr.
them to build long-term relationships withHardesty said at the 2015 American Society of
administrators, nurses, and prescribers,” Dr. ByRyanMarotta,AssistantEditorConsultant Pharmacists Forum in Baltimore,
Hardesty stated. “Everyone works together asMaryland. “There's a huge opportunity for
a team, which contributes to a successful LTC Culled from Pharmacy Times. See more at:consultant pharmacists to make a difference
partnership.”in long-term care.” Yet, consultant pharmacy
services have been significantly affected by
Compared with tactical pharmacists,changes in the acuity of residents, lengths of
consultant pharmacists who take a strategicstay, electronic health records, and complex
http://www.pharmacytimes.com/news/Con
sultant-Pharmacists-Provide-Enhanced-
Long-Term-Care-
Services#sthash.hKXeqqeU.dpuf
esearchers sought to project the Annals of Internal Medicine (04/21/15) Vol. 162, No.
population effect and cost 8, P. 533 Odden, Michelle C.; Pletcher, Mark J.; Coxson,
effectiveness of statin therapy in PamelaG.;etal.Radults aged 75–94 years. The
intervention was statins for primary The American research shows that
prevention based on LDL cholesterol threshold of cholesterol lowering statins (e.g. atorvastatin -
4.91 mmol/L, 4.14 mmol/L, or 3.36 mmol/L; Lipitor brand by
presence of diabetes; or 10-year risk score of at least Pfizer), if prescribed
7.5%. All adults in this age group in the National for old men and
Health and Nutrition Examination women aged 75-
Survey have a 10-year risk score greater 94years can prevent
than 7.5%. According to the study onset of or death due
results, primary prevention strategies to heart attack and
with statins would prevent myocardial other heart diseases.
infarctions and coronary heart disease S u c h t re a t m e n t
deaths and be cost-effective, as long as would also help save cost of
there is no effect on functional limitation healthcare in addition to
or cognitive impairment. Treatment of t h e a f o r e m e n t i o n e d
all adults aged 75–94 years would prevent benefits. However, in spite
105,000 (4.3%) incident MIs and 68,000 of the potential benefits of
(2.3%) CHD deaths at an incremental cost preventing heart diseases
per disability-adjusted life–year of $25,200. using statins, adverse
A small increase in geriatric-specific effects of the drug in old people (e.g. muscle
adverse events could offset pain affecting mobility etc.) would make all
cardiovascular benefits, the itspotentialbenefitsnotworthit.
researchersnote.
In lay terms:
Cost Effectiveness of Statins for Primary Prevention in Older Adults
7
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image credit: google.com
image credit: google.com
9
8

food + health tips
with Sisi Jemimah
Jemimah Adebiyi is the author
and recipe developer at
sisijemimah.com, a food blog
which features delicious family
friendly recipes with detailed and
carefully illustrated preparation
methods. She is legal case
researcher by day and an
unbridled food enthusiast by
night.
She blogs at sisijemimah.com
Twitter: @sisijemimah
Ican't believe I'd lived almost all my life without tasting Coconut fried rice until earlier this year. I'd always
had a mental image of rice and coconut milk not being a good combo so I stayed away. Anyway, I tried it out
forthefirsttimeinFebruaryandIwassold!
The recipe is pretty simple, very similar to traditional Nigerian fried rice. Most rice recipes require chicken or
beef stock but this one doesn't and you still get the same delicious taste as with stock. To achieve this, you'll
need raw chicken fillet; you'll get more details as you read on. You can use either breast or thigh though I find
thigh absolutely more flavourful compared with breast. Coconut fried rice is bound to be a hit at any party. It
addsclassaswellandswaysfromtheusualJollofriceandfriedricenormpopularatmostparties.
Now,coconutfriedrice,let'sgetstarted!
Ingredients which stands out in fried rice)
3 cups of rice 1 teaspoon minced garlic
2 cups/ 500ml coconut milk 1/2 teaspoon white pepper
1cup raw diced chicken(preferably thigh fillet) 1/2 teaspoon cumin
1/2 cup baby prawns 1/4 teaspoon black pepper
2 tablespoon Coconut oil and 1 teaspoon olive oil 1/4 teaspoon cayenne pepper
1 large carrot chopped 1/4 teaspoon mixed herbs
1/2 small green and red pepper chopped 1/2 teaspoon each Curry, thyme,
1/2 cup green peas Salt to taste
1/2 cup sweet corn 2 Knorr chicken cubes or any bouillon cubes
1/2 small chopped yellow onion you prefer.
1/2 small size red onion (you can use just one type of 1/4 cup desiccated coconut (optional)
onion, I like yellow for taste and red for the colour
ce ok ca
on
m
u
o
t
t
ri
w
c
o
e
h
with fun!
hicc kee nht .etanira
m
1
2
ecirehthsa
w
tos ck klimtunoco
cehtdda
3
o marinate, mix the olive oil,
cumin, one Knorr cube,
black pepper, cayenneTpepper and mixed herbs, let
it refrigerate for at least an
hour. The chicken can be
marinated for as long as
possible though I always
marinate overnight to allow
the chicken soak up the
flavours from the spices better
I'll suggest at least an hour.
After it's been marinated, take
it out, dice it into bits and set
aside.
hen, wash the rice
thoroughly and leave to
drain in a colander.T ext, into a heated pot, add
the coconut milk stock and
Nsome water. It's better to
use fresh home-made coconut milk
for this recipe, it tastes so much
better and creamier.
Also add 1/4 teaspoon curry,
thyme, salt, white pepper, one
Knorr cube and bring to a boil on
medium heat. Stir, add the rice,
cover the pot and let it boil till soft.
8
CONQUERING
FEARS
RECIPE
culinary
at a time
ONE

hile that's boiling, add the
coconut oil into a frying pan
Won low-medium heat. Now,
add the onions, sauté for a minute, add
the garlic and one Knorr cube, sauté till
fragrant. Then add the diced chicken,
one Knorr cube and fry till the chicken
loses its pinkness and turns brown. Add
the carrot, sauté for another minute,
then add the chopped peppers, green
peas, sweet corn, prawns and red
onions. Stir for 5 minutes but be careful
not to overcook your veggies. Switch off
the heat when it's fully done.
The natural flavours of the chicken is
released and then incorporated into the
veggies which then goes into the
cooked rice (Nothing is wasted!).
Cooking it this way creates a juice
which replicates chicken stock and
ends up tasting extra flavourful.
heck the rice at this time, when
the liquid is all dried up and the
Crice soft, stir lightly to add the
fried veggies and chicken. Stir till all are
fully combined. Adjust seasoning and
salt if necessary. Reduce the heat and
steam for a further 2-3 minutes or turn
off and let it steam with the residual
heat……and it's ready.
ext, into a heated pot, add the
coconut milk stock and some
Nwater. It's better to use fresh
home-made coconut milk for this
recipe, it tastes so much better and
creamier.
Also add 1/4 teaspoon curry, thyme,
salt, white pepper, one Knorr cube and
bring to a boil on medium heat. Stir, add
the rice, cover the pot and let it boil till
soft.
food + health tips
with Sisi Jemimah
4
5
Check the rice at this time
Add the coconut oil
6
9
s we round off this session partcanbeusedincooking,themilk, also essential for bone formation and good
on making coconut fried the water, flesh, oil, sugar. The leaves cellhealth.
rice, let's talk coconut. Yes! and husks on the other hand areACoconut palm is one of the usedforfurniture,decorationandas Coconut (and its' milk) contains a type of
very few trees that gives its' brooms for cleaning. Isn't that fat called Lauric acid. Unlike other
entirety for living. Almost all its amazing,nothingliestowaste! saturated fats, Lauric acid is used up more
rapidly by the body and are less likely to be
Coconut milk, which is the key stored as fat. It is also changed in the body
ingredient for this recipe is highly into a highly beneficial compound called
nutritious with commendable monolaurin, an antiviral and antibacterial
health benefits. It is rich in vitamin that destroys various disease causing
B, vitamin C and E as well as organisms.
minerals like iron, selenium,
sodium,phosphorus,magnesium. Although the British Heart Foundation
recommends swapping coconut oil with
Now, let me explain what all that less saturated ones live olive oil, it is now
means. Vitamin C helps boost your thought that consumption of coconut milk
immune system by fighting against may help protect the body from infections.
infections and promoting wound For this recipe we have used both coconut
healing. Vitamin E promotes healthy and olive oil. So you get all the benefits
skin while B and iron helps in blood however…
formation. The other minerals are
Food is ready!
Presentation
Temitope Ojedokun
Ensure you take your 5 portions
of fruits and vegetables daily

10
Kidney disease affects millions of people around the world. It is important for you to maintain
healthy kidneys as it is such a crucial organ which helps your body remove toxic metabolic
wastes e.g. urea, drug metabolites, blood pressure regulation and blood formation via the
synthesis of an hormone called erythropoietin. We present to you some natural fruits/herbs that help
keep your kidneys healthy.
food + health tips
Natural foods that help cleanse your kidneys
eets contain a lot ofbetaine, antioxidants and
Bnutrients that increase
urine acidity. Increase in urine
acidity helps the removal of
calcium phosphate and struvite
whichcancausekidneystones.
1
photocredit:
http://www.ideadigezt.com/
et a glass of warm water. and
squeeze the juice of four lemons
Gintoit.Andyoucanenjoyadrink
rich in citrine, a chemical which
acidifies your urine thereby clearing
your kidneys of substances which may
causepainfulkidneystones.
2
ater is the number one and
readily available kidney
Wdetoxifier. For most people
water is almost free and within reach.
Yet many never take advantage of it to
improvetheirhealth.
How much water should you drink?
Well, 8 glasses of water daily is
generally recommended, but people
living in countries with hot weather
obviouslyneedmore.
One sure way of knowing you’ve had
sufficient water is when your urine is
cleari.e.withoutcolour.
3
nions are every woman’s companion! They
are household seasonings. You can eat onions
Oraworcookedaspartofyourmeal.
Yes, onions are rich in flavonoids notably quercetin
which helps prevent cholesterol deposits in blood
vessels.
A powerful antioxidant, quercetin mops off free
radicals from your system and protect your kidneys
againstcancer.Italsopreventsheartdisease.
Also, low potassium content of onions means they
are kidney-friendly and your kidneys wouldn’t wear
outtryingtogetridofexcesspotassium.
4
Diabetes risk and how you microwave your food
cientists at New York University have plasticmaterials,youincreaseyourexposure
found that harmful phthalate to toxic phthalate as small amounts enters
Schemicals from plastic materials get your food. It is safe to use aluminium wrap
into the food we eat. Phthalates (DINP & andwaxpaper.
DIDP) thought to be safe are used by
industries to strengthen plastic materials, Also avoid washing plastic food containers in
but have been found by Professor Leonardo the dishwasher, because phthalates can leak
Trasande and his colleagues at NYU to be out.
associated with insulin resistance (a risk
factor for diabetes) and small increases in Also, check the recycle symbol on plastic
bloodpressure. containers and avoid those labelled
numbers3,6or7.
Whenyoumicrowavefoodinorcoveredwith

“
Nigerian doctors
had not been
able to make
reasonable
contribution to
healthcare
delivery in the
last two years as
a result of
incessant strikes.
Addressing health workforce crisis and
strikes in nigeria: a policy framework
cover story
with Opeyemi Akindele
11
1
H etc.sincemanydonotreporttothehospitalorhealthcentres.uman resource is the most important factor in any
institution. It is even more important in a health
Barely half of births are attended by skilled health personnelsystem since it deals directly with human life and
(midwives,nurses),andthat'smuchworseintheNorthwesternhealth. Health workforce is the driver of health system
region where only 3 out of 10 women are delivered by skilledperformance and takes the largest share of health budget.
birth attendants on average. Currently, Nigeria is 40% short ofTherefore, it is imperative that issues affecting human
its 2015 maternal mortality target (250 per 100,000 liveresources for health in Nigeria be once and for all be
births), according to the Nigeria MDG 2013 Report. Malariaaddressed by the Buhari administration if any progress
which accounts for 1 in 10 maternal deaths still remains a bigmust be made in the Nigerian health system under his
issue due to poor living conditions, endemic fake antimalarialsadministration. In this essay, I take on a problem that has
and the failure of the government to improve access healthcare.effectivelybroughttheNigerianpublichealthcaresystemto
The only good news that has emerged from theits knees –incessant strikes embarked upon by various
Nigerian health system seem to be the successfulunions in the health sector. My analysis and commentary
eradication of Guinearevolves around the triangle of [inadequate] health
Wo r m i n 2 0 1 3 ; afunding,thegovernmentandhealthworkersunions.
development which,
albeit commendable inHealth system is a complex arrangement of coordinated
itself suggest that we arepersonnel, departments and activities geared towards
decadesbehind.disease management and health improvement. The WHO
defines a health system as “all the activities whose primary
As observed by thepurpose is to promote, restore or maintain health.” There
president of Medical andare three key functions of any health system as delineated
D e n t a l C o n s u l t a n t sbytheWHO:
Association of Nigeria
( M D C A N ) , D r S t e ve·improvingthehealthofthepopulationtheyserve
Oluwole, Nigerian doctors·respondingtopeople'sexpectations
had not been able to make·providing financial protection against the costs of ill-
reasonable contribution tohealth.
healthcare delivery in the
last two years as a result ofUnfortunately,healthsysteminNigeriaisquitefarfromthis
incessant strikes. Or whatideal. Nigeria's health outcomes are among the worst in the
value could a large, butworld, and it contributes the lion's share to many of the
hardly working contingentheart-rending morbidity and mortality statistics in West
of health professionals canAfrica and sub-Sahara Africa. Most Nigerians who seek
add to a people in need ofhealthcare in public health facilities do so because they
their services? It washave no affordable and decent alternative. The level of
without a shred of shamedistrust for health professionals among Nigerians is high,
thatmanyhealthprofessionalsspokeafterPatrickOliverperhapslikeneverbefore.
Sawyer the Liberian-American diplomat imported the
deadly Ebola virus to Lagos in July 2014: “Thank God we werWhile Nigeria has one of the largest health workforces in
e on strike!” That's how bad the Nigerian health system hasAfrica, the state of healthcare is very bad nonetheless. I
gone.Wearenotpreparedtorespondtoemergencieswhetheritmean VERY BAD, at least for over 80% Nigerians who
is an epidemiological threat to the country or a threat to the lifecannot afford decent, dignifying healthcare from private
ofanindividual.providers. In 2000, the World Health Organisation (WHO)
ranked Nigeria's health service performance 187th
In the 21st century where it is unimaginable in many countriesposition among 191 countries in its publication –Health
that health professionals would leave the dying unattended forSystems: Improving Performance- far below many less
even one hour, Nigeria's unions of health professionals haveendowed countries. Today, nothing much has changed.
made an ignoble competition out of industrial strikes whileAccording to the Nigerian Bureau of Statistics, infant
continuing to earn their relatively fat salaries within the civilmortality and under-5 mortality rates are still high,
service. There is no other sector of the Nigerian state, howeverespecially in rural areas where 67 and 105 children die out
rickety, that has witnessed inter-professional wrangling andof every 1000 born alive respectively. There is sufficient
regular industrial strikes that can come close to that of theground to believe that these official child mortality figures
healthsector,particularlythehospitalsector.may be less than the actual number of children who die
daily of malaria, typhoid, diarrhoeal diseases, pneumonia,

it is possible to
r e v e r s e t h i s
terrible trend by
creating a robust
health workforce
p o l i c y w h i l e
executing same
with a sincere
p o l i t i c a l w i l l
across all levels of
government.
Y
ou could count how many days Nigerian health Nigeria, was never implemented as intended –or at least, not
professionals were at work in the year 2014. If their seentohavebeenimplemented.
national unions were not on strike, those at a
particular federal or state institution would be on strike due Moreover, it is fair criticism of the document to assert that
to some local issues with their chief medical nowhere is industrial strike given due attention as a major
director/hospital management. Then their sister unions in militating factor “improving access” to health services or a
other parts of the country would abandon their patients and wildaffronttopublicstewardshipandaccountability.
life-saving duties in order to “show solidarity” for their
striking colleagues. The government is indifferent. Health Since the much touted National Health Bill has been assented
workers are adamant. Who cares about babies who timely by former President Goodluck's administration, it is equally
surgery could have saved from permanent deformity, important for robust and sustainable national human
prolonged pain or even needless death? How about tens of resources for health policy be formulated and implemented.
thousandsofmotherswhorequireregularantenatalcare? Such a document may also be adopted or adapted by state
ministries of health. The policy should
Strikes and union/solidarity meetings address health workers' strike while
constituteasignificantpercentageofthetime encompassing health workforce
resident doctors are supposed to spend in performance monitoring and evaluation,
their training to become medical consultants. health facility performance assessment,
The gap created when pharmacists are on hospital rating/ranking based on clearly
strike is happily filled by charlatans and defined criteria and a working model for
quacks who help helpless patients inter-professional co-operation and
complicate their conditions by giving drugs teamworkamongclinicalprofessionals.
they know next to nothing about. Nurses,
m e d i c a l l a b o r a t o r y s c i e n t i s t s , If the problem of industrial strike is not
physiotherapists, others turn down patients addressed as a matter of urgency, the
and expectant mothers who are always told much hyped National Health Bill would
to access affordable antenatal care in soon join the league of policies and
governmenthospitals. legislations that never made the
differencetheywereintendedtomake.
The tales are endless. Our health system is
weak and terribly so. However, it is possible Some well-meaning Nigerians have said
to reverse this terrible trend by creating a thewaytogoistomakeanyformofstrike
robust health workforce policy while action by health workers illegal. Indeed,
executing same with a sincere political will healthcare is an essential service which
acrossalllevelsofgovernment. should not be denied anyone who needs
it. However, that view would leave health
National Human Resources for Health workers at the mercy of an indifferent
Strategic Plan 2008 to 2012 is a key policy document drafted government or insincere politicians who often fail to meet
by the Federal Ministry of Health (FMOH) under the short- legitimate demands of health workers. A workable policy
lived administration of Professor Adenike Grange. The wouldbeonewhich,ononehand,compelsthegovernmentto
publication was perhaps produced in response to an earlier provide excellent working conditions (not falling below
publication on the state of health workforce in Nigeria set/agreed minimums) and welfare package for all cadres of
published by the Africa Health Workforce Observatory. In health workers without which they may legitimately
principle,thestrategicplanfortheNigerianhealthworkforce withdraw some of their services (and for no other reason);
was designed for “improving on access” (to health services), while demanding accountability, excellent health services
“stewardship and accountability”. Very insightful analysis of andtruecommitmenttoworkfromhealthworkers.
health workforce disparities across geopolitical zones, the
key challenges of recruiting and retaining health Thetimeisnowtostopplayingpoliticswithhealthcare.
professionals as well as practical solutions were discussed.
Sadly, but unsurprisingly, the Human Resources for Health
Strategic Plan 2008 to 2012, like many other policies in
strikes in nigeria: a policy framework
cover story
2
photo:www.lifeway.com
12

13
cover story
with Wole Oladapo
A
s great as the effect that HippocraticOathtakenbydoctors
conflicts of interests In most of the stories, some is sure not a license to take
between medical doctors sections of the Hippocratic Oath medicaldoctorsandtheirservices
a n d a u t h o r i t i e s [the health of my patient shall be for granted. The Oath does not
—governments, ministries, my first consideration; I will provide a cheap tool for
departments, agencies, and maintain the utmost respect for blackmailing doctors. Nowhere in
professional bodies— have on the human life] are often invoked the Oath is it stated that doctors
people, public knowledge of the against the doctors' strike to should be subjected to degrading
conflictsislimitedinmostcasesto describe the action as inhuman and inhuman treatment in the
what the media publish. Even and insensitive to patients' name of service to humanity. If
manypolicymakersarenot better plights. Only careful media do doctors' service is that critical,
aware as they are often manage to condemn the strike their concerns must also be
individuals drawn from fields without casting aspersion on the t r e a t e d a s s u c h b y a l l
other than medicine. That is why practitioners of the noble stakeholders, most especially in
the role of the media in finding a profession. From all indications, timesofindustrialcrises.
lasting solution with a human face this kind of reporting has not
to the nagging problem of medical yielded sufficient desirable What then should the media do
doctors'incessantstrikeactionsis outcomes as the role of the media better? If the justifications
crucial. No other time is this need inresolvingdoctors'strikehasnot provided by doctors for their
more imperative as whatever beenrecognisedasinfluential. strike are considered insufficient
concerns the health of the citizens or unjustifiable, it is not enough to
isamatteroflifeanddeath. Thereisneed,therefore,formedia simply say that. Rather than adopt
practitioners to evolve a reporting an episodic frame in their reports
Duty calls that the responsible style that recognises the rights of (treating each strike as an
media treat health independent event),
issues as important media practitioners need
b u t s a d l y, i t i s to provide an in-depth
problematic knowing analysis of the current
t h e n a t u re t h a t situation in the light of
importance should history.Havethedemands
take. How then can been made earlier? How
the media mediate did the government
medical doctors' r e s p o n d t o t h o s e
strikes such that it demands then? How did
will preserve the the public respond? What
all the stakeholders affected bydignity and interest of the were the views of other
doctors' strike. The media publicprofession and at the same time professionals in the health sector
sphere must serve as a publickeep the citizens at the heart of its aboutthosedemands?
forum where issues leading toreporting?
d o c t o r s ' s t r i k e s a r e There is need to track how the
contextualised in the light ofWhenever doctors in Nigeria situation gets to the present
history, global standards inembark on a strike, the following condition. History provides us
medical practice and standards inare the usual news headline: with a wealth of experience
other professional practices in the“Crisis Deepens, As Lagos Doctors needed to well understand the
health sector. A reporting styleStrike Enters Day Six” and present. If there is a persistent
that pitches doctors against“Nigerian Doctors' Strike Selfish, recurrence of doctors' strike, we
p a t i e n t s , o t h e r h e a l t hIllegal and Unethical Say Nurses”. need to know how different
professionals, governments andThe media often do more to stakeholders have kept their sides
the public will do nobody anydisplay social empathy in their of the promises and agreements
good as it cannot by any meansreporting: they visit hospitals, that suspended the previous
compel or persuade the doctors tointerview patients and caregivers, strikes. This will provide a
shift their grounds when theirand keep a public record of the directionfor'progress'reporting.
demands are not yet met. Thevictimsofthestrike.
There is need, therefore, for media
practitioners to evolve a reporting
style that recognises the rights of
all the stakeholders affected by
doctors'strike.
Mediating Doctors' Strikes in Patients' Interest:
What Should the Media Do Better?
photo:googleimage
1

A
nother important angle to rivalry is responsible for many of health faculties and departments
reporting doctors' strikes is thehavocsthataredonetopatients inNigeria.
p r o v i d e d b y g l o b a l i n h o s p i t a l s . U n t i l t h o s e
standards in medical c o n t r o v e r s i a l i s s u e s a r e This is where the patients come in.
practice. In August 2014, The satisfactorily resolved, we cannot If the public is furnished with
Nigerian Medical Association hope for a functional health sector. detailed and balanced information
released a document enumerating Doctors' strike always triggers about doctors' strike and a proper
the 24 reasons why Nigerian such issues into public discourse. context for understanding and
doctors went on strike. Many The media can appropriate the interpreting the information, the
media outlets made that the opportunities a crisis period offers stage is set for making issues
headline of their stories about the to explore how inter-profession resulting in doctors' strike a public
strike the subsequent days. Most of relationships are maintained in concern. If members of the public
the media outlets that published or functional health sectors to push understand the justifiability of the
aired the story simply relayed the such models to the front burner of demands made by medical doctors,
reasons as hard as the NMA national health politics. For those demands become those of
presented them. This approach is instance, is it the practice the public as well, since the health
not very useful for properly everywhere in the world that only system is designed for the patients,
understandingthosedemands. medical doctors could be CMDs? If thepublic.
it is a national peculiarity, is it
The media can help the If the public lend their
public to understand support to the demands,
how the issues raised by the demands become
NMA are addressed in unavoidable for the
countries with a healthy government and other
health sector. If NMA stakeholders. Then, the
demands that medical fight for a functional health
doctors be paid a sector becomes everyone's
minimum of #100,000 fight. The Ebola outbreak
as monthly hazard in Nigeria reminded us
allowance, the media again that the sacrifices
should tell us what being made by medicalpossible that it be managed
obtains in other climes just as they professionals in the delivery ofpeacefully? How do other
dowiththesalariesandallowances their services are in every sensec o u n t r i e s h a n d l e s i m i l a r
of political office holders. They overwhelming. That some medicalcontroversies in their health
should also examine the criteria professionals had to pay thesectors? Exploring angles such as
used by NMA to arrive at such highest price to save the countrythese will provide us with points of
figures. How do countries with a from the scourge of terriblereference when assessing the
functional health sector manage diseases like Ebola is a call to bothsituations in our health sector. All
residency training for medical the government and the entireof these efforts are important
doctors? Responding to the country to re-examine the honourbecause the world is gradually
demands of medical doctors from a we accord the noble professions.discarding the idea of professional
global perspective will provide all I n s t e a d o f p i t c h i n g t h esuperiority and embracing that of
the stakeholders with clearer stakeholders against one anotherprofessionalinterdependence.
lensesforviewingthedemands. when reporting doctors' strike,
media practitioners should try toMost schools in developed
The most sensitive aspects of find a common ground amidstcountries adopt multidisciplinary
doctors' strike are the issues that conflicting interests and provide aorientation in developing their
concern other professionals in the unitedfrontfordemandingabetteracademic curriculum. If this is not
health sector. The Nigerian health andfunctionalhealthsectorforall.yet the practice, now is the time to
sector is characterised by rivalry set it as an agenda, most especially
among its constituents. Sadly, this for medical schools and other
If the public lend their support to
the demands, the demands
become unavoidable for the
government... then the fight for a
functional health sector becomes
everyone’sfight.
cover story
with Wole Oladapo
Mediating Doctors' Strikes in Patients' Interest: What
Should the Media Do Better?
2
14

esearch on women’s experiences during pregnancy, and particularly during labour shows that women across the world receive
disrespectful treatments. Disrespectful treatments range from neglect, verbal abuse to coercion (like coercive caesarean
sessions) or even spanking and unwarranted episiotomy (an incision between the vagina and the anus). This disturbingRphenomenon can potentially cause a rise in maternal/child mortality from complications in labour when women begin to
substitutedisrespectfulhealthcarewithunassistedorhomedeliverieswithunskilledattendants.
Having served in some government hospitals myself coupled with reports from
friends and families, I have witnessed first-hand how nurses in particular maltreat or
neglectwomeninlabour. Manydon’t showempathyallinthenameofbeingmothers
themselves i.e. they think if they had been through labour, why should another
woman be treated specially. This is not to say that is always the situation, however
disrespectful maternal care is not uncommon in Nigeria and has remained largely
unexplored. Imagine someone who is paid to take care of you raining insults on you
(e.g. “Didn’t you know it would turn out like this when you were doing the thing...”)
when they should be reassuring their clients. I doubt I would be able to paint the
exact degree of apathy on our female labour wards in Nigeria, therefore, I have
inserted a true life story in here, as
Despite growing evidence and reports of poor or disrespectful maternal care, currently there is no international consensus on how
disrespect and abuse should be defined and measured. We need to understand the root of this problem, could it be work stress, poor
attitudes or lack of sufficient staff or lapses in health workers training? Understanding, measuring and preventing abusive and
disrespectful care is a research agenda that remains unexplored. In many instances policies to promote respectful maternal care have
notbeenadopted,areunspecific,andareyettobetranslatedintosignificantaction.
Olutosin Oladosu-Adebowale shares her own
experienceofdisrespectfulmaternalcareinNigeria.
arrived just in time took the baby from
“When the time came for me to deliver At the hospital, there was not a single his arms. I don’t know how, but by some
my first daughter, my maternal doctor. The room was crowded with miracle of God he was able to revive my
grandmother took me aside and told me women in various stages of delivery. We daughter.Relieved,Ifellasleep.
tositdown. were forced to labor on benches, as there
was only one bed. When the baby I woke in a pool of blood—the nurses had
“There is no pain as that of child birth,” crownedatthebirthcanal,womenwould forgotten to stitch my vagina where the
she said. “It is indescribable. Delivery can betransferredtotheonlyavailablebed. episiotomy had been performed. I
only be done by God. Put your faith in recovered after eight days in intensive
him.Asforthedoctors—forgetthem.” A nurse sternly warned me not to push, care.
despite my baby’s insistence on coming
Her words made me deeply afraid for into this world. When I could not take it These horrible experiences happened in
what I was to experience next, and my any further, I screamed and the nurse oneofthelargesthospitalsinLagos.Iwas
mother’swordsonlyconfirmedmyfears. almost hit me. "I told you not to push! No lucky to survive. My daughter, whom we
spaceforyoutodeliver!" named Oluwatobiloba meaning 'God is a
“Has she explained everything to you?” Great King', was lucky to survive. Every
shesaid.“Itwillbepainful.” The pain of attempting to stop my labor day, women are sacrificed at the altars of
mademecryoutinmorepain.Ipulledmy medicalnegligenceinNigeria.
True to their words, my labor was the husband aside and gave him these
most horrific experience of my life. My instructions: "If I die, ensure that you I could quote statistics of maternal
relatives prepared me for the physical take me back to my village for burial. I do deaths in my country, but they would be
pain, but I was not alerted to the not want to be buried in Lagos, or in your useless: official numbers do not
conditions I would meet in Nigeria’s village."Herespondedwithahiss. represent the actual quantity of
healthcarefacilities. casualties we see daily. I call on our
When my baby was finally delivered, she government to commit to proper funding
I went to the hospital to deliver my could not breathe. The nurse looked at and staffing for our health care system.
daughter on April 25, 2002. Pain gushed me straight in the face and said, "Witch, We must all come together to reduce the
out of me like the flow of a river. I you have killed your daughter." She number of women and infants buried in
screamed, expecting soothing handed the baby to my husband and said, thegraveyardsofNigeria”
medicationstoreducemypain,oratleast "She is a still birth. Your wife killed your
soothing words to help me through. child." ByOlutosinOladosu-Adebowale.
Instead, one of the nurses shouted at me: Source:http://www.impatientoptimists.
"Shut up! It is time for you to know that a I began to cry as my husband wrapped a org/
baby’s head is bigger than a man’s scarf around the baby to prepare her for
manhood." burial. But suddenly, a doctor who
Disrespectful treatments of women during :
a major barrier to utility of hospitals for baby delivery
childbirth
Women &
Development
with Temitope Ojedokun
15
“Shut up! It is time for you to know that a
baby’s head is bigger than a man’s manhood."

Allocation to
health dropped
by 17 billion
(approx.
85million USD)
in 2014 to 262
billion naira.
ccording to the United Nations, the ultimate have been enrolled under the National Health
responsibility for healthcare lies with the Insurance Scheme in ten years of its existence
government. Claiming that the Nigerian (2005-2015). However, 60 per cent coverage hasAgovernment has recorded abysmal performance in been achieved in many African countries that
healthcare provision is not a matter of comparing it launched their health insurance programme after
to developed countries such as Switzerland where thelargesteconomyinAfrica.
health insurance coverage is 99.9%. Nigeria fails
woefully even when compared to other African Conversely, politicians know how to take care of
countries. Nigeria's economic prosperity does not their own health at the expense of the public. In May
matchitsgovernment'sshareofhealthexpenditure, 2014, Nigerians were shocked to learn through
which is a little over 20% compared to Egypt and media reports that an outgoing governor (Godswill
South Africa where government spending on health Akpabio of Akwa Ibom state, now a senator of the
average40%. federal republic) and his wife would be getting
annual health insurance coverage to the tune of
Barely a year after the United Nations launched the 100million naira (about 600,000 USD) after leaving
Millennium Development Goals, African heads of office. Knowing they have not made any reasonable
states converge on Abuja from April 26-27, 2001, at provision or funding for a decent healthcare service
the invitation of the former President Olusegun in hospitals, Nigerian politicians almost always
Obasanjo, for a conference where they affirmed chatter private jets or take the next available flight
their commitment to fight HIV/AIDS, tuberculosis to Dubai, India, Germany or other medical tourism
and improve healthcare delivery for their citizens. destinations. This happens in a country where
The 26th point in the Abuja Declaration reads: "we children die because
pledge to set a target of allocating at least 15% of their mother cannot
our annual budget to the improvement of the health afford to pay for
sector". Till date, the percentage of annual budget malaria treatment
that goes to health in Nigeria is less than half of the which often cost less
15%thatwaspledged14yearsago. than 1500 naira (about
6USD).
Governmentspendingonhealthhas,formosttimes,
been around 5% of budgetary allocation since 1999 While health workers
when a democratic government was ushered in. In s o m e t i m e s c i t e
2014,6%(262billionnairaor1.7billionUSD)ofthe government's failure
national budget went to health, over 80% of which to provide Nigerians
is meant for paying salaries and buying petrol and w i t h a d e q u a t e
diesel to power hospitals, research institutes, healthcare as their
health ministry, departments and agencies. Only a reason (or a main
little is left for improving access to healthcare and reason) for going on a
quality of care, purchase of essential medicines, strike, we know that it
provision of new health facilities, diagnostic is only to give an altruistic face to their own struggle
equipment, medical and surgical devices. As a for higher salaries or higher salary competition as
result, the health insurance scheme only covered the case may be. In any case, if health workers'
those in the formal sector –mainly government unions were to fight for better healthcare for
employees who are barely 4% of the entire Nigerians, denying and depriving the same people
population. access to healthcare by refusing to work is not the
way to go about it. It is Nigerians who should go all
The vast majority of Nigerians pay for health care out protesting against an unjust, unfair and
out-of-pocket, accounting for about 75% of health oppressive government while unions of health
expenditure. Private health insurance is purchased professionals and civil societies should champion
for a privileged few who are employed by good advocacy and mediation as they interface between
companies such as multinationals. Of over 160 themassesandthegovernment.
million people, only about 6 million (about 3%)
cover story
Failure of government to finance healthcare
strikes in Nigeria: some key issues
16
1
image:www.idssociety.org

The
mentality is
that when
you work for
the
government,
hard work
isn't worth it.
urthermore, Nigerian health workers go on by poor healthcare service. The poor masses continue
strike because generally they do not earn as tobearthebrunt.
much as they should. As a result, even whenFhealth workers are not on strike, they do not work On other hand, Nigerian senators earn about 1 million
enthusiastically or put in their best. The mentality is USD a year with great healthcare packages while
that when you work for the government, hard work representing a people
isn't worth it. Morale is low as workers are not of whom 70% wallow
motivated. in extreme poverty
–living on less than
Many Nigerians would rather not patronise public 1.25 USD per day-
hospitals because they are repulsed by the poor w i t h o u t s o c i a l
attitudes of nurses and fagged out resident doctors security or health
who shout at their patients. Salaries and wages earned i n s u ra n c e . Wa rd
by a worker have been referred to as "hygiene factors" councillors flaunt
that influence performance, morale, and motivation by their largesse before
Hertzberg, Mausner, and Snyderman in their book The theirconstituencies.
MotivationtoWorkpublishedin1959.
Consequently, the
Health workers in Nigeria earn less than their general feeling among
colleagues in neighbouring countries. A physician health workers is that
employed by the federal government may earn up to if politicians who
$1000 at entry level, a pharmacist or physiotherapist appear to do less, and
earns about $700 per month. Nurses, medical have not improved the
laboratory scientists, others earn even less. Those lot of Nigerians earn
employed by the state or local government generally so much, then the
earn much less. Yet the cost of living -cost of decent government must
accommodation, school fees, electricity etc.- continue have enough in its coffers to pay health professionals
to rise. In order to improve their income, many health whoprovidehealthservicestothepublic,sometimesat
professionals engage in side activities and private the risk of their own lives. Hence, for Nigerian health
practice to the detriment of public service. Since workers strike is the most effective way they can
practitioners are engaged in two ventures none of squeeze funds out of the pockets of an unyielding
which gets their best, even private practice is plagued government
cover story
17
image:Debamboozled
Remuneration lags behind rising cost of decent living
2

t is not uncommon that government's insincerity other. Key factors that will affect how much is available
when it comes to implementing agreements it for the government to spend of health include but not
Isignedwithhealthworkers'unionsleadstostrikes. limited to: rising internal and external debts, huge
spending on fuel subsidy, skyrocketing cost of
WesawhowpoliticalgimmicksplayedbyNyesomWike governance, declining demand for crude oil and
(as education minister) kept university students out of reduction in flow of development assistance for health
school in 2013 when the Jonathan administration (DHA).
failed to execute the agreement it signed with the
AcademicStaffUnionofUniversities. Onewaythegovernmentcanboosthealthfundingsoas
to provide fair, robust and satisfactory
Similarly in the hospital sector, in order to save its face salary/allowances package to all cadres of the health
and stop public outcry, it is not unusual for the Nigerian workforce is via total removal of oil subsidy so that the
government to sign an agreement to pay better salary billions of dollars saved can be invested in healthcare.
packages with striking JOHESU or NMA even when it Also, ministries and agencies serving duplicate or
knows it would not be able to meet the demand or similar functions should be merged while savings in
sustainit. runningcostsshouldbeinvestedinhealth.
Health workers' unions too, who have become However, how much of additional budgetary allocation
accustomed to the cunning of politicians, would only to health should go to increasing health workers'
say they “suspended” the strike whenever they cut any salaries rather than healthcare capital projects may
promising deal with the government. So, by the time need to be debated, especially in a situation whereby
the going gets tough and the promised salary packages NMA and JOHESU continue to competitively demand
or due allowances are not delivered, the unions soon forhighersalariesoutofjealousy.
makeafreshcallforstrikeaction.
Apart from pervasive irresponsibility among
Noteworthy is the fact that chances are high that the politicians, higher salary demand competition by NMA
government may find it difficult to increase and sustain and JOHESU partly explains why a government bogged
payment of health workers salary while investing down by salary payments may sometimes fail to
meaningfully in universal health coverage at the same implement agreements it signed "under the duress" of
time; and if prudent, evidence-based health economics anindustrialaction.
is not applied, one might be done at the expense of the
cover story
18
Government insincerity in implementing
agreement with health workers’ unions
3
OF CLEAR LANGUAGE IS
THE GREAT
ENEMY
INSINCERITY
George Orwell

he lion's share of government expenditure on community better are not at the forefront of striking
health personnel goes into salaries and unions' agenda. And if they are, they are only used as a
Tallowances earned by health workers in the pretext to give a human face to their struggles. Or how
hospital sub-sector. Yet, shockingly, it is the same canyouclaimtobeonstrikeforaltruisticreasonswhen
hospital sub-sector (which gets the lion's share of our you are depriving the same patients you want to be
budgetary allocation on health) that also goes on strike better served of healthcare, apparently for selfish
for salary related reasons most frequently. What often reasons?
comes as a rude shock to patients and the general
public is that health workers go on strike out of While it is true that Nigerian health workers are not
jealousy. remunerated as much as their colleagues even in some
African countries, it is also true that health workers in
Unfortunately health professionals in Nigeria have the Nigerian government employment are better paid
been pitched against each other by their union leaders relative to other civil servants. Sadly, many health
and associates who do not have the interest of workers have not justified the current level of salary
Nigerians at heart. Doctors under the aegis of the NMA they earn by their input into the health system,
would go on strike with fresh demands should the efficiencyandworkethics.
government agree to a pay rise for nurses, pharmacists,
medical laboratory scientists, optometrists, To address this facet of health workers' strike, the
physiotherapists and other health workers under the government may need to review the various salary
JOHESUumbrella.JOHESUinturnwouldmountthreats structures in the entire civil service (i.e. all ministries,
to shut down all public health facilities all over Nigeria departmentsandagencies).Apartfromusingacademic
shouldthegovernmentappeartocutaperceivedbetter qualification or level of study as a yardstick to
dealwithNMA-medicaldoctors'union. determine what a cadre of workforce should earn, their
respective contribution to the economy should be
It's the same way a kid would ask for more portions measured by experts and factored into deciding how
whenever their mother adds more to the meal served muchshouldoneearnrelativetotheother.
the other child/ren: one group or union contends with
the government that it has agreed to an unfairly robust For instance, the contribution of teachers to improving
salary and benefit package with the other group, national health outcomes has been underestimated
resulting in a strike by the group which felt cheated. over the years, leading to poor remuneration of
And then counter-strike by the other party should the teachers compared to others workers with same
governmentaccedetotheformer'sdemand. university qualification e.g. health professionals. And
within the health workforce, those whose contribution
According to some government officials, the ever rising to national health and the economy has been
demand for higher salaries by health workers is underestimated (hence paid much less relative to
pushingthegovernmentbeyondwhatitcanreasonably othersworkersinthesamesector)e.g.midwivescanbe
afford. Patients' interests and the thirst to serve the adequatelyremunerated.
cover story
19
Unhealthy igher salary
among health workers…
competition for h4
image: www.getrealphilippines.com

SouthAsia
Afestivalofstrikes… Indian Medical Association study divulges ratio might become stiffer in future.
he resident doctors of ten that over 75% doctors experience Moreover, frequent strikes over the issue of
government hospitals in Delhi went workplace violence in India. On the other security would make the matter worse for
Ton one-day strike from 10 am to 4 pm hand, literature reveals other attributing thealreadysufferingpatients.
on 20th February 2015. Over hundred factors such as communication gaps, lack of
nursing homes and hospitals in Panvel, presence of senior doctors and shortage of ImpactofstrikeonhealthcareinIndia…
Maharashtra supported by Association of doctors in the hospital. The proposals to Thousands of patents flocking the
Medical Consultants called a daylong strike inculcate the communication skills module government hospital with a slight hope of
on 6th April 2015. Tamil Nadu chapter of in the medical curriculum have failed to being seen by the doctors is the usual scene
Indian Medical Association along with maketheirwayforward. on days of strike. Some of them might have
its 33,000 members called a 24-hour travelled miles from their villages for the
strike on 2nd May 2015 along with health facilities at the hospital.
3,500 members of Indian Dental These people are often forced
Association by staying away from to stay back until the strike is
duties. Meanwhile, Tamil Nadu Government called out as neither can they
Doctors Association's 16,000 members travel back and forth again nor
supported the strike by working with black they can afford it. On the other
arm badges. Indian Medical Association's hand, most of the emergency
Lucknow chapter called a 12-hour strike on s e r v i c e s a r e u s u a l l y
8th May 2015 crippling the services at all operative. Nevertheless, theMoreover, shortage of doctors continues to
diagnostic and pathology centres, clinics, scheduled surgeries andhaunt the healthcare sector. The limited
andprivatehospitals. outpatient department facilitiesavailability of doctors during night hours,
often remain suspended. Althoughand multiple cases being reported in the
This is a slice from cake of protests and complete shut down for all the healthemergency at the same time have led to
strikes by doctors this year. However, the services for long period is an extreme rarity,brawls in the past. The unavailability of the
important issue is the reason for these but shutting down the usual outpatientsenior doctors for interaction with the
strikes. These different strikes were called s e r v i c e s l e a d s t o c o n s i d e r a b l efamily members of the patient is another
by different groups of doctors in different inconveniencetothepatients.common source of conflict. The junior
states on different incidents but for one doctors reporting the condition of the
same reason, security. All these strikes were Other reasons for health workers'patient to the family are often foreseen as
sparked by various incidents of attacks strike…inexperienced by the relatives and
against the doctors by relatives or friends of Demands such as salary hikes, timelyconsideredassofttargets.
patients for different reasons. The doctor on payment, better facilities, and living
duty at Lifeline Hospital, Maharashtra was conditions, etc. have traditionally being theMeasurestostopassaultandbattery…
brutally beaten on death of a 65-year-old major reasons for strikes by the healthcareFrom time and again doctors have been
woman patient in Intensive Care Unit (ICU) professionals. Health workers and nursesdemanding security in the hospitals to
on ventilator by her relatives. A often complain about the dismal wages.prevent such acts of violence from the
gastroentologist in Allahabad was admitted Whereas, doctors often protest againstgovernment authorities. Escalation in the
toICUafterbeingbeatenondeathof80-year working conditions, equipments, facilitiesnumber of guards for a few days is all what
oldseriouslyillpatient. and policies. However, in this scenario, itthey did manage before another such
would be rather overwhelming if doctorsincidence happens. Although some state
Manycauses… would have been indulging in strikes forgovernments have passed protection bills,
Hospital is a place for compassion, not reasons more than protecting themselvesexecution remains questionable. A blind
collision. The relatives do need to and their lives. At least in those cases,approach from the government might force
understand that it is impossible to assure a reasons like duty, ethical prerogatives,doctors to migrate from this daunting
cent percent success in every medical saving lives could be cited as more thanprofession. With more doctors openly
procedure. Studies indicate unexpected reasonablereasonstocriticisesuchstrikes.discouraging their children to take up this
deaths as the major cause of violent challenging profession, the doctor patient
behaviour from the relatives. An ongoing
Assault on doctors by frustrated patients
and relatives, a major cause of strikes
embarked upon by Indian doctors.
with Dr Agrima Raina
20
...The doctor on duty at Lifeline
Hospital, Maharashtra was brutally
beaten on death of a 65-year-old
woman patient
Photo credit: www.thehindu.com

SouthAsia
Ending open defecation in India:
long way ahead
India's flaw: Agrima tells us why
public health has remained a
casualty despite all the progress in
many of fields.
Photocredit:sunuptimes.com
squatting every now and then at a
considerable distance from the track
defecating in open. This practice is more
grieve for women who simply cannot afford
the luxury to ‘openly’ defecate in open. “We
have to spot where most men are going andessimists claim that world is in a the world but a casual visit to one of the
then go in the opposite direction to find amess. Optimists however differ. Their scores of slums would reveal the darker side
desertedplaceinfieldstodefecate,”explainscontentionisthatprogressinscience, of the picture. India’s financial capital,P Laxmi, a labourer from outskirts of Delhi.technology and communications has Mumbai offers a stark contrast to its high-
The plight of women does not end at findingcomparatively made the world a better rise towers in the slums where people live
suitable place, but fears of privacy andplace to live in. Optimists are right in their like sardines cramped in one shack, making
sexual abuse haunt them every day.own belief. Their belief emanates from their every effort to just survive. For them caring
Meanwhile dangers of snakebites and wormair-conditioned chambers located in highly about health and sanitation is a luxury they
infestations remains to be quite common.developed metros in the world. Obviously, can simply not afford. Kolkata, the cultural
Moreover, many teenage girls drop out ofthey are far from factual realities. The capital of India is no better nor is the IT
schools when they start menstruating duegroundrealitiesareentirelydifferent. capital, Bangalore. Smaller cities are
to lack of toilets taking a toll on educationobviouslyevenworse.
andfutureoftheseyounggirls.The overall living conditions of a very large
number of the people on the planet remain Nearly 600 million people defecate in the
Prime Minister Narendra Modi launched aextremely pathetic, to say the open in India. This lack of sanitation facility
massive cleaning and sanitation campaignleast. This pitiable condition of can commonly cause diarrhoea and
aimed for cleaner surroundings asthe people, who cannot afford
well as build sanitation facilitieseven a morsel of food, makes
throughout the country. Thethe pessimists to conclude that
programmetargetstobuild12millionthe world, is in a mess. Public health is
Toilets in current fiscal year and morea major causality .There has been
than 110 million toilets in next fiveremarkable progress in various fields
years with budget of 600 billionincluding agriculture, medical
IndianRupees.Anumberofbusinessresearch, diagnostic means and
houses as well as NGOs have alsocommunication, to name a few that
intestinal infestations and diseases like pitched in to build toilets in villagesconcern a common person, but sanitation
hepatitis, cholera, typhoid among others. and school. Advertisements haveand hygiene have remained a major
Every minute, more than 1 million litres started rolling on television for thedilemma demanding an imperative and
humanexcremententersthelongestriverof importance of building toilets in everyimmediate solution. That is why public
the country, Ganga. A WHO report claims household. Women organisations havehealth has remained a casualty despite all
loss of nearly Rs.6500 (approx. $104) per initiated campaigns urging women totheprogressinavarietyoffields.
person in India due to highly preventable demand constructing a toilet in the house
diseases caused by lack of hygiene. If beforemarriageifitislacking.To get a clearer picture of the state of public
affluent households having access to proper
health, one has to travel through the dark
sanitation and hygiene are excluded, this However, a more daunting task in theand dingy mud lanes of Asia, Africa, Latin
figure rises to almost Rs. 12,000-15,000 per horizon is change. A change in the centuriesAmerica and other continents and reach an
person. These diseases cause much more old practices of relieving themselves underobjective conclusion. Despite all the tall
than poor health, which is, loss of income. the open skies. Meagre toilet building wouldtalks, sometimes doling out cash incentives
Due to illness, an auto rickshaw driver may probably not solve the problem, or say yes,by international agencies and even the UN
not be able to go for work causing the may be for females, but what about thoseagencies, hygiene and sanitation remains a
worthy daily income, which is quite men who love their freedom in the naturalmajor concern in all under-developed, least
necessary to feed children. Things get even surroundings? They would still be out there.developed, developing and even many areas
worse for the lone bread earners of the Mass media campaigns on importance ofindevelopedcountries.
family adding them to vicious chain of toilet use perhaps would be the next on list
povertyandillhealth. for building clean and healthy surroundingsTake for instance India, the largest
for the future generations. Though, road isdemocracy and a fast developing country,
An early morning walk along the tracks of farahead,atleastthejourneyhasstarted.which has made marvels in space
world’s fourth largest train network, Indian
technology. Indian political capital New
Railways will force you to notice men
Delhi looks like the most developed place in
Nearly 600 million people poo
in the open in India...WHO says
about $104 is lost per head to
preventable diseases.
21

The heart of the
problem…
Manyunansweredquestions?
Indiaindenialmode…
Healthissues
A recent WHO study of
1600 cities in the world
divulges that New Delhi
has the most polluted
air, even worse than
Beijing. The city's
average annual PM2.5
level was whooping
153micrograms per
metre cube of air as
compared to 56 in
Beijing. This figure is
way above the safe limit
of 25 micrograms per
cubic metre of air
within 24-hour time
scale as demarcated by
WHO.
What is even more
alarming is appearance However, the greatest impact on health is due to As result, Delhi Transport Department
of other Indian cities on the list like Patna, long-term exposure affecting the quality of life. introduced one of the largest fleets of eco-
Gwalior, and Raipur with 149, 144 and 134 These particulates can even lead to premature friendly busses in the world –all running on
PM2.5 levels respectively competing with Delhi deaths in people with pre-existing heart and CNG. Due to consistent law enforcement, strict
for the top spot in this pollution race. These are lung conditions. PM2.5 is potentially emission norms were enforced; outlived and
somewhatless-developedthanthecapitalofthe carcinogenic and may cause lung and other polluting vehicles were phased out from city
country with much lesser vehicles and lesser cancers as well. Meanwhile studies also link roads. However, despite all these measures still
urbanisation. excessive PM2.5 exposure to arteriosclerosis running, the pollution monster is back. Delhi is
andevenprematurechildbirths. no more that 'green and clean' and yes, that is
Meanwhile, the financial capital of the country, theuglyorratherpollutedtruth.
Mumbai scored way less than its counterpart However, these excessively high levels of PM2.5
'greener Delhi' with 45 micrograms despite could be linked to ever increasing vehicular If one goes out of the air-conditioned cabins and
being the biggest competitor of Delhiin terms of traffic in Delhi, which alone accounts for about cars to walk along a busy congested Delhi road,
development and urbanisation. However, even 8% vehicles in the country. Delhi boasts of more lungs will definitely tell the reality. Same air that
Mumbai fails to fall into the safe-zone category vehicles than the three metropolitan cities of sustains life has become a massive killer. A
ofPM2.5levels. Mumbai, Kolkata and Chennai put together. As government of India study reveals about 2.63
of March 2015, Delhi has more than 8.8 million million people suffer from Acute Respiratory
PM2.5 level refers to the fine particulate matter registered vehicles in the city, besides vehicles Diseases in the country due to air pollution.
inairhavingdiameterof2.5micrometresorless fromotherneighbouringcities. Global Burden of Disease by WHO identifies air
which are only visible via electron microscope. pollutionassixthmostdangerouskillerinsouth
PM2.5 are generally composed of toxic organic Moreover, Five National Highways pass through Asia with India alone accounting for a quarter of
compounds as well as some heavy metal the Capital, making Delhi as a major trading and its share. Moreover, 15-16% of asthma patients
primarily resulting from automobile smoke or distribution centre in the north. On an estimate, in Delhi are children, which 40 years back was a
burningplantsoryardwastes. 78% fruits and vegetables, 49% fuel and 47% meagre2%.
food grains traded in Delhi are destined for
So, why are these tiny particles important? Well, otherstates.
these particles are so small that they can easily According to a study by Chittaranjan National
penetrate deep into lungs and blood stream and Cancer Institute conducted in 2010, more than
may reach vital organs such as brain, kidney, Amidst this, India is still in the denial mode for 40% schoolchildren in Delhi have reduced lung
liverandspleen. Delhi having the most polluted air in the world; function. These figures raise many unanswered
perhaps due to successful pollution control questions. Are Delhites breathing highly
measures undertaken in the past. Delhi's contaminated air for years? Will they be
Exposure to high concentrations of PM2.5 may compressed natural gas (CNG) revolution a compelledtodosoforyearsorevengenerations
exacerbatetheheartandlungconditions.Short- decade ago along with plantation drives to come? Will most of them have respiratory
term exposures can cause symptoms like cough, definitelyhaditsimpactontheenvironment.All problems sometime in lives? Are they
wheezing, shortness of breath, difficulty in the public vehicles started using CNG or other susceptible to lung cancer more than others
breathing and even asthmatic attacks. Children cleanerfuelssince2001. are? Clearly, cost of pollution control is much
andelderlybeingtheworstaffected. cheaperthanthecostofthepollutiondamage.
Death by : Delhi's killer air.breath
SouthAsia
22

WhatisPM2.5?
Where does PM2.5
comefrom?
H ow i s a i r s a f e t y
measured?
W h a t P M s i z e i s
dangerous?
greatest health risks.
Particulate matter, or PM, Because of their small
is the term for particles size (approximately
found in the air, including 1/30th the average
dust, dirt, soot, smoke, width of a human hair),
and liquid droplets. fine particles can lodge
P a r t i c l e s c a n b e deeplyintothelungs.
suspended in the air for
long periods of time.
Some particles are large
or dark enough to be seen Sources of fine particles
as soot or smoke. Others include all types of
a r e s o s m a l l t h a t combustion activities
individually they can only (motor vehicles, power
be detected with an plants, wood burning,
electronmicroscope. e t c . ) a n d c e r t a i n
industrial processes.
Many manmade and Particles with diameters In addition to air quality
natural sources emit PM between 2.5 and 10 data, EPA guidance on the
directly or emit other micrometers are referred The PM2.5 standards are PM2.5 designations
pollutants that react in toas"coarse." based on averaging air process also discusses
the atmosphere to form quality measurements other important factors,
PM. These solid and liquid S o u r c e s o f c o a r s e both annually and on a 24 including emissions of
particles come in a wide particles include crushing hour basis. The annual pollutants that lead to
rangeofsizes. or grinding operations, standard for PM2.5 is met P M 2 . 5 f o r m a t i o n ,
and dust from paved or whenever the 3 year population, commuting
unpaved roads. Other average of the annual patterns, and expected
particles may be formed m e a n P M 2 . 5 growth, that states should
Particles less than 10 in the air from the c o n c e n t ra t i o n s f o r evaluate in order to
micrometers in diameter chemical change of gases. designated monitoring determine whether a
(PM10) pose a health They are indirectly sites in an area is less than c o u n t y i s a l i k e l y
concern because they can formed when gases from or equal to 15.0 µg/m3. contributor to the area's
be inhaled into and burning fuels react with The 24 hour standard for airqualityproblem.
a c c u m u l a t e i n t h e sunlight and water vapor. PM2.5 is met whenever
respiratory system. These can result from fuel the 3 year average of the Adapted from the US
Particles less than 2.5 combustion in motor annual 98th percentile of E n v i r o n m e n t a l
micrometers in diameter vehicles, at power plants, values at designated P ro te c t i o n A g e n c y :
(PM2.5) are referred to as and in other industrial monitoring sites in an http://www.epa.gov/pm
"fine" particles and are processes. area is less than or equal designations/faq.htm#0
believed to pose the to35µg/m3.
Do you know the of the air in your ?
Here is why you ignorant is not bliss!
PM2.5 city
health
intelligence
Most of us want our country to become an industrial
hub, creating wealth. But when that happens, you may
no longer take innocent breaths. Air pollution is such a
threat to our health.
23
infographic:www.tceq.texas.gov

VISION
Build and consolidate on the remarkable gains already made
by previous Presidents of the Bank and work closely with the
Bank's shareholders to implement its strategic plan to position
the Bank for even greater performance, efficiency and
effectiveness in delivering transformational impact for Africa.
Catalyze and mobilize resources globally for the Bank Group
and the continent through strategic partnerships.
Leverage the Bank Group’s market and concessional windows
to ensure that adequate financial resources are available to all
regional member countries from the African Development
Bank (ADB) and the African Development Fund (ADF).
Nurture first-rate multi-lingual staff at the Bank with the skills
required to usher in a new Africa. The diverse gender-balanced
world-class human resource pool will
comprise of globally respected professionals, and
performance-based incentives will be adopted to attract top-
notch talent.
Foster strong ethics, transparency, good governance and
accountability within the Bank to enable it become known as
“Africa’s Bank for integrity”
Ensure that the Bank adopts a “people-oriented approach”,
able to address and meet the needs of millions of Africans – a
true development Bank for Africa.
Transform the Bank into a “go-to-institution” on development
in Africa, with renewed and strong partnerships with its
member countries, the Africa Union, the Economic
Commission for Africa and the Regional Economic
Communities.
Re-ignite the passion of the Bank’s staff to work diligently and
selflessly to attain the mission of the Bank, to spur sustainable
economic development and social progress in
its regional member countries.
Afristory
Akinwumi Adesina
24
He has dared to offer himself to serve an extraordinary continent. He will
resume as the substantive president of Africa Development Bank (AfDB)
headquartered in Abidjan, Ivory Coast in September 2015. The following are
excerpts from his vision statement.
A
frica’s growth has been uneven. Incidence of poverty remains a challenge across
Africa with about 40% of the population living in extreme poverty. With such a
large share of the population disconnected from the growth process, African
economies face the challenge of growing discontent from disenfranchised youths,
which could lead to economic, social and political fragilities. Private sector growth
faces challenges to fully unlock its potential. Industrialization of the continent remains
low, limiting the space to generate quality jobs. Africa’s challenge is to generate high-
quality economic growth that is inclusive, sustainable and more effective in reducing
poverty and addressing social inequities.
The African Development Bank Group (“AfDB” or “the Bank”) has played major roles in
driving Africa’s development. The Bank Group has become a trusted partner to the
Regional Member Countries for policy and advisory services, development planning,
infrastructure financing and implementation. The Bank’s Strategy for 2013 to 2022 has
articulated the agenda to support the transformation of the continent by improving
the quality of growth – making it shared and more sustainable. If elected as President
of the African Development Bank, I will lead the Bank to effectively implement its
strategy to drive inclusive and green growth for Africa, by focusing sharply on areas of
high-impact, building strategic partnerships and mobilizing resources to deliver
impact at scale.
1. Integrated smart-infrastructure for
p r o d u c t i v i t y g r o w t h a n d
competitiveness: to target and focus
infrastructure projects by considering
the entire development ecosystem for
operational effectiveness, scale,
socio-economic, and environmental impact, while ensuring
green growth.
2. Growing Africa’s private sector for
industrialization and wealth creation: to
grow the private sector to ensure
sustainable economic growth in Africa,
towards a governmentenabled, private
sector-led structural economic transformation in Africa.
3. Jobs for Africa’s youths and women: to turn Africa’s
“demographic dividends” into
“economic dividends” for regional
member states through innovative
programs and investments to shore up
Africa’s human capital, with special focus
on youths and women.
4. Reviving
Africa’s rural economies for
inclusive growth: to transform
and revitalize Africa’s rural
economies through targeted
investments to unlock Africa’s
rich agriculture resources and
value chains and generate
wealth.
5. Regional integration for shared
prosperity: to ensure more equitable
growth and development for all
regional member countries through
transnational infrastructure, expansion
of regional markets, good governance,
peace and security.
Five key interrelated strategic priority

nfortunately, the health sector is management procure used and out-dated Secretary of National Health Insurance
among the least scrutinised for equipment. Go to the back end of the Scheme (NHIS), Dr Femi Thomas said he
Ufinancial mismanagement in hospital to see theft of diesel and petrol had uncovered 100,000 fake patients on
Nigeria. Maureen Lewis, a non-resident meant to power intensive care unit, theNHISscheme.
fellow at the Centre for Global theatres, radiology department etc., thus
Development, wrote a comprehensive inflatingtherunningcostofthehospital. Early in his administration in 2011, the
brief on healthcare corruption and governor of Oyo State (South Western
governance woes in developing countries. It is not unusual to find that several cases Nigeria) Senator Abiola Ajimobi was
While his paper touched on many key of resident doctors' strike are due to their reportedly shocked on uncovering the
issues, corruption in the Nigerian health allowances/salaries being embezzled or number of ghost doctors, nurses etc. on
sector has several peculiarities which denied by sitting medical directors. How thestatepayroll.
needaddressing. can we hope to grow a sustainable and
efficient healthcare system when health Also, in the course of writing this article, a
Since the current administration has been ministers, directors of departments and medical officer working in one of the
living up to its anti-corruption brand, it agencies as well as those involved in the public hospitals in Nasarawa reported
would do a great service to the Nigerian execution of various health projects signingagainstthenameofaghostworker
people by designing sustainable systems (vaccines, malaria control, etc.) help who earns more than double the salary he
which can significantly reduce corruption themselves to a significant percentage of is paid on the payroll. The hospital
inthehealthsector. budgetary allocation and contracts –and management are usually privy to such
even helping themselves to funds donated sharp practices, leaking public funds to
Rather than merely increase hospital by international health agencies such as their insatiable private pockets. Yet same
funding simply because it is easier to UNICEF, WHO, PEPFAR, GAVI etc.? Indeed, hospitals lack the most basic items such as
accept the logic that greater health development assistance for health has cannular, gloves, needles & syringes etc.
funding is necessary, the Buhari become a big opportunity for our health would often lament it does not have
governmentshouldfocusmoreoncurbing authorities and cronies to enrich enough health professionals when the
and checking corruption while improving themselves. huge amount of money they embezzle
efficiency of the current structure. Some every month is enough to recruit
of the key elements of corruption in the Similarly, Nigerian volunteers who additional health workforce and re-stock
Nigerian healthcare industry are traveled to Liberia to help fight Ebola thehospitals.
summarisedinsubsequentparagraphs. complained upon their return that the
DirectorGeneraloftheNigerianCentrefor If all the three tiers of government
Why are even “common” medications out Disease Control Professor Abdulsalami (federal, state and local governments)
of stock in pharmacy departments of Nasidi embezzled the 28 million naira should take a stringent stock and an
public hospitals? Contrary to the which was supposed to be disbursed to investigativeauditofmembersofstaff,the
principles of pharmaceutical needs them as their welfare package. Recently, number of ghost workers as well as those
assessment, hospital management concerned individuals have blownwhistle who illegally collect triple (and more)
–without the know-how or due to bribery that the billions of naira donated to fight salaries will be frightening. Such exercise
and kickbacks- award supply contracts of the short-lived Ebola crisis in Nigeria last and system cleansing can potentially help
drugs in quantities and mix which do not year was misappropriated by the Rapid the government recruit more health
reflect the spectrum of diseases and Response chief of the Federal Ministry of professionals and free more funds for
conditions being managed and the Health. Moreover, Nigerians need to know significantly improved healthcare
demography of patrons in the health that the power tussle between the NMA delivery even at the current rate of
facility. and JOHESU has its roots in corrupt use of spending. And such system audit should
moneyandabuseoftheprivilegesofoffice becarriedout.
Apart from shrinkages due to lack of by health authorities such that JOHESU
inventory automation, the hospital desires more stake in the power One way is to ensure that those to be
management often mismanage the arrangement. appointed as medical directors are
statutory Drug Revolving Fund that is competent and do not have not pay their
supposed to be used for the procurement C a s e s o f e m b e z z l e m e n t s a n d way into the office with huge sums of
of essential drugs for patients. maladministration of hospital funds and money. Also, central professing and
Pharmaceutical suppliers refuse to materials, foreign health assistance on payment of salaries initiated by the
releasemoredrugsbecauseofabacklogof HIV/AIDS, tuberculosis, malaria etc. are Jonathan administration must be
debt the hospital owes them. Also, cases of rifeandaboundinthenewspapers. sustained and applied to all health
shady and shabby procurements of workers on the pay roll of the federal
medical equipment are rife. The Early in March 2014 during the governmentwithoutexception.
government is billed the cost of new and Presidential Summit on Universal Health
latest equipment, while hospital Coverage, the newly appointed Executive
25
cover story
Tackling healthcare corruption in Nigeria:
agenda for the Buhari government 1
photo:www.youtube.com

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