‘We are de­ter­mined to change the face of health­care’

Dr Ado Muham­mad

Daily Trust - - HEALTH - By Ruby Leo Dr. Ado Muham­mad

is the Ex­ec­u­tive Di­rec­tor of the Na­tional Pri­mary Health Care De­vel­op­ment Agency (NPHCDA). In this in­ter­view, he speaks on how Nige­ri­ans will ben­e­fit from the Uni­ver­sal Health Cov­er­age (UHC) and how it will change the face of health care in the coun­try. Ex­cerpts:

How would UHC ben­e­fit your agency, and how will it af­fect pri­mary health care?

UHC pro­vides health care ac­cess for all Nige­ri­ans, with­out lim­i­ta­tion of fi­nan­cial ac­cess or bar­rier. We have keyed into this. There are two as­pects to uni­ver­sal health cov­er­age: sup­ply and de­mand side. The agency is com­pletely re­spon­si­ble for sup­ply side, and that means for ev­ery 5km ra­dius of where any per­son in Nigeria re­sides, there should be a func­tional pri­mary health care cen­tre. This will in­clude func­tion­al­ity in terms of phys­i­cal in­fra­struc­ture, com­modi­ties, drugs, vac­cine—and the right hu­man re­source at the right time.

The avail­abil­ity of pri­mary health care is strate­gic to us suc­ceed­ing in uni­ver­sal health cov­er­age. With­out a func­tional PHC there won’t be uni­ver­sal health cov­er­age. The de­mand side can only come af­ter we have guar­an­teed ge­o­graph­i­cal ac­cess.

What it means is that we have to work closely with NHIS so that when we take care of the de­mand side, the other as­pect will be han­dled by the NHIS.

What about the qual­ity of care?

It is a ma­jor as­pect of UHC. Even when the sup­ply and de­mand sides are han­dled, it is also im­por­tant that the qual­ity should be en­trenched. We have what’s known as the world min­i­mum health­care pack­age that de­fines the stan­dard of prac­tice, these in­clude equip­ment, hu­man re­sources, and ser­vices in ev­ery PHC and also en­sure that these are reg­u­lated. It also speaks of ex­pec­ta­tions in terms of meet­ing the needs of the cus­tomers. A Nige­rian does not de­serve any­thing less than the best care pro­vided any­where in the world.

Would people in hard to reach ar­eas have ac­cess to these ser­vices?

That’s why we have the 5km [ra­dius model]. For those ar­eas that fall out­side the 5km, it is im­por­tant that out­reach ser­vices will also be car­ried out. That’s why we have com­mu­nity health ex­ten­sion work­ers as­signed to the PHC who go out to the com­mu­ni­ties to carry out ex­ten­sion ser­vices, col­lect data and come back. We also have the prac­tice of vil­lage health work­ers so that ir­re­spec­tive of where you re­side, it is ei­ther you have ac­cess to PHC in­fra­struc­ture or out­reach ser­vices will be car­ried out to meet your health needs.

With the na­tional health bill not yet passed to make fi­nances avail­able, how will this be pos­si­ble?

They are com­ple­men­tary. The pri­mary health­care fund cap­tured in the health bill will com­ple­ment what we are do­ing. It is a move­ment; it is not only govern­ment that will con­trib­ute. We have other stake­hold­ers, pri­vate sec­tor work­ers who would as­sist.

How are ef­forts to erad­i­cate polio in Nigeria com­ing along?

As part of our child sur­vival strat­egy, we are de­ter­mined to stop trans­mis­sion of wild polio virus in this coun­try. Be­tween last year and this year, we’ve been able to re­duce the bur­den of wild polio trans­mis­sion by 57 per­cent. And, it might in­ter­est you to know that there are three types of wild polio virus. We have type one, type two and type three. We’ve not seen a sin­gle case of wild polio virus in this coun­try for 13 months. We have also been able to col­lapse the ge­netic clus­ter and se­quenc­ing of wild polio virus from eight to two. We have also been able to re­duce the sanc­tu­ar­ies of wild polio virus from four to two.

Be­fore now, we had four sanc­tu­ar­ies of wild polio virus trans­mis­sion. We had the Kano-Katsina axis; we had the Sokoto-Zam­fara axis; we had the Yobe axis; and then, we had the Borno axis. Now, we have two sanc­tu­ar­ies: the Borno-Yobe sanc­tu­ary and the Kano sanc­tu­ary. We have also been able to con­fine and re­strict the ar­eas that are trans­mit­ting wild polio virus to BornoYobe and Kano.

You will re­call that over the years, the North-West part of this coun­try was ma­jor epi­cen­ter in terms of wild polio virus trans­mis­sion. The whole of North-Western part of this coun­try is now clean ex­cept for Kano. So, we’ve cleaned up the whole of North-West re­gion, ex­cept Kano. Vir­tu­ally, all other states have been cleaned up, ex­cept Borno and Yobe.

Why not Borno and Yobe states?

The rea­son the two states have not been cleaned up is due to in­se­cu­rity. Be­fore the State of Emer­gency was de­clared, about 17 lo­cal govern­ment ar­eas in Borno could not be re­ally reached. What it means is that chil­dren in the 17 lo­cal govern­ment ar­eas could not be ac­cessed in terms of im­mu­niz­ing them. But, with the State of Emer­gency, we have limited ac­cess to 15 of these lo­cal govern­ment ar­eas, leav­ing two not ac­cessed. We are work­ing with the state and lo­cal govern­ment ar­eas to en­sure that for these two lo­cal govern­ment ar­eas, we use some other pub­lic health in­ter­ven­tions as en­try point to get chil­dren vac­ci­nated in them.

So, by and large, for polio erad­i­ca­tion, we are be­gin­ning to see the signs that come into play when a na­tion is about to stop trans­mis­sion. First, col­laps­ing the ge­netic clus­ter­ing; sec­ond, re­stric­tion in terms of scope; third, the dis­ap­pear­ance of wild polio virus three; and, four, we have only seen two in this coun­try this year. These are signs that man­i­fest when polio trans­mis­sion is about to stop.

And, the global com­mu­nity has com­mended the ef­forts of Nigeria; this cli­maxed with the com­ing of Bill Gates into this coun­try few weeks ago. He came to com­mend the Pres­i­dent for lead­er­ship in terms of child sur­vival strate­gies. He also ac­knowl­edged the good ef­forts Nigeria is mak­ing in terms of stop­ping wild polio virus trans­mis­sion. We are op­ti­mistic that by next year, Nigeria will exit as a polio en­demic coun­try.

Vac­cine lo­gis­tics is quite im­por­tant, how ef­fec­tive is ours?

Im­mu­niza­tion sys­tem can­not be said to be func­tion­ing if you don’t have an ef­fec­tive and ef­fi­cient vac­cine lo­gis­tic in place be­cause ul­ti­mately, what you want is that that prod­uct, vac­cine, should get to Nige­rian chil­dren in a safe and de­cent man­ner.

This can only hap­pen when you have a cold-chain sys­tem that is work­ing very well. We are work­ing to­wards en­sur­ing that we have ef­fec­tive vac­cine sup­ply sys­tem in place. So far, Kano and La­gos are ben­e­fit­ting from our first phase of in­ter­ven­tion. You will be won­der­ing why Kano and La­gos? The choice of Kano and La­gos is not un­con­nected with the fact that Kano and La­gos ac­count for over 50 per­cent of the num­ber of unim­mu­nized chil­dren in Nigeria.

So, if you ad­dress the prob­lem of Kano and La­gos, then, you should have ad­dressed 50 per­cent of the num­ber of unim­mu­nized chil­dren in Nigeria. We set out a ro­bust, real­is­tic cold-chain im­prove­ment plan in Kano and La­gos. In part­ner­ship with states and lo­cal gov­ern­ments, we have been able to reach more chil­dren in Kano and La­gos. We’ve been able to pro­vide additional cold-chain in­fra­struc­ture in Kano and La­gos; we’ve been able to pro­vide so­lar re­frig­er­a­tors in Kano and La­gos.

We in­tend to repli­cate this and ex­pand it to other states. You will be won­der­ing why lo­gis­tic sys­tem? There is a cor­re­la­tion be­tween a work­ing lo­gis­tic sys­tem and im­prove­ment in rou­tine im­mu­niza­tion cov­er­age. Sim­ple in­ter­ven­tion in Kano and La­gos have re­sulted in re­duc­ing the num­ber of unim­mu­nized chil­dren in Kano by about 35 per­cent and in La­gos, we’ve been able to re­duce the num­ber of unim­mu­nized chil­dren by about 30 per­cent.

We will ex­tend the pro­gramme to other states and lo­cal govern­ment ar­eas, na­tion­wide. What it means is that with vac­cine lo­gis­tic im­prove­ment plan, we are go­ing to en­sure that for ev­ery ward in this coun­try, there is a so­lar re­frig­er­a­tor in place. We have slightly lower than 10,000 po­lit­i­cal wards in this coun­try, and we’ve done a vac­cine cold-chain as­sess­ment, we have 6000 wards in this coun­try that need cold chain in­fra­struc­ture. So, what we are do­ing is to pro­vide so­lar re­frig­er­a­tors for 6000 wards in this coun­try. The first phase of this in­ter­ven­tion will be be­tween Jan­uary and March in which we will be pro­vid­ing about 2200 so­lar re­frig­er­a­tor for 2200 wards.

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