Institutional Reform : Health Desk Second Edition

June 1, 2012 § Leave a comment

The saga between the Lagos State Physician Group and the Lagos State Government is finally over. All previously fired doctors were rehired right before other chapters of the same labor group made real their threats to join the struggle. It was a mess and a glaringly evidence of the breakdown of the Nigerian health system. The victim is the patient, 70% of those who simply cannot afford to go to private hospitals since they cannot afford the cost of care there.

So how do we go about changing the system? What reforms will matter in the long run?

We attempt to answer these questions in this edition of the Nigerians Talk Health Desk.

Hezekiah Shobiye continues his detailed and thorough analysis of the health system financing mechanism, with the Part 2 of the Paying for Health Series. His analysis is certainly worth reading and is incredibly timely as it presents the plight of those poor Nigerians whose lives are worse of because of the inefficient health financing system we have in place.

Maimunat Adeomi, a seasoned physician and a Global Health Fellow writes on the institutional difficulties in meeting the Millennium Development Goals 4, which calls for the world to reduce child mortality. This chilling analytical piece shows just how far Nigeria currently is in saving the lives of the most vulnerable, our children.

Speaking of Children, Tayo O writes about the horrors that parents of Autistic Children in Nigerian might face without a proper social and medical support system. Autism in Nigeria does not get its due analysis in our country and considering just how many Autistic Nigerians there are, this is a conversation that is long overdue. Tayo O’s kind and informational piece starts the conversation.

Oyedeji Aderemi brilliantly evaluates the new strategy of reforming the primary health care delivery system in his Doctor’s Note column. It is not good news. There is so much wrong with the entire institutional framework that attempting to reform a part of a rotten whole is likely to result in failure.

I am especially proud of this informative and analytical edition. It improves upon the silence and that is the goal of the Nigerians Talk Health Desk.

Temie Giwa



Introducing The Health Desk

May 15, 2012 § Leave a comment

Health is a prerequisite for development and the current state of the Nigerian health care system does not give any indication that the country’s renaissance is coming anytime soon.  Nigeria boasts the dubious honor of one of the highest maternal mortality rates in the world, child mortality does not fare any better either. Malaria, Polio, HIV/Aids rates are still far too high for comfort. As such, it is imperative for the country to generate new ideas and bring new actors into the system. Something has to change.

This Health Desk is Nigerians Talk’s attempt to start conversations about how Nigeria will gather the will and ideas to change the health system.

In this issue, the current struggle to eradicate polio in the country is debated by 3 prolific analysts. Temie Giwa argues that parents who refuse vaccination be prosecuted in this interesting pieceHez Shobiyeand Maimunat Adeomi both argue for soft power in getting suspicious parents on the same side as the health workers who want to save their children’s lives. Another piece by Tayo O argues for eradicating mosquitoes to save thousands of children and pregnant women who are still dying of Malaria in 2012. Seyi Taylor discusses the current Lagos State doctor’s strike and its effect on the health of Nigerians. Hez Shobiye provides an analytical and accessible introduction to the way Nigerians pay for health care and how that affects their health outcomes. And finally Remi Oyedeji’s Doctor’s Note takes you into the world of a young Nigerian physician, with its attending horrors and moments of grace.

All these pieces aim to educate, explain and analyze how the Nigerian health system got where it is today and how to innovate for better health for all Nigerians.

It was a labor of love, and we hope you enjoy reading and that you will learn something.

Useful Global Health Links 5

May 8, 2012 § Leave a comment

1. The Best Birth Control Ever is called RISUG  (reversible inhibition of sperm under guidance). It takes 15 minutes, it has “no latex, no daily pill to remember, no hormones to interfere with mood or sex drive, no negative health effects whatsoever, and 100 percent effectiveness.” To help speed up the process of RISUG, sign this PETITION & join this MAILING list to learn more about the procedure.

2. A male contraceptive that can help stop the spread of HIV, here comes clean sheets pill.

3. A brilliant and poignant series from journalists from developing countries on sexual reproductive health in their countries can be found HERE. The series was curated by The Pulitzer Center.

4. There are many studies out there about contraception usage and the effects of abortions, but we currently don’t know much about how bodies react when need for contraception is not met. This PIECE evaluates possible research questions.

5. Does Abortion cause long term mental distress? A STUDY from Johns Hopkins finds out that the relationship between these two phenomena is neutral at best. And that there are no mental health differences between women who had abortions and those who didn’t.

Useful Global Health Links 4

April 6, 2012 § Leave a comment

1. Lack of Access to Contraceptives Hurts the American Economy.

2. Community Based Approach Gives Women Better Health.

3. A full history of America’s War on Women.

4. Best Hospital ever designed. 

2 Years Anniversary of Affordable Health Care for America Act (Obamacare)!

March 24, 2012 § Leave a comment

Its the two years anniversary of the Affordable Health Care Act, and here are some of its accomplishment.


Telemedicine & Trauma

March 23, 2012 § Leave a comment

Dr. Rafael Grossman is clearly passionate about medicine and more specifically about getting trauma patient the help they need on time. This Ted Lecture shows his commitment to this ideal and showcases his innovation in pushing the ideal.

Dr. Grossman’s team have perfected emergency telemedicine. Although it is not clear exactly how the idea can be scaled to developing country, I am still hopeful.

Spotlight: The Surgery

March 6, 2012 § 1 Comment

Getting ill in a developing country, if you aren’t from around there, is a very scary proposition. It is even more terrifying if you, like me, work in the health system and are intimately aware of the possible terrifying consequences of giving yourself up to an inefficient system. I help manage seven hospitals and health centers in the southwest region of Uganda, and I absolutely adore my job. I have developed various interventions that help to improve the health services we offer our clients. I have worked on distributing bed nets to cut malaria cases, helped to monitor the growth of potentially malnourished children in our district and developed an integrated supply chain system for the health centers. I also work as a health economist, costing the services of my clinics and looking for partners that can help support our work. That is my job and I love it, until I got ill.

The illness was not malaria, something this health system is fantastic at treating. It wasn’t diarrhea disease either; I stocked drugs for that before moving to Uganda. This was much more serious and I found out that I would be needing surgery. I was referred to a private clinic called The Surgery,located in Kampala5 hours from my base. Fortunately after 2 weeks of hospitalization I was discharged. Although I am doing very well, I have not stopped thinking about my time in Kampala.  I had a few surprises I will like to share.

The very first thing that surprised me was the total cost of the entire surgery and post surgical care. The procedure cost $160 without insurance. In the United States, out of pocket surgery of this type would have cost at least $1,000. While we are all aware of the prohibitive cost of health care in the US, I did not know that the difference in cost would be this great.

The other positive finding was the incredible professionalism of my caregivers. I spent more time with my physician during this episode than I have ever spent with my surgeon in the United States. He explained all that was wrong with my body to me patiently and in a language that I could understand. He took the time to explain each step of the procedure, constantly asking if I understood, and taught me about how my body works. It was as if I had the world’s greatest biology teacher. Perhaps he was an outlier, but I must say that most of the staff members I had contact with were professional and willing to teach. I got the nurses to teach me how to dress a wound and I can now do it myself.

The clinic was also focused on making sure that I didn’t come back with the same problem. They behaved and delivered care to me in a way that suggested a commitment to prevention. In the end, I realized that this little clinic in the heart of Kampala was the model every health system should attempt to emulate. The services were relatively inexpensive, professionalism in care, and finally a focus on educating their clients on how to care for their bodies. This model is what I will call a no-frills approach to delivering services. I did not have to be tested for all possible illness because the physician recognized what was wrong immediately, (which I must add is what he is paid to do). The service was professional and to the point. The cost was not as prohibitive as I imagined at first and overall I know that there is a high chance that I will not be going back to the hospital for the same condition, something I could not have said after many years of care in the United States. This is the standard. Now some will argue that the surgery’s care is expensive for the Ugandan environment and they might be right. However, if we are able to implement a social health insurance models, similar to this one in Kenya, the cost would be much less for the patients. It is surprising that I had to come to Uganda, to access the very best care, and for a much affordable cost.

This is a major lesson for policy makers hoping to create an efficient health system all over the world, not to look to the West all the time, but that great service is already here in the developing world. I believe that if this model of service delivery can be scaled, in addition to a micro insurance system, the health gains will incredible.

So I am healthy and happy and above all, I am newly inspired.

 Cross-posted on the GHC Blog.

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