health

UNIVERSAL HEALTH COVERAGE IN NIGERIA: A MEDICAL STUDENTS’ PERSPECTIVE

INTRODUCTION

Health as defined by the World Health Organization is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.  Everyone has the right to be in good health and good medical services irrespective of their class in the economy. The aim of the universal health coverage is to secure access to adequate healthcare for all at an affordable price. What is Universal Health Coverage?

Universal Health Coverage is a health care system that provides health care and financial protection to all citizens of a country. It is organized around providing a specified package of benefits to all members of a society with the end goal of providing financial risk protection, improved access to health services, and improved health outcomes.

 

Universal health coverage is one of the set goals for Sustainable Development Goals (SDGs) that Africa and other countries pledged to achieve by 2030.To monitor the progress of Universal Health Coverage, the focus should be on

  1. The proportion of a population that can access essential quality health services.
  2. The proportion of the population that spends a large amount of household income on health.

World Health Organisation uses 16 essential health services in 4 categories as indicators of the level of achievement of coverage in countries. The 4 categories have different services under them. These include

CATEGORY I: Reproductive, maternal, new born and child health:

  1. Family planning
  2. Antenatal and delivery care
  3. Full child immunization
  4. Health-seeking behaviour for pneumonia.

CATEGORY II: Infectious diseases:

  1. Tuberculosis treatment
  2. HIV antiretroviral treatment
  3. Hepatitis treatment
  4. Use of insecticide-treated bed nets for malaria prevention

CATEGORY III: Non-communicable diseases:

  1. Prevention and treatment of raised blood pressure
  2. Prevention and treatment of raised blood glucose
  3. Cervical cancer screening
  4. Tobacco (non-)smoking.

CATEGORY IV: Service capacity and access:

  1. Basic hospital access
  2. Health worker density
  3. Access to essential medicines
  4. Health security: compliance with the International Health Regulations.

Universal Health Coverage is Sustainable Development Goal 3 and it should not be achieved alone. It must be achieved with other Sustainable Development Goals.

UNIVERSAL HEALTH COVERAGE AS AN SDG

Sustainable Development Goals(SDGs) or Global Goals for Sustainable Development are a collection of 17 global goals set by the United Nations(UN) in 2015. The 17 goals are further broken down into 169 targets. Accomplishing these targets means achieving the 17 goals. The SDGs covers social and economic development issues including poverty, education, gender equity, urbanisation, health, hunger, climate change, environment and social justice.

The SDGs was developed to replace the Millennium Development Goals (MDGs). The MDGs had 8 goals, and it categorised the countries into developed and developing countries. The reason for introducing the SDGs is that countries would use it as a template or a road map for development. The SDGs do not categorise the countries, as all countries are undergoing different degrees of transformation. Thus, even the developed is still developing.

Universal Health Coverage as an SDG focuses on the good health and well-being of citizens of a country.  Progress has been made in the last 25 years before the commencement of SDGs, as preventable child death reduced by almost more than half.

 

UNIVERSAL HEALTH COVERAGE IN THE WORLD

Some countries in the world have started providing health services for their citizens even before the World Health Organisation was established. One of the ways these countries achieved this by providing health insurance schemes for their citizens. For example, Luxemburg in 1901 established compulsory health insurance for manufacturing and industrial workers. Universal Health Coverage does not involve health insurance alone. Germany has a good healthcare system and Nigeria can learn a lot from their success

GERMANY: The German health care system is divided into three major areas. These include the outpatient care, the inpatient care and rehabilitation facilities. The health care system in Germany are based on four basic principles which are

  1. Compulsory insurance: Every citizen must have a statutory health insurance provided that their gross earning is within a fixed limit. Anyone who earns more than the fixed limit can choose to be on private insurance.
  2. Funding through insurance premium: Insured employers and employees pay insurance premium. This premium is also supported by tax revenue surplus.
  • Principle of solidarity: In statutory insurance, citizens pay according to their income. According to the principle of solidarity, the rich that pay more support the poor that pay less so that at the end of the day, everyone receives the same quality of health care service.
  1. Principle of self-governance: The German government set rules and standard for medical care, but further organisation and financing of individual medical services is the responsibility of self-governing bodies which are composed of physicians, nurses, pharmacist and physiotherapist within the health care system

 

UNIVERSAL HEALTH COVERAGE IN AFRICA

Africa is developing and has a lot of problems. Africa has 12 years to achieve these goals and the current look of things, a lot still must be done. Some countries in Africa have recorded improvement, for example, Kenya ministry of health claimed to have recorded a decline in the death of children below five years from 74 per 1000 live births to 52 per 1000 live births and decline in infant death from 52 per 1000 live birth to 39 per 1000 live births since 2013. This is just the result of one of the indicators to measure progress of universal health coverage.

Rwanda has moved ahead as the country allotted 13.1% of her annual national budget to health in 2015. This is close to the prescribed 15% by the AU. Since 2015, there have been a decline in the percentage allotted to health in Rwanda, but it is still greater than that allotted to health in Nigeria.

Figure shows percentage of annual budget allocated to health in Rwanda

 

UNIVERSAL HEALTH COVERAGE IN NIGERIA

Nigeria, with a population of over 170 million needs strategic plans to achieve universal health coverage. To provide affordable health service for everyone in Nigeria, there is need to have at least a standard primary health care facility in every ward in Nigeria. According to the minister of health, this would sum up to about 10,000 primary health care facilities in the country within 12 years. There would also be needing to revitalise the secondary and tertiary healthcare facilities. These are nice mouth-watering feats to achieve. Every patriotic Nigerian would love to live to see the day all these would be achieved.

There is no hard and fast rule on how to achieve these goals, but it must be systematically broken down to achievable goals to encourage and facilitate their actualization. Attaining universal health coverage would involve identifying the problems that have plagued the healthcare system, providing a solution to those problems and improving on the achieved feats.

Figure showing the 2017 WHO summary of the Nigerian health system

 

PROBLEMS OF THE NIGERIA HEATHCARE SYSTEM

Some of the problems facing the healthcare systems are highlighted below

1. INADEQUATE FUNDING

The Nigerian health care system is poorly funded. The funds that are allocated favour the secondary and tertiary healthcare facility more than the primary health care facility. Though the secondary and tertiary healthcare facility provide relatively cheap health services compared to the private health facilities scattered around the country, the capacity of these healthcare facilities is small and must be augmented by adequate primary healthcare facility to cater for the population. Heads of state of members of the African Union (AU) agreed to AU health funding commitment which requires member countries to assign 15% of their annual budget to improving the health sector. This agreement was reached in 2001 at Abuja, but till date the highest Nigeria have ever allocated to health was 5.95% in 2012. The percentage allotted to health in the 2018 annual national budget is 3.9%; this is lower than that assigned in 2016 and 2017 which are 4.23% and 4.16% respectively

2. INADEQUATE STAFFING

Health facilities would not just be provided without having adequate workforce in the facilities. It is not news that even the tertiary health facilities are short staffed, not to mention the primary healthcare facility.According to the Medical and Dental Consultant Association of Nigeria (MDCAN), the current ratio of doctors to patient is 1:6000, that is to every 6000 patients, there is only one doctor. The MDCAN recommended that the acceptable ratio of doctor to patient should be 1:600.

3. INADEQUATE INSURANCE SCHEMES

The high rate of poverty in the country has only added to the problem of the country. The desire of a man that lives less than a dollar per day would be that he would be able to confidently walk into any healthcare facility and receive adequate healthcare services without having to pay too much out of pocket. Health insurance should be made compulsory for every citizen of the country. The health insurance scheme isineffective, and a lot of changes still must be made. Using university of Ibadan as an example, a matriculated student of university of Ibadan have access to affordable health service at the university clinic but medical student that cross to the university teaching hospital to continue their training usually must run down to the university clinic to access medical services when there is a teaching hospital in their immediate environment. If health coverage organised by a university in inadequate, what would we say of the country. Moreover, health insurance usually covers more of the formal populace that is the civil servants and other educated people that work for good private companies. The informal populace which forms majority of the Nigerian population know little or nothing about insurance scheme.

4. INADEQUATE KNOWLEDGE OF THE HEALTH SCHEME: Most people in Nigeria do not know about universal health coverage. A survey was carried out among the medical students in the University ofIbadan to verify this assumption. It is surprising that most of them do not know about the Universal Health Coverage. The statistics are thus

 

 

If medical students are not on health insurance and do not know much about health insurance, it can be inferred that a large percentage of the Nigerian population do not know about it.

 

PROPOSED SOLUTION TO THE PROBLEMS IN NIGERIAN HEALTHCARE SYSTEM

The problems of the Nigerian healthcare system have so far been identified, providing adequate and long-lasting solutions to them should be the focus. Some of the proposed solutions are

1. CAMPAIGN AND GRASSROOT ENLIGHTENMENT: Medical students have a big role to play in enlightening the people in the immediate environment about the universal health coverage but from the data gathered, medical students needs to be educated and enlightened first before they can enlighten others. Community funded health insurance could be adopted wherein members of the community pool resources to support their primary health care facility. For example, if the members of the university college hospital Ibadan community can have access to health insurance, it would be easier to communicate it to other people. Rwanda for example has used this method successfully. In Rwanda, every leader in each community is responsible for enrolling members of the community. He is also responsible for collecting or pooling funds within the community and allotting them to the primary healthcare facility in the community. This has resulted in 75% health coverage for people in Rwanda. This method of pooling resources is called Community Based Health Insurances (CBHI). Nigeria can adopt this method too. Imagine if every community in Nigeria could adopt this; sit would take little time to increase the percentage of people that are reached by the Universal Health Coverage.

2. REGULAR FUNDING: Government should be committed to funding the available healthcare facilities in the country. There should be increase in funds allotted to the secondary and tertiary healthcare facilities though the primary healthcare facilities should be the major focus as this would provide immediate easy accessibility to health service in every community. Funds would be primarily provided by government and should be augmented by funds from international donors and innovative financing schemes. Much of funds should go more to primary healthcare unit. Plans should be made on how the funding would be regular and consistent. There are different methods through which the government can use to make funds available for the health system. For example, Earmarking taxes on some goods: Taxes on goods like tobacco and alcohol should be set aside to fund the health system. Philippines for examples earmark 85% of the taxes on tobacco and alcohol to their healthcare system. These funds are used to enrol the poor into insurance scheme and to improve their primary health facilities.

Nigeria can also adopt this method to generate regular supply of funds to the primary healthcare facilities.

3. ADEQUATE STAFFFING OF HEALTHCARE FACILITIES

This should be addressed adequately especially in the primary healthcare facilities. There should be massive recruitment, training and support of rural-based health workers. There should be incentives and special benefits to encourage workers to stay in primary healthcare facilities in rural areas. Workshops could be provided to educate health assistance workers so that people in the rural areas can be informed. There could also be a law that mandates it for medical student to have their elective postings in primary healthcare centres in the country to augment the manpower available in the primary healthcare facilities.

4. AMENDMENT OF HEALTH INSURANCE SCHEME

Health insurance should be made compulsory for everyone in the country. There should be intensified campaigns to create awareness on the importance of insurance. Only a few numbers of people are currently on insurance schemes in Nigeria. Nigeria can learn and adopt Germany’s method where there is statutory insurance by being a citizen of the country. This will make it easy for those in the informal setting that is those that are not civil servants to benefit from the insurance scheme. Insurance should also be made compulsory. If insurance were to be voluntary, people with low health risk and people that can pay out of pocket without adverse effect on their standard of living would have no reason to reason to register. Those that would register would be people with high health risk and the effect would be that there would be insufficient funds to cover their health management thus making it ineffective.

5. INCREASED PUBLIC-PRIVATE PARTNERSHIP

Government should encourage partnership with private investors. Private investors would want to make gain and as such make health services more effective. Partnership encourages effective management of scarce resources. This would strengthen the health system and bring about cost effectiveness in the health sector. Government should make private partners invest more in primary healthcare as much more people can be reached though improvement of the primary healthcare services.

 

CONCLUSION

The aim of Universal Health Coverage is to provide good affordable healthcare services for every citizen of a country. Africa as well as Nigeria still has a long way to go in achieving and fulfilling the aims of Universal Health Coverage. Everyone deserves access to good health services without much financial hardship, but someone must pay for these services. This then calls for the active involvement of the Government, non-governmental organisations, private companies and individuals in promoting and sponsoring quality health services.

 

REFERENCES

  1. Oreh, A. (2017). Universal Health Coverage – Is Leaving No One Behind in Nigeria a Pipe Dream? [online] Pubs.sciepub.com. Available at: http://pubs.sciepub.com/ajphr/5/5/4/ [Accessed 22 July. 2018].
  2. Seye, A. and Arnold, I. (2015). Operationalizing universal health coverage in Nigeria through social health insurance. [online] Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698843/ [Accessed 20 July. 2018].
  3. (2017). Adewole: Nigeria is committed to Universal Health Coverage – THISDAYLIVE. [online] Available at: https://www.thisdaylive.com/index.php/2017/12/13/adewole-nigeria-is-committed-to-universal-health-coverage-2/[Accessed 25 July. 2018].
  4. org. (2017). [online] Available at: https://www.unicef.org/esaro/UNICEF_Rwanda_–_2017_–_Health_Budget_Brief.pdf [Accessed 23 July. 2018].
  5. World Health organization. (2018). Frequently asked questions. [online] Available at: who.int\suggestions\faq\en  [Accessed  27 July. 2018]
  6. World Health Organisation. (2017). Universal health coverage (UHC).[online] Available at: http://www.who.int/en/news-room/fact-sheets/detail/universal-health-coverage-(uhc)  [Accessed 26 July.2018]

 

Author: Moses Bamigboye

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WORLD HEART DAY: THE IMPORTANCE, CARDIOVASCULAR DISEASE BURDEN, FAMSA’S ROLE AND THE ROLE OF THE GOVERNMENT.

THE HEART

The heart has been described over the years as the engine of life. From the moment it is created in a foetus, it continues to beat till the last moment of life. The heart being a muscular chamber, supplies blood and is the pump which controls the circulatory system. It is estimated that every day, the heart pumps blood through 90,000 kilometres of blood vessels.

 

WORLD HEART DAY

World Heart Day is a World Health Organization (WHO) recognized day that has been set aside to inform people around the globe about Cardiovascular Disease, the world’s leading cause of death which claims about 17.5million lives each year. World Heart Day is celebrated on 29 September each year.

 

WHY MARK WORLD HEART DAY?

 

World Heart Day being an initiative of the World Heart Federation aims at

  • Creating awareness about Cardiovascular Disease (CVD) which include stroke, heart failure, coronary heart disease and hypertensive heart disease.
  • Educating people on the need for controlling risk factors such as tobacco use, unhealthy diet, excessive alcohol intake, physical inactivity and obesity which help in preventing at least 80% of premature deaths from CVD.

It is estimated that 90% of CVD is preventable. Risk factor such as tobacco has been identified. Approximately 10% of CVD is attributed to tobacco smoking. Within two years of stopping smoking, the risk of coronary heart disease being a form of CVD has been found out to be significantly reduced. However, people who quit smoking by age 30 have almost as low a risk of death as never smokers.

High dietary intake of saturated fat, trans-fats and salt, and low intake of fruits and vegetables have been found out to be associated with increased risk of CVD. The World Health Organization attributes approximately 1.7million premature deaths from CVD to low fruit and vegetable consumption. Reducing intake of saturated fat has been found out to reduce the risk of CVD by 17%.

 

BURDEN OF CARDIOVASCULAR DISEASE

Cardiovascular disease remains the leading cause of death and disability worldwide accounting for about 17.5million deaths every year. CVD resulted in about 17.9 million deaths (32.1%) in 2015, up from 12.3 million (25.8%) in 1990. Of the 57 million global deaths in 2008, 36 million (63%) were due to Non Communicable Diseases (NCDs) and 17.3 million (30%) were due to CVDs. Nearly 80% of NCD deaths occur in Low – and middle – income countries (LMICs). Coronary artery disease and stroke account for 80% of CVD deaths in males and 75% of CVD death in females. Most CVD affects older adults. In the United States, 11% of people between 20 and 40 have CVD, while 37% between 40 and 60, 71% of people between 60 and 80, and 85% of people over 80 have CVD.

Cardiovascular is among the top three causes of death in Sub-Saharan Africa with about 210 daily deaths from CVD in South Africa. The challenge is that the prevalence of major risk factors has increased in the last 10 years.  Hypertension has been identified as the biggest single risk factor in Sub-Saharan Africa. The African region has the highest prevalence rate, 46% of adults aged 25 and above. The prevalence has been suggested to be increasing rapidly. The number of adults with hypertension in 2025 is predicted to increase by about 60% to a total of 1.56billion, with a disproportionate prevalence developing countries including Sub-Saharan Africa. 1 in 3 South African adults have hypertension and about 10% of the population over 15 years of age are pre-hypertensive. In the Sub-Saharan African region, 30% of adults over the age of 18 suffer from hypertension. In contrast with other CVD risks such as high BMI, the burden of hypertension is greater in lower income countries than higher income settings. Multiple risk factors positively interact to exacerbate CVD risks. Hypertension, for example, combined with unhealthy diets (high sodium and excessive alcohol intake) and lack of physical activity has a multiplicative negative effect on CVD mortality and disability-adjusted life-years (DALYs). In Sub-Saharan Africa, the prevention, detection, management and control of hypertension should now be regarded as a high priority. It is estimated that if the 10 – 20 million people who are believed to have hypertension in Sub-Saharan Africa were treated effectively, about 250,000 deaths would be prevented annually.

 

FAMSA’S OBJECTIVES

Federation of African Medical Students’ Associations (FAMSA) is a Non Governmental Body which has contributing towards the improvement of health in Africa as one of her objectives.

Having identified the rise in incidence of CVD in Africa, in marking this year’s World Heart Day, FAMSA aims at

  • Creating an awareness about CVD related deaths via various media platforms

The social media being a vital tool in disseminating information is being employed by FAMSA in staging a world class online campaign on the need to have a healthy heart. In line with this year’s theme of “My Heart, Your Heart”, the social media messages will preach sharing power via various ways. Other plans include gathering medical students together to display the need for a healthy heart by snapping with campaign posters and also forming a heart shape.

  • Educating the African populace about the possibility of reducing the risk of CVD

Studies have proven that about 80% of CVD risk can be reduced by lifestyle changes. FAMSA hopes to use the various campaign media to educate the African man on the need to engage in daily exercise, stop tobacco smoking, promote healthy diet and check his blood pressure regularly.

  • Identifying the risk factors of CVD and how they can be prevented

This campaign will aim at identifying risk factors with high prevalence in our community. In so doing, people who are at high risk are identified and educated about the need to put a stop to the identified risk factors or ensure adequate control as seen in diabetes mellitus.

 

ROLE OF GOVERNMENT IN REDUCING THE RISK OF CVD

The burden of CVD in Africa can be reduced if the African Government rises up to the increasing rate of CVD related deaths. Various measures that should be put in place include:

  • Creating a surveillance system to monitor CVD deaths and identifying those at risk of having CVD
  • Implementation of stringent tobacco control policy
  • The prevention, early detection, management and control of hypertension should be regarded as high priority.
  • Ensuring availability of diets that promote healthy heart and putting in place measures that limit the availability of diet high in fat, sugar and salt.
  • Putting in place strategies that control excessive consumption of alcohol
  • Promoting physical activity among the populace by creating an awareness on the need for it
  • Equipping the healthcare services available and provision of new and effective ones.
  • Making available healthy diet for school children.

 

CONCLUSION

Healthy heart is essential for healthy living. Ensuring a healthy heart begins with you as an individual. The risk of CVD related death can be reduced and it begins with you. The African government should rise up to the increasing rate of CVD related death. The message of ensuring a healthy heart should be preached to every individual. You and I should make a promise towards a healthy heart!

 

REFERENCES

Cooper RS, Rotimi C, Kaufman JS, et al.(1998) “Hypertension treatment and control in Sub-Saharan Africa: the epidemiological basis for policy. Br med J. ; 312:614-617. doi: 10.1136/bmj.316.7131.614 (Accessed 28th September, 2018)

Francesco PC, Michelle AM. (2016) “Cardiovascular disease and hypertension in Sub-Saharan Africa: burden, risk and interventions”. Intern Emerg Med.; 11: 299 – 305. doi: 10.1007/s11739-016-1423-9 (Accessed 28th September, 2018)

GBD 2013 Mortality and Causes of Death, Collaborators (2014). “Global, regional, national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990 – 2013: a systemic analysis for the Global Burden of Disease Study 2013”. Lancet. 385 (9963): 117 – 71. PMC 4340604. PMID 25530442. doi:10.1016/S0140-6736(14)61682-2. (Accessed 28th September, 2018)

Ibrahim MM, Damasceno A. (2012) “Hypertension in developing countries”. Lancet; 380:611 – 619. doi: 10.1016/S0140 – 6736 (12) 60861 – 7 (Accessed 28th September, 2018)

Kearney PM, Whelton M, Reynolds K, et al (2005). “Global burden of hypertension: analysis of worldwide data”. Lancet ; 365:217 – 223.doi:10.1016/S0140 -6736(05)70151-3 (Accessed 28th September, 2018)

Liesl Zuhlke (2016). “Why heart disease is on the rise in South Africa”. The Conversation Africa (Accessed 28th September, 2018)

Lim SS, Vos T, Flaxman AD, et al.(2010) “A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990 – 2010: a systematic analysis for the Global Burden of Disease Study 2010”. Lancet. 2012;380:2224 – 2260. doi: 10.1016/S0140-6736(12)61766-8. (Accessed 28th September, 2018)

McGill HC, McMahan CA, Gidding SS (2008) “Preventing heart disease in the 21st century: implications of the Pathobiological Determinants of Atherosclerosis in Youth (PDAY) study”. Circulation. 117 (9): 1216 – 27. PMID 18316498. doi:10.1161/CIRCULATIONAHA.107.717033 (Accessed 28th September, 2018)

Seedat YK (2004). “Recommendations for hypertension in Sub-Saharan Africa”. Cardiovasc J S Afr. 15:157 – 158. (Accessed 28th September, 2018)

 

Authors: Odedara A. M. and Ogunfolu A. A.

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PRESS RELEASE ON THE DEATH OF FORMER UNITED NATION SECRETARY-GENERAL AND NOBEL PEACE PRIZE LAUREATE – KOFI ANNAN

 

The Federation of African Medical Students’ Associations (FAMSA) is profoundly disheartened by the passing of former United Nations Secretary-General and Nobel Peace Prize Laureate Mr. Kofi Annan.

Kofi Annan, in full Kofi Atta Annan was born April 8, 1938, in Kumasi, Gold Coast (now Ghana); died August 18, 2018.

He served as the seventh Secretary General of the United Nations from January 1997 to December 2006. Annan and the UN were the co-recipient of the 2001 Noble Peace Prize. He was the founder and chairman of the Kofi Annan Foundation as well as chairman of the Elders, an international organization founded by Nelson Mandela.

Mr. Annan was the first black African to head the United Nations, was deeply respected by all who knew and worked with him. He left an unforgettable legacy through his work at the United Nations.

Of his numerous mind blowing works, it is worth noting that Mr. Kofi Annan worked on ending human rights abuses and also to combat HIV/AIDS virus especially in Africa. He began his new term as the UN secretary general in 1997; the outlook from the AIDS epidemic was bleak. Some 23 million people were living with HIV there were 3.2 million new HIV infections and access to life saving treatment was only available to a privileged few. Under his leadership in 2000, the UN Security Council adopted resolution 1308, identifying AIDS as a threat to global security.

Also, in 2000, at a time, when less than one billion dollars was invested in the AIDS response, he called for a war chest of at least 7-10 billion dollars for AIDS tuberculosis and malaria.

As UN secretary general, he spoke glowingly on gender equality including its role in development. According to him, no other policy is as likely to raise economic productivity or reduce infant and maternal mortality as well as improve nutrition including the prevention of HIV/AIDS. These were directed towards the improvement of health in Africa and the world as whole.

A highlight of Annan’s strides in office was his issuance of a five-point Call to Action in April 2001 to address the HIV/AIDS pandemic and his proposal to create a Global AIDS and Health Fund. He and the United Nations were jointly awarded the Nobel Peace Prize in December of 2001 “for their work for a better organized and more peaceful world”. A few of his strides in office include:

• Adoption of the UN’s first-ever counter-terrorism strategy,

• Involvement in the transition to civil rule in Nigeria in 1998,

• Launch of the “Global Impact” initiative in 1999 which has become the world’s largest effort to promote corporate social responsibility,

• Being responsible for certifying Israel’s withdrawal from Lebanon in 2000 and in 2006, his efforts contributed to securing a cessation of hostilities between Israel and Hezbollah.

• Also in 2006, he mediated a settlement of the dispute between Cameroon and Nigeria over the Bakassi peninsula.

While Under-Secretary-General for Peacekeeping in 1990, Kofi Annan facilitated the repatriation from Iraq of more than 900 international staff and other non-Iraqi nationals and also served as Special Representative of the Secretary-General to the former Yugoslavia and Special Envoy to NATO (1995-1996).

“Mr. Annan devoted his life to making the world a more peaceful place through his compassion and dedication to service. He worked tirelessly to unite us and never stopped fighting for the dignity of every person” (Nikki Haley).

Mr. Kofi Annan will be greatly remembered as a colossus of peace and justice

The Federation of African Medical Students’ Associations join the international community in remembering and acknowledging his remarkable service to the world.

May his soul rest in peace

 

 

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FEDERATION OF AFRICAN MEDICAL STUDENTS’ ASSOCIATIONS (FAMSA) 31st GENERAL ASSEMBLY

⁠⁠⁠🌍 Federation of African Medical Students’ Associations (FAMSA)🌍

presents

31st General Assembly

Date 🗓 : 13th-17th September, 2017.

Venue 🏫 : Niger Delta University, Yenagoa, Bayelsa State, Nigeria.

This historic event is an annual platform where medical students from over 30 African countries come together to discuss health issues pertaining to Africa.

Featuring:
🛑 Scientific Seminars/Lectures
⚫ Inter medical school Quiz
🔵 Sight seeing
✳ Native Dinner
🌐 General Election

DELEGATE FEES
➡ Nigerian: $16
➡ Foreign : $32

It promises to be enlightening, fun and adventurous. We look forward to your arrival at Yenagoa!
FAMSA….Towards the improvement of health in Africa

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DEPRESSION – A CALL TO ACTION

The study, published in the Public Library of Science (PLOS) Journal of Medicine, found that globally, the prevalence of depression was 4.4 per cent, while Afghanistan and the Palestinian territories were amongst the most depressed states.

According to the research, depressive orders are second only to lower respiratory infections when it comes to inflicting the most years of disability on people throughout the world.

Clinical depression is defined as involving at least one major episode in which the affected individual experiences a depressed mood almost all day, every day for at least two weeks.

The researchers used data on the prevalence, incidence, remission rates and duration of depression and dysthymia (a milder, chronic form of depression that lasts for at least two years), and on the excess deaths caused by these disorders from published articles.

They found that the prevalence of depression for women was almost twice as high than it was for men.

More than five per cent of people in the Middle East, North Africa, Eastern Europe, sub-Saharan Africa and the Caribbean have depression, the researchers found.

However, it is important to note the research was based on the rate at which people were diagnosed with clinical depression, rather than actual rates of depression.

Maymunah Yusuf Kadiri a consultant Neuro Psychiatrist and Psychotherapist, Medical Director at pinnacle medical service, in an interview with Kemi Ajumobi of Business day newspaper, Nigeria. Depression affects people of all ages, from all walks of life, in all countries. It causes mental anguish and impacts on people’s ability to carry out even the simplest everyday tasks, with sometimes devastating consequences for relationships with family and friends and the ability to earn a living. At worst, depression can lead to suicide, now the second leading cause of death among 15-29-year olds. When mild, people can be treated without medicines but when depression is moderate or severe they may need medication and professional talking treatments. The risk of becoming depressed is increased by poverty, unemployment, life events such as the death of a loved one or a relationship break-up, financial challenges, physical illness, abuse-physical, sexual, emotional and drug, conflicts, economic instability and recession.

There can’t be a better time to spring into action than now when there is an upsurge of depression around the world. At a time where conflicts are daily arising among nations and communities causing economic instability and recession making life more difficult for people especially in Africa and in the Middle East.

According to Prof. Lourens Schlebusch, there are at least 23 suicides a day in South Africa – which may be underestimated due to the stigma involved in suicide. However, data on suicides and other unintentional injury deaths are not systematically tracked by any agency in the country making accurate statistics hard to come by, says SA’s largest mental health NGO, the South African Depression and Anxiety Group (SADAG).

Depression is the most prevalent mental illness in the developing world. In Africa, it’s devastating: 66 million women are suffering. The great majority have no medical services to turn to for help–strong minds.org. If this number of our women ( clinically diagnosed alone)are suffering from severe depressions in a continent Where most women are housewife’s, how will they be able to Take adequate care of our children emotionally. I hope we are not breeding a “depressed future generation”.

From being some of the happiest people on earth, Nigerians have slumped to the rank of the most depressed in Africa. This was the conclusion contained in the latest figures released by the World Health Organisation (WHO), which show that Nigeria has 7,079,815 sufferers of depression, that is 3.9 per cent of the population.

Also, 4,894,557 Nigerians, that is 2.7 per cent of the population, suffer anxiety disorders. The country is closely followed by Ethiopia with 4,480,113 sufferers, that is 4.7 per cent of her population; Democratic Republic of Congo with 2,871,309 sufferers (3.8 per cent); South Africa with 2,402,230 sufferers (4.6 per cent); and Tanzania with 2,138,939 sufferers, that is 4.1 per cent. Seychelles has the lowest number of depressed persons with just 3,722 that is 4.0 percent

One thing about depression is that you can’t sufficiently know how it feels and what debilitating impact it Can have until one goes through depression. Unlike myriads of other clinical illness, it can’t be readily diagnosed and can even be easily missed. It’s like a smothering fire. It gradually and quietly eats away the sufferer’s life. Most of the time, their health parameters may even be normal yet there’s this huge sore in their lives which can’t be picked by any new generation medical diagnostic kit.

Depression is pilfering our lives and future; let’s curb it.

 

AKINDE TITUS GBOYEGA
5th year medical student,
University of Ibadan,
Oyo state, Nigeria.

 

 

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DEPRESSION: A CALL FOR ACTION

On Wednesday 8th October 2014; my re-sit results were out and I failed. I had to re-do my 5th year of medical training. Where do I start? How do I get over this? ‘‘One day at a time….″ I told myself.

As the days turned into weeks, I felt my strength literally leave me. I was going through a downward spiral of mental anguish, unable to carry out even the simplest of tasks; I slept a lot, thought a lot but ate little. Then I figured; I was depressed.

It was difficult, oh yes, it was! Some days, I woke up with the world on my shoulders, some other days, I didn’t just care. I saw myself as a failure, a disappointment to my parents, my relatives, my friends and above all, myself.

I knew I had to act fast, to stop the “haemorrhage”, so i got to my feet and picked myself up again. I began to talk to other medical students who had repeated, I listened to motivational talks and I prayed a lot. Thank God it helped, it wasn’t all rosy but I got better, I felt better…. “All is well that ends well…” I said to myself.

Then it hit me, what about the “other medical students” who had experienced or will experience what I just went through? What about people from other walks of life?  How did or do they cope? Do they know they are depressed? Do they get the help they actually need? Then I concluded; depression is real.

Depression is an illness characterised by persistent sadness and a loss of interest in activities that you normally enjoy, accompanied by an inability to carryout daily activities for at least two weeks (WHO). It affects people of all ages, from all walks of life and in all countries, yes even Cameroon, my country.

It can be long lasting or recurrent, substantially impairing a person’s ability to function at work or school, or cope with daily life. At its most severe, depression can lead to suicide.

According to WHO, depression is the second leading cause of death among 15 -29 year olds.

When mild, depression can be treated without medications but when moderate or severe, people may need medications and professional involvement treatments.

Depression often starts at a young age. It affects women more than men, and unemployed people are also at high risk.

It can affect anyone, no matter your social status. It can be caused by poverty, life events such as the death of a loved one, a relationship break-up, physical illness, and the list goes on and on.

Many of life’s experiences can predispose to depression:

How do you carter for your wife and kids when you just lost your job?

What do you do when you spend several years, looking for a job, but end up sitting at home with your degree in your pocket?

How do you carry on when you suddenly lose a loved one to the cold hands of death or a long term relationship which you cherished so dearly goes to waste?

When faced with such situations, we often feel worthless, useless and helpless. We then use unorthodox methods to mask or alleviate our pain (alcohol, marijuana, etc).

Don’t drown yourself in alcohol, don’t smoke that cigarette. It won’t help.

Find someone you trust; a relative, a friend, a spouse, or a medical professional and talk about it. I did so and it helped. You don’t have to do it all alone. Life is already hard as it is.

Depression is everywhere in our communities; unfortunately, it often goes unrecognized and is frequently attributed to “witch craft″. There’s also very little information available on the subject matter.

Non – specialists can reliably diagnose and treat depression as part of primary health care. Specialist care is needed for a small proportion of people with complicated depression or those who do not respond to first-line treatment.

Depression is treatable; we all have a role to play;

  • The governments health sector should organize awareness campaigns to educate the public on the subject matter.
  • Health care givers should empower themselves through workshops to be able to properly diagnose depression at its embryonic stage.
  • We should all be there for our loved ones when they are feeling down, let’s listen to them keenly, let’s talk with them, let’s let them know that they are not alone. This form of therapy is cheap, effective, and has no side effects.

Depression is more common than we think. Let’s pay attention, let’s talk…

 

NJANG MBENG EMMANUEL,
7TH Year medical student
Faculty of Health Sciences University of Buea,
Cameroon.

 

 

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MIGRATION CRISIS: THE REFUGEE HEALTH

For the purpose of getting our terminologies right, lets understand that “all refugees are migrants but not all migrants are refugees”. They’ve been persecuted in their homeland, fleeing the crisis, and now, seeking asylum. A refugee isn’t your typical immigrant. Over the years, the world has had to deal with issues of migration which led to the formation of the Office of the United Nations High Commissioner for Refugees (UNHCR), a programme mandated by the United Nations (UN) to protect and support refugees while assisting in their integration, resettlement or voluntary return to country of origin. However in 2015, crisis began all over the European continent as immigration numbers skyrocketed from unauthorized foreign migrants. These foreign migrants encompassed not only the vulnerable mass seeking refuge, but also some hostile agents.

The world has experienced the highest number of forcibly displaced people since World War 2-about 59.5million-and by 2015,over a million entered the European region and about 3700 died/went missing during the journey. The point is; this is a global crisis and concerted efforts should be made globally, not just by the European Union. Addressing the migration crisis, the Vice President of Nigeria, Professor Yemi Osinbajo stressed the need for care and respect for the migrants as most of them were forced to leave their ancestral homes. He also advised the International Organization of Migration (IOM) to ensure the proper documentation of all migrants.

Analyses from the World Health Organization (WHO) reviews the health status and access of a refugee from their country of origin, to their transit country and finally in their destination country.

In Syria alone, over 7 million people are internally displaced with the unrest causing shortages of qualified medical personnel and other medical aid and support. Interventions made by the WHO and partners include provision of supplies for treatment of critical conditions like diabetes and heart disease; vaccination against diseases like measles, rubella and polio; prevention of vector borne diseases like malaria; delivery of integrated primary health care, including mental health services; deployment of surgical teams and supplies; support for mobile clinics and outreach services for reproductive, maternal and newborn child health; and strengthened disease surveillance and outbreak response. All these are considered very important for integration in their destination countries as well as it helps to prevent the spread of communicable diseases amongst the refugees during transit.

Refugees in transit are usually vulnerable because their finances are usually limited. Therefore, special care and assistance should be rendered at this level. In countries like Turkey, Lebanon and Greece hosting the refugees, the

 

WHO works with the governments to improve access to basic healthcare needs by setting up clinics especially for the refugees; providing medical supplies, equipment and fuel; training for frontline health workers; collecting and analysing health data to shape decision-making and providing Ministries of Health and other partners with technical guidance on key public health issues.

Finally, even with the unprecedented influx of refugees in the European region, the WHO supports the receiving countries by performing joint assessments with Ministries of Health to assess health-system capacity to manage large influxes of refugees and migrants; giving policy advice on contingency planning for the health sector; providing emergency medicines and supplies; providing maternal and child health care services; providing mental health and psychosocial care; training for health workers; technical and financial assistance for outbreak response and immunization campaigns; dissemination of health information and educational materials to refugees and health workers; and cross-border collaboration for improved data collection and analysis.

It is in fact now widely understood that being and staying healthy is not only part of migrants’ human rights, but also a fundamental precondition for them to work, be productive and contribute to the social and economic development of their communities, both of origin and destination. Therefore, coordinated efforts are needed to ensure that migrant health is addressed throughout the migration cycle, as are efforts to adapt and strengthen the resilience of local health systems in light of more diverse population health profiles. Addressing the health of migrants and affected local populations reduces long-term health and social costs, is good public health practice, facilitates integration and contributes to social and economic development. The healthier migrants are and remain the more efficient and balanced the future of our highly mobile and globalized society will be.

 

ALUKO OLUWABUSAYO DANIEL
2ND YEAR, MEDICINE AND SURGERY
COLLEGE OF MEDICINE, UNIVERSITY OF LAGOS, NIGERIA.
oluwabusayoaluko@gmail.com
+2348179380972

 

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OCCUPATIONAL HAZARDS IN OUR HEALTH SECTOR 2

  • Introduction

It is awry that the health sector, whose main objective is to the take care of the sick and stand against anything that proves detrimental to the wellbeing of the society, is itself a “hazard-filled” field for the workers it employs. The goals of the health sector should include “to foster a safe healthy work environment” and to protect it workers, employers, customers, and many others who might be affected by the workplace environment.

 

  • Hazards and Challenges of the health sector.

Challenges arise in pursuing protections for the healthcare workers in the health sector, in view of this our highly complex and hazardous work environment. Predilection exists within the health sector and health community itself concurs to limit both the awareness of hazards that do exist and the approaches used to secure a safe job.

There are millions of workers under the banner headline of the health sector. These workers represent different occupations under the sector that expose them to a variety of hazards.

In addition to the medical staff, large healthcare facilities are embraced by a wide variety of trades that have health and safety hazards associated with them.  These include medical equipment, housekeeping, mechanical maintenance, food service, laundry and administrative staff.

For example, doctors confront such potential hazards as exposure to infectious diseases and toxic substances, radiation exposure and stress, the one we hardly take cognizance of.

 

Why is hazard awareness lacking?

The health sector is often imagined by the public to be clean and free of hazards.

  • Hazard classes

Physical hazard

This is caused by physical agents or physical forms of energy

Examples: Radiation, lasers, noise, extreme temperature, electrical energy

Effects: Burns, cancer, physical and psychological trauma

Precautions:

– Wearing proper personal protective equipment, including hearing protection where necessary.

– Not entering restricted radiation areas, unless trained and authorized.

 

Chemical hazard

This is caused by chemical substances that potentially toxic, including medications, solutions and gases.

Examples: Hazardous anticancer drugs, sterilants, disinfectants, hormones, antineoplastic, anesthetic gases, latex gloves, aerosolized medications and hazardous waste.

Effects: Irritation, asthma, allergy, dermatitis, cancer, reproductive effects e.g. spontaneous abortion

Precautions:

– Wear proper personal protective equipment.

– Dispose of hazardous agents in proper containers.

– Avoid recapping needles.

– Use tools to apply or handle hazardous agents.

 

Biological hazard

This is caused by infectious agents, such as bacteria, fungi, virus or parasites, which may be transmitted through air, needle-stick injuries or body contact

Examples: Influenza, hepatitis B and C, HIV

Health effects: HIV and AIDS, tuberculosis, hepatitis, liver damage and other diseases

 

Mechanical hazard

This is caused by factors in the work environment that cause musculoskeletal injuries, strain, discomfort, bad postures

Examples: Lifting and moving patients, tripping or slipping and fall hazards

Health effects: Musculoskeletal disorders, strain injury, fracture, wound, upper and lower extremity injuries

Precautions:

– Provide assist devices for lifting.

– Encourage team lifts or start a no-lift program.

Psychological hazard

This can be caused by stressful work conditions, threats of physical violence, work organization, shift work

Examples: Unsafe staffing, workplace threats, bullying, physical violence

Health effects: Psychological stress, physical injury

Precautions:

– Regular staff meetings to share feelings and innovative ideas.

– Reasonable shift schedules.

– Organized and efficient work functions and environment.

– Exercises.

Conclusion

The health care workforce is embraced daily with harm from exposure to agents encountered in this unique and complex workplace. Understanding the real concept of occupational hazards in our Health sector and taking the precautions and safety measures into practice would be of huge gain both to the employers and the employees.

We implore the health sector to do anything within its reach to protect and retain the vital health workforce, which is a fundamental pillar of all health systems.

 

ARTICLE BY: AJEKIIGBE VICTOR OLUWATOMIWA

SCHOOL: LADOKE AKINTOLA UNIVERSITY OF TECHNOLOGY, OGBOMOSHO, OYO STATE, NIGERIA.

CONTACT: Victorajekiigbe@gmail.com   +2347066514358

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