A new dawn for Health in Nigeria?

With bated breath I waited for the results of the elections,it was a close call between the two candidates. What a relief! To hear that General Buhari won filled me with hope, not because I think he is the best we have, however he is the best we could come up with... there were some developments during his previous regime from 1983-1985;most noticeable was the discipline and order which ,made life easier. I also don't have any personal issues against Mr Goodluck, however,he did not fill me with any confidence and I didn't perceive that 'leadership essence' from him; those who know him personally may have a different opinion.If he was effective,it didn't show and his PR team were not helping.

My main interest is seeing the Health manifesto achieved and since both parties launched their manifestos, I have paid close attention. As the All Progressive Congress (APC) have won the Federal elections, my focus will be looking closely at this and offering my opinion. Over the next few weeks, I aim to dissect each point. I'd welcome views and evidence for or against.

The first priority for APC is to reduce infant mortality to 3% by 2019. Infant mortality rate (IMR) is the number of deaths of infants under one year old per 1,000 live births. This rate is often used as an indicator of the level of health in a country.

I struggle with the expression of the statistic as a percentage to start with.Are we talking about 3% of 74?I would value the opinion of my public health colleagues to delve more into this expression.Using a standardised measure will certainly help.

The current IMR in Nigeria is 74/1000 (ranges between 65 and 74 depending on which source you believe).To put it in perspective,Nigeria is 16th highest out of 221 countries with most of the countries in the top 20 being African;the picture is dire.It is time to drastically improve and take our place as a leading light in Africa and the world.

I recently worked with my team to reduce the IMR in my area from 7.5/1000 to 5.1/1000 over over 3 years. This required a very aggressive, multifaceted and consistent campaign to tackle all the contributing factors.In my experience,the biggest challenge was understanding health beliefs that had been held for centuries and beginning to work with them to achieve a compromise.There was also maternal obesity,smoking to name a few.

What sits behind the very high IMR in Nigeria? (we won't even delve into deaths in under 5's which is one of the highest worldwide). Some of the factors in my particular experience will no doubt be shared by different areas of Nigeria,however various local research have attributed illiteracy, home births, poor roads and lack of medical facilities as contributing factors. There is also a huge variation according to geo-political zones and whether the area is rural or urban.

General Buhari has pledged to: • Unveil a health sector review policy to ensure efficient and effective management of our health systems with focus on prevention. • Ensure that no Nigerian will have any reason to go outside the country for medical treatment. • Guarantee financial sustainability to the health sector and minimum basic health care for all. • Review occupational health laws and immediately commence enforcement of the provisions to reduce hazards in the work place. • Partner with State Governments and development partners to ensure all-round implementation of our primary health plans by expanding access to health insurance for rural communities.

The pledge General Buhari has made may be the key to start to reduce infant mortality in Nigeria.So many promises have been made and I hope this is not another wild goose chase.There are enough brains locally and in diaspora to implement necessary changes. An urgent review is needed by each individual state as the contributing factors are very different across geopolitical zones.

There are certain must dos' but by no means exhaustive including

• Data collection supported by strong information technology systems that can talk to each other.I recently asked a number of Public Health specialists where I could access a Nigerian health database and came up with nothing! The world health organisation appears to know more about our health than we do.A culture of data collection at all levels is crucial.

• Audit and research.We need to start to understand what works,tweak our interventions and then check again.The audit cycle is continuous.We have world class universities that have been downgraded on the world stage,let us start to use our undervalued specialist to assess our interventions.

• Training and Clinical Governance at all levels and not just doctors and nurses.I have used the training of community leaders,neighbours to get the message across.There are methods that work.Organisations are held accountable for keeping their staff trained and improving and safeguarding the quality of Clinical care.

• Regulation and holding to account.How effective are our medical councils in highlighting poor practice.

As the eternal optimist,I sense that we are on the cusp of change.We all need to be committed to the change we seek.I hope the Health leaders can get to work immediately,there is no time to waste.If we can reduce infant mortality rate by 15% (74/1000 to 62.9/1000) in 5 years then I would say the administration has been successful.

#Nigeria #health