She Has Cast A Spell On Me {POEM}

By Odimegwu Onwumere

She has cast a spell on me

With her languorous voice.

{Picture: Culled Online}

Her voice sweetens, so intoxicating

I can hardly remember what she has said

But can’t forget how she said it.

My mind is now disturbed,

Racing between nightmare and reality;

I’m wondering what will remain of me

If we lay beside each with our lips

Making tunes of appealing music.

Her eyes wax, firing me, even when am wet,

As am drowning because of her eyes full of passion,

Her smiles radiating with affection,

Her vibrations that’s electrocuting.

I’m blazing by her beauty and charm;

She is beautiful and facially attractive

Unlike many women who are beautiful

But not attractive.

I’m bewitched by her fantasy,

My psyche is being ruined,

Causing me elderly libido.

When a woman knows

What it takes to be a woman

She derobes men of their masculinity.

I’m in trouble, but let this spell remain!

Odimegwu Onwumere; April 28 2017.)

apoet_25@yahoo.com

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When Health Insurance Becomes Unattractive in Nigeria

In this report, Odimegwu Onwumere writes that there are loggerheads surrounding the Health Insurance scheme, causing intricacies in the areas of regulation and implementation, thereby creating loopholes for funds to go down the drain

A clash of interest has been brewing between the National Health Insurance Scheme (NHIS) and the parent body of Health Maintenance Organisations (HMOs) in Nigeria, Health and Managed Care Association of Nigeria (HMCAN).

{Minister for Health Prof Isaac Adewole}

A seeming fraud has allegedly been exposed in the Health Management Organisations (HMOs) by members of the House of Representatives’ Committee on Healthcare, early March this year, to the tone of N350b.

Irked by the shoddy picture, Chairman of the Representatives Committee, Chike Okafor frowned that the money in question was the eventful efforts of Nigerians in making the National Health Insurance Scheme (NHIS), an initiative of the federal government since 2005 after the Health Act of 1999, was made. Okafor therefore advised the NHIS to hold back from funding HMOs till examination into the matter was completed.

The federal government had although convinced the citizens that there was going to be NHIS monthly capitation under the National Health Insurance Scheme Act Cap N42, Laws of the Federation of Nigeria, 2004, meant to actualise the universal health coverage for the citizens but especially for children, women and the vulnerable in the society, through inexpensive cost and diverse prepayment systems. This was after the institutionalisation of NHIS in 1999 via Decree (now Act) 35 of the Federal Government of Nigeria.

Owing to the fact that health insurance is regarded as one of the most influential insurance policies, the NHIS was given a mandate to see that Nigerians did not lag in their overall health concern. But this exquisite initiative might have lost its focus as fraud and irregularities have supposedly been characterising the effort to give Nigerians a befitting health insurance.

Experts judged that there was a glaring misinterpretation in the way the health insurance has been handled on the part of government officials that hypothetically wanted to implement and regulate. The experts were consequently calling on the authorities for a talk in order to take a stand, given what the law has said. They believed that the government should not be the implementer of the health insurance and as well, as the regulator. In their effort, they wanted the government to come in as a regulator whereas the implementer would be the HMOs.

Speaking to newsmen on the issue in February, Prof. Mustapha A. Danesi, a consultant physician/neurologist at the College of Medicine University of Lagos (CMUL)/Lagos University Teaching Hospital (LUTH), said, “So at present the government seems to dabble into implementations rather than keep strictly to regulation and I believe it is in the interest of everyone to make sure that government keeps to its role as regulator and facilitator.”

In the cause of investigation, Mahmud Yusuf, NHIS Executive Secretary threatened to resign when the Pandora’s Box was discovered in the health insurance agency and he did not sing a different song to that of the Representatives, saying that the health insurance agency has not lived up to the responsibility it was formed. Yusuf said that not upto 5 per cent of Nigerians have been covered by the insurance scheme as against 60 per cent that was the nomenclature on ground at the formation of the health insurance agency.

Given the slapdash practices in the way funds meant for health insurance have been handled, some private health organisations in the country had earlier raised their voice in the way remittances were made in the NHIS monthly capitation. Some private organisations in a state like Plateau State made this known. In February, Chief Medical Director of Sauki Hospital in Jos, Dr. Daniel Gana, who was a former Chairman of Nigerian Medical Association (NMA), Plateau State Branch, was angst-ridden.

Gana said that the federal government has only been keen in staying at the NHIS office in Abuja, but allowed other individual health and other organisations to totter. Gana’s words were that some organisations that include Health Maintenance Organisations (HMOs) were paid up front, every quarter, by the federal government. Literarily, Gana’s statement suggested that hospitals nationwide hardly get their salaries as at when due. For instance, checks revealed that as at February 24, 2017, no hospital across the country received their salaries, making “what the hospitals are doing now as just humanitarian services.”

There are obviously many challenges facing the health sector in the country. The 2017 budget of 4.15 per cent for health, for instance, is the fraction of 3.65 per cent it was in 2016, as against 15 per cent WHO and African Heads of State declared for countries healthcare in a meeting at Abuja in 2001. The federal government was oblivious or it knew but pretends to shy away, that health insurance has been hardly penetrated in the country given its (federal government)  unconcern attitude to the health sector.

Pundits in the health sector like the Chief Executive Officer of Novo Health Africa Ltd, Dr. Dorothy Jeff-Nnamani said, “with the objective of providing healthcare delivery solutions across Nigeria and internationally through collaborative partnerships”, while in a public presentation in 2015, that the government has not really made the citizens to understand what insurance really is.

Jeff-Nnamani was of the opinion that aside the health sector, the citizens were still aloof in the understanding of insurance in its entirety. Manifestly in a religious country like Nigeria, the source added that majority of the citizens don’t agree in preparing for the unanticipated circumstances that might befall them hence the churlish for insurance. On the assertion that the federal government has only been sitting at the NHIS office in Abuja, Nigeria’s seat of power, to supervise the health insurance scheme, the source added that federalism has been part of the culprits besetting the health insurance.

The highlight of this is that the federal government insures public servants in its employ, but the state governments most times do not follow up, thereby not relieving their employees the insurance they needed. In a nutshell, the specialists believed that the authorities have made health insurance unattractive to the citizens in a country known for nepotism. Those who know better were of the view that health insurance should not have any barrier in how people access healthcare.

While fielding questions to newsmen in January this year, Danesi said, “Nigerians do not need free health but free access to health. Free access to health is only available to those who have a lot of money.” Danesi had a view that lack of finance was not only the barrier in accessing healthcare; many people that had the money hardly get healthcare as at when due.

In a quest to proffer a solution to resolve the crisis rocking the Health Insurance scheme, Danesi added, “Regulation means, make sure that the laws are implemented and make sure every accredited HMOs are quality HMOs, and make sure that accredited health care providers are quality providers. Those are regulatory issues and make sure that the money that is paid is properly kept and disbursed to the HMOs in order to pay the providers and so on, and that is facilitation. If we are housing the money that is paid, disburse it as fast as possible so that there will be no hitch in the implementation.”

The source, however, frowned at the situation where a patient lineup in the hospital for hours to see a doctor; something that ought to be easy for the patient. Adding, it stated that in a state where free access to health is fad, it means that a patient sees the doctor on arrival to the hospital and not need donkey hours to see a doctor. This is even as a Senior Director for the Health, Nutrition and Population Global Practice at the World Bank, Dr. Tim Evans, said, “Universal health coverage is an essential ingredient to end extreme poverty and boost shared prosperity within a generation. Putting people’s health needs ahead of their ability to pay stems poverty and stimulates growth.”

It is believed by connoisseurs that the only way to get free access to health is through health insurance.

Odimegwu Onwumere is a Poet, Writer and Consultant based in Rivers State. He contributed this piece via apoet_25@yahoo.com

Atrociousness of Cancer on Nigerian Women

Odimegwu Onwumere writes that cervical and breast cancers are undermining the development of women in Nigeria with over 9,000 of them dying yearly from the scourge, and if government does not take urgent step to proffer solutions against the malady, the number of victims will increase

Madam Chinyerem Michael’s husband died in 2013 of blood pressure (BP), leaving their three teenage children to her care in their squalid situation. Later, she developed cancer of the breast.

Without a proper access to the hospital due to poverty, on December 26, 2016, her matrimonial family in Afikpo, Ebonyi State, was thrown into mourning, as her remains were lowered into grave, after she died.

“I’m yet to believe that my mum is late from the cancer complications she battled for two years and could not have entrée to suitable medication in the country, because we’re not financially stable to take her overseas,” Michael Sunday Michael, her first son in his early 20s, said.

While the Michaels were gnashing their teeth for their loss, the family of Priye Walson residing at Seaside Road, Oyigbo, Rivers State, was celebrating the survival of their mother and wife that survived cancer in India.

“My wife was flown to India when it was detected that she had cancer and today, I’m celebrating her survival. The in-thing was that I could afford sending her to India for treatment. If not, she could have died in the process in Nigeria where the healthcare is zero,” said Mr. Priye Walson.

Chinyere was one of the 800,000 women in developing countries including Nigeria, which international oncologists have said die of breast and cervical cancers yearly, especially due to destitution.

Specialists believed that cervical cancer had taken lives of women than could be related to HIV/AIDS, tuberculosis, and malaria plunked together. There was apprehension that more women numbering 3.2 million would be diagnosed of breast cancer in 2030, from 1.7 million that have been the ratio, according to The Lancet, a medical journal.

The Director of Sebeccly Cancer Care and Support Centre, Dr. Omolola Salako, at a health sensitisation and screening for Health Writers Association of Nigeria (HEWAN) in Lagos, bared fears that out of the numbers, no less than 9,000 Nigerian women die annually as a consequence of cervical cancer.

There were detections that many of the women, perhaps, could not have had cancer or died, especially those with cervical cancer, if the Federal Government had distributed cervical cancer vaccine to reduce the pervasiveness of the malady in Nigeria.

Investigations revealed that during the Dr. Goodluck Jonathan presidency, the then Minister of Health, Prof. Onyebuchi Chukwu increased cancer awareness through the media.

According to a reliable source, “In 2011, Prof. Chukwu launched the cervical cancer prevention vaccination, Human Papilloma Virus Vaccine, being the first time it has been done in Nigeria.”

But under the President Muhammadu Buhari presidency, the Minister of Health, Prof. Isaac Adewole recently told the News Agency of Nigeria that the Federal Government would ‘soon’ start giving out cervical cancer vaccine to reduce the commonness of such cancer in Nigeria.

“There is now a vaccine to prevent cervical cancer and we are working to make the vaccine available,” the minister said, adding, “I can tell you today that there is no public hospital that has a functional cancer machine.”

Head of Radiotherapy and Oncology Department of the Lagos University Teaching Hospital, Idi-Araba, Lagos, Dr. Remi Ajekigbe, told authorities that breast cancer was the major disease affecting women with a quarter number of the affected detecting it earlier, whereas over 70 per cent detect it late. Ajekigbe supposed that the later does so because of the myth that such illness was inflicted by witches and wizards, but largely due to they cannot afford treatment at the hospital.

“The hospital is always not the first port of call. The patients must have gone to all sorts of places before coming to the hospital. The pastors are not helping issues by claiming miracle cure for cancer. It is wrong. The ‘Whiteman’ that brought Christianity came along also with medicine and hospital care. Pastors should tell them to come for medical care while they continue praying for them,” Ajekigbe said.

Unlike in Nigeria where low survival rates from breast cancer is accommodating owing to late diagnosis due to poorly equipped hospitals, the International Agency for Research on Cancer, said that breast cancer is the most recurrently detected cancer among women.

According to the source, “1.38 million cases were diagnosed worldwide in 2008.” Unlike it is the most regularly reported cause of death in cancer among women in Nigeria, “Breast cancer survival rates vary greatly worldwide, ranging from 80 per cent or more in North America, Sweden and Japan to around 60 per cent in middle-income countries and less than 40 per cent in low-income countries.”

The cost of the vaccine was said to be N21,000 and cervical cancer is the second biggest killer cancer of women in Nigeria after breast cancer. Despite the coordinated efforts through international public health agencies in tackling breast and cervical cancers affecting Nigerian women, casualties are on the increase due to poor access to hospital.

However, there was an advise by Dr. Salako, who is also a Consultant Clinical and Radiation Oncologist at the Lagos University Teaching Hospital, saying: “Every sexually active woman is at risk of contracting HPV and should adopt the habit of going for regular screening in order to detect the virus early. It takes only N7,000 to get a Pap smear test once in five years and N21, 000 to get vaccinated for life. But when the infection has been allowed to grow into full blown cancer, one is not even sure of curing it with N500,000.”

Contradicting the views that there are airs of hope in the Nigerian hospitals, the Pink Pearl Foundation, a community-oriented organisation that provides support, facilitates connections and empowers young women facing cancer, said, “Nigeria is ill equipped to deal with the complexities of cancer care. A wobbly healthcare infrastructure makes clinical services hard to come by and inadequately distributed. Only a few health centres have functioning radiotherapy equipment and the cost of care remains out of reach for most Nigerians who have received a cancer diagnosis.”

For Nobel Laureate Wole Soyinka who disclosed in 2014 that he is a cancer survivor, “The important thing is that I am convinced that we have enough funds in this nation to build cancer centres, including research that this nation requires. It is very capital intensive, some of it, but there are many ways and treatments for cancer just like there are many kinds of cancer. Even diet forms an important part. Diet is critical.”

Odimegwu Onwumere is a Poet and Writer based in Rivers State. E-mail: apoet_25@yahoo.com

Losing a Generation to Obstetric Fistula

Odimegwu Onwumere writes that despite government’s efforts in the media against Obstetric Fistula, many rural women and girls are still suffering from the menace without proper access to hospital

{Minister for Health, Prof. Isaac Adewole}

Aishat Sani, 14, had pushed for a long time in the labour room at a hospital in Kaduna State. It was 4-5 hours and her handlers said that the blood provision to the urethra has stopped, which means in the medical term “ischemic death and drop off”.

Sani’s channel of urine is intervallic between the bladder and birth canal. She can no longer control her urine as it later comes from kidney and empties into the birth canal. After the experience, she oozes out unpleasant odour resulting to her husband abandoning her. She is now a Vesico Vaginal Fistula (VVF) patient and conversely, being derided by her friends and well-wishers.

While she survived during the child birth but only developed Fistula, Nkechi Lawson, 15, from Ebonyi State, is not living to tell her experiences during a child birth. She is no more, resulting from what stakeholders in the health sector attributed to “unfortunate admittance to quality and reasonable healthcare as well as dearth of emergency obstetric care.”

Despite media hype by government and its agents saying that everything VVF, a condition linked with discharge of urine in women was under control, Aishat Sani is one among the many girls and women in Nigeria, especially in the rural areas, who are untreated and cannot access treatment. The United States Agency for International Development (USAID) recently unearthed that many girls and women are badly affected with the disease in Nigeria, with Ebonyi State encompassing the highest of over 3,000 cases.

Across the country, experts’ opinion is that the number of girls and women suffering from Fistula has risen to 90 per cent, with about 13, 000 novel cases diagnosed annually. In a chat, a Clinical Associate, Fistula Care Plus, Dr. Suleiman Zakariya was angst-ridden, stating that 150,000 Nigerian women are living with Fistula. The irony is that there’re only 20 Fistula surgeons across the country, handling just a minute number of the victims, as against thousands.

Besides this influence, specialists said that not all medical doctors know about repairing Fistula. While many girls and women are affected by Fistula, professionals said that the exercise of early marriage being a major contributory factor to Obstetric Fistula in Nigeria; in climes like North America and Europe, Fistula has be hounded away more than a century ago.

However, the UN General Assembly Report in 2011, titled ‘The Girl Child – Report of The Secretary Genera’, stated, “The younger a girl is when she becomes pregnant, whether she is married or not, the greater the risk to her health. Girls under the age of 15 are at more risk of dying in childbirth than women in their 20s.” According to the World Health Organisation (WHO), “Adolescent pregnancies put newborns at risk. The risk of death during the first month of life is 50 per cent higher among babies born to adolescent mothers. The younger the mother is, the higher the risk for the baby.”

In an assessment, Dr. Ejike Orji, Country Representative, Ipas Nigeria, warned against girl-child marriage, saying that it’s a major contributory factor to Fistula. Orji said, “Early marriage puts girls at great risk for premature child-bearing, disability and death. When a girl is under-aged and is pregnant, the birth canal is not well developed.

“It is narrow and unable to carry the head of the baby. If the baby is forced to pass through the birth canal, two things can happen. The girl, who is a baby herself and has no business having babies, would either rupture her uterus, and both the girl and the baby will die.

“The other thing that can happen is that even if the girl succeeds in delivering the baby after several hours of labour, she will end up with VVF, or if it is in the rural area where there are no skilled attendants, she will develop RVF. VVF occurs as she is pushing; she is stressing the tissues of the birth canal, because the head of baby is bigger than the birth canal.”

Checks revealed that about 230 million girls and women (that include Nigerians) worldwide are afraid to be pregnant for the reason of family planning because they do not have entree to novel contraception. Many of the women are even derided in their different villages for the reason of myths surrounding family planning. Mr. Ban Ki Moon as United Nations Secretary General held-responsible the pushiness of Fistula in countries that include Nigeria on extremely pitiable access to reputable maternal health services. He bemoaned this during the 2016 International Day to End of Obstetric Fistula.

Moon observed that the victims of Fistula annually were not less than two million globally and these were poor and marginalised women and girls. “The persistence of Fistula in some countries and regions is an indicator of very poor access to quality maternal health services,” he said.

Executive Director, United Nations Population Fund, UNFPA, Dr. Babatunde Osotimehin, accredited in the course of the world Fistula Day, saying, “For UNFPA, ending Fistula remains one of our highest priorities, and we will continue to accelerate efforts, both in our own work and within the United Nations system.

“The global Campaign to End Fistula, launched in 2003 by UNFPA and partners, has made significant progress towards eliminating fistula and supporting its survivors through prevention, treatment, social reintegration and advocacy. UNFPA has supported more than 70,000 Fistula repair surgeries for women and girls in need, and Campaign partners have enabled many more to receive treatment.”

In another vein, Zakariya added, “There is need for government to provide needed policies to reduce chances of women coming down with Fistula. There is need to improve the health seeking behaviour of Nigerian women and access to family planning. There is also the need to upgrade care for obstetric care to prevent obstetric fistula.

“There is still need to increasing awareness at the community level about fistula, improve the health seeking behaviour of women at the community level, institute girl child education, women empowerment, poverty reduction, road networks and other infrastructures.”

This was as Moon added, “We must strengthen health systems and address broader development and human rights issues affecting women and girls: poverty, gender inequality, early marriage, early childbearing, and lack of education. Fistula has virtually been eliminated in most high-and middle.”

Osotimehin noted, “As we talk about ending polio, HIV/AIDS, female genital mutilation and so many other forms of suffering, so must we commit to stepping up our efforts to end Fistula, once and for all.

“This means heeding the call of the 2030 Agenda for Sustainable Development to leave no one behind, especially those most neglected, invisible and powerless, including the women and girls living with Fistula. Now is the time, and I am confident we can do it.”

Odimegwu Onwumere is a Poet and Writer based in Rivers State. E-mail: apoet_25@yahoo.com

Budget: Nigeria Still Toying Around With Health

Odimegwu Onwumere is concerned that Nigeria only marginally improved the 2017 budget for the health sector from 3.65 per cent in 2016 to 4.15 per cent, but is still a far cry from the 15 per cent recommended by WHO and African Heads of State

{Minister for Health, Prof. Isaac Adewole}

“The House of Representatives has faulted the allocation of 304 billion naira to the health sector in the 2017 budget,” said the media on January 30, 2017.

This suggests that the country’s health sector may be heading towards financial challenges this year due to unseemliness in the besmirched proportion of money allocated to the sector in the 2017 budget.

Given the financial downturn that the country is facing, the assurance to achieve exhilaration in the child health, nutrition and family planning could be a tall dream as N500 equals a dollar, whereas the budget was asked for N197/1USD.

There would be no gainsaying the fact that the N304 billion 2017 budget that was allocated to the Ministry of Health was a child’s play. The country merely touched the health budget of 2017 from the fraction of 3.65 per cent it was in 2016 to 4.15 per cent, as against what the World Health Organisation (WHO) and African Heads of State declared in a meeting at Abuja in 2001, where there was an accord that every country should apportion 15 per cent for healthcare in its yearly budgetary expenditure. The Partnership for Advocacy in Child and Family Health (PACFAH) in teamwork with the Health Reform Foundation of Nigeria (HERFON), grieved in a seminar that Kaduna, Nassarawa and Oyo states were aloof in taking issues pertaining to family planning programme in the health segment of their 2017 budgets seriously, as a study conducted by HERFON revealed.

Other states like Bauchi, Kano, Niger and Lagos in their respective 2017 budgets for health were stained. In Lagos for instance, analysts said, “Although the entire budget increased by N150 billion when compared to the 2016 budget of N662.6 billion, the health budget reduced from N64 billion which represents 9.76 per cent of the total budget in 2016, to N57.29 billion, representing 7.05 per cent in 2017.”  From all angle, how the health sector was being treated in the country has raised eyebrows in different quarters.

On December 20, 2016, the Pharmaceutical Society of Nigeria (PSN) threw its weight against the allotment for healthcare by President Muhammadu Buhari-led government in the 2017 budget. What the presidency of Buhari has done may be termed as retrogression in the sense that countries like China had 12.6 per cent for that purpose, while Turkey had 10.7 per cent in the year 2015, while United States had 20.7 per cent and Germany had 19.4 per cent, and Iran had 17.5 per cent for their healthcare systems. It was only in 2012 that health spectators believed was the best Nigeria has done in Health allocation of 5.95 per cent.

However, Bauchi State had mapped out 16 per cent of her 2017 budget for health, above the 15 per cent that was the hope of the WHO for countries and above Nigeria’s 4.15 per cent. Today, critics are appraising Governor Abdullahi Abubakar of the state for this singular act, saying that he meant well in the 2017 budget of N145 billion tagged ‘Budget of Sustainable Development’ which has a planned periodic disbursement of N58 billion equal to 40 per cent of the overall budget and capital outlay of N86 billion 60 per cent of the total budget.

Kaduna might have gone lower than expected with her N10.49b for health from the total budget figure of N214.9 billion encompassing of N83.46 billion periodic spending and N131.45 billion in capital expenditure. This money for the health sector in Kaduna, in earnest, may not take care of what Governor Nasir el-Rufai of Kaduna State charcterised as “an Emergency Nutrition Intervention Programme to reduce malnutrition and hunger amongst our poorest citizens and children.” Likewise, the N10 billion that was allocated to the Health Ministry by the Kano State Governor, Abdullahi Ganduje from the N209.8 billion 2017 budget proposal could not be enough.

Taking a look on what the governor spent on malaria alone before September 2016, one would say that his budget dubbed ‘Budget of Sustainable Self Reliance’ is the obverse. Evidence was that on September 22, 2016, Ganduje made it public that his government had acquired drugs and diagnostic equipment at the value of N59m to combat malaria in the state. And if every part of health in that state gulp such an amount, it then means that the N10 billion was an amount meant for the wallet.

It could be said that Niger State’s N108b budget for 2017, the health sector had nothing to boast about no matter the opinion of yesmen saying that the Niger State Governor, Abubakar Sani Bello was head bent on tackling health issues in the state. Again, looking at the total budget in the state, there will not be a better word to say that the sum was miserly.

Coming to Nasarawa State, the lawmakers even pushed for a bigger health allotment in the state’s 2017 budget. Sadly, they once kept the health budget in 2017 under the carpet. There were reports suggesting that “Partnership for Advocacy in Child and Family Health into how Nasarawa financed its health sector between 2012 and 2014 showed less than half of allocation appropriated for health in each year was actually paid out to ministries, departments and agencies. Only N2.4 billion out of N5.4b was released in 2012; N4.2b out of N8.2b was released in 2013 and N4.3b out of N11.8b was released in 2014.”

Imagine. The effects of the clumsiness in Nigeria’s health budget were that in 2016 alone, resident doctors of 25 teaching hospitals across the country, embarked on strike because of financial irregularities from the government to reach their needs. In a country where there is no functional cancer treatment centre, many medical doctors have left the country in search of a better living in other climes.

There were reports suggesting that only 21, 000 of Nigerian medical doctors registered with the Medical and Dental Council are working in the country from 80,000 the number was. The highlight of this was that the doctors were leaving the country given that doctors working for government in other countries like South Africa merit about N300,000 individually in a month, whereas those in Nigeria gain about N170,000 individually, per month, and often owed for months.

The House of Representatives Committee on the Diaspora was thrown aback in the surge of migrating Nigerian doctors and raised eyebrow, saying that in the United States of America, Nigerians consist about 77 per cent of dark-skin doctors working in that country. In some arguments, it’s understood that no matter the 4.15 per cent the national health sector was raised to in this year’s budget, the 3.65 per cent it was in 2016 was far better, because of the financial collapse that has engulfed the country, where the currency continues to depreciate than has ever been heard of in the country’s history.

PACFAH once captured this view thus, “The total sum of N304 billion has been proposed for the Federal Ministry of Health, amounting to 83 per cent for recurrent expenditures (salaries and overheads) and 17 per cent for capital expenditure (health infrastructures and services).

“This 2017 proposed Ministry of Health budget is 4.17 per cent of the national budget, a poor improvement on the 2016 budget of 4.13 per cent. With about 80 about improvement in terms of capital expenditure of the 2017 proposed budget compared to that of 2016, the reality is that this proposed health budget is cumulatively lower than that of 2016 due to the skyrocketed foreign exchange value of a naira to dollar.”

Dissecting that, the N304 billion was budgeted when the Central Bank of Nigeria doweled the trade rate at N197/1USD.  “Mid-year of 2016 and for the 2017 proposed budget, the exchange rate is at N305/1USD. As a result, while 2016 health budget was $1.269m, the proposed 2017 health budget is less by 21 per cent at $0.997m. This is important because most of our health services are reliant on importation,” the source bemoaned.

Odimegwu Onwumere is a Poet and Writer based in Rivers State. E-mail: apoet_25@yahoo.com

Of Suicide and Health Workers’ Call for Mental Health Bill

With the recent call by psychiatrists in the country for the setting up of Mental Health Bill into law, Odimegwu Onwumere writes that there is need to pay heed to the call given the concerted and coordinated concern that a sound mental health requires to help curtail suicide

The suicide buzz has left healthcare workers in Nigeria in a helter-skelter mood and they are looking for solution to curb the operation in the country.

On March 19 2017, one Dr. Allwell Oji, a 35-year-old medical doctor said to be working with Papa Ajao branch of Mount Sinai Hospital in Lagos, took his life.

Dr. Oji threw himself into the lagoon at the Third Mainland Bridge, Lagos. Nigeria has been awash with all manner of stories surrounding his death ranging from a diabolical call he got to other sinister stories. But, it is suicide!

The health sector feels devastated if it cannot arrest further situation given that after the incident, some Nigerians apparently have attempted suicide and reports say that many are still promulgating the idea.

Opinion leaders say that the suicide attempters might not know that suicide is restricted in the Nigerian law and this is contained in Section 327 of the Nigerian Criminal Code. And the law states, “Any person who attempts to kill himself is guilty of a misdemeanour and liable to imprisonment for one year.”
According to them, “If the attempters knew that suicide was illegal, one Taiwo Titilayo Momoh, a textile dealer at Balogun Market, and Mrs. Abigail Ogunyinka that wanted to take their lives by jumping into a river, just six days after Dr. Oji took his life, would not have attempted that.”

However, a consultant psychiatrist at Lagos University Teaching Hospital, LUTH, Dr. Yewande Oshodi is among the persons that raise awareness on the issue. Dr. Oshodi who was among the professionals that gathered at LUTH to campaign against suicide on March 25 2017, made this known:

“Suicide is most unwanted incident anyone could like to experience either by losing a loved one and it is preventable to some degree. The stigma of psychotics and mental health makes it difficult for people to come out when they are going through issues.”

Specialists in the health sector are gearing to map out measures to save Nigerians from depression given an account by the World Health Organisation (WHO) which predicts that sicknesses like cancer, stroke, HIV/AIDS will be a tap at the back to the pending disaster people will suffer from depression by the year 2020.

This being heralded, health experts say that Nigeria has been showing untoward attitude to mental health. For instance, the Association of Psychiatrist in Nigeria (APN) says that the authorities have shown deaf ears in its harangue that the mental health bill should be passed into law as the number of victims is increasing.

The healthcare workers have however called on the senate to pass the Mental Health Bill into law in order to arrest the psychological problems that might be besetting some citizens. Investigations therefore reveal that since 2003 a new Mental Health Bill was introduced and Nigerians were in high hope that succour had come their way.

But this patronising idea of a Bill ended on the floor of the Senate, without a passage of it into law. In 2008, it was yet expected that the Mental Health Bill had been passed into law. Those who know better say that when the Bill was raised in 2003, “The Bill lacks certain provisions that are now considered de rigeur in mental health law internationally.”

Fourteen years after, opinion leaders in the health industry frown at this, saying that the country is still operating legislation on mental health which is the Lunacy Act, 1958, following the Lunacy Ordinance, passed in 1916.

From Lagos to Lokoja and sundry, medical professionals like Dr. Moruf Mustapha and Dr. Oluwadamilola Ajayi raise their voice in requesting for a mental health law with the belief that it is not a bad idea to have the law.

Their fear is heightened on a confirmation showing that Nigeria is not working with more than 500 psychiatrists who are practicing in Nigeria: A country with an estimated population of 180 million people.

Worried by this, statisticians crux that what this means is that 360,000 citizens are cared for by just one psychiatrist and this is a far too burden of load. Professionals’ anguish, as they bare their minds on the subject, is that mental disorders are rarely diagnosed in the country and treated.

Consequently, it becomes stealthy that one in half a dozen persons have trait of this disorder in their life time with depression being a major perpetrator. They narrate their tribulation that depression is an ailment that must be cramped before sufferers pull the line of suicide. In their words, “Depression is not profound sadness; it is not just an inability to cope with life experiences; it is not caused by a character or personality flaw; it is not a moral failing, neither is it a spiritual affliction.”

This is even as the WHO states, “Every year more than 800, 000 people take their own life and there are many more people who attempt suicide. Every suicide is a tragedy that affects families, communities and entire countries and has long-lasting effects on the people left behind.”

At a public lecture recently, Consultant Psychiatrist, Irrua Specialist Teaching Hospital, Edo State, Dr. Obagaye Olukunle said that “80 per cent of people who commit suicide have psychiatric diagnosis.”

Olukunle’s voice suggests that where there is a decline in psychiatric handling in the country, tendencies of psychiatric disorders skyrocketing is not farfetched and this might as well lead to suicide.

Dr Oshodi adds, “Over a five-year study period, 7.2 per cent of cases referred to psychiatry consultation – liaison services in LUTH – were cases related to suicide. Reports had shown that during lifetime, about 3.0 per cent of Nigerians have had thoughts about ending their lives, 1.0 per cent will plan on how to kill themselves, while just under 1.0 per cent will carry out an attempt to kill themselves.”

Against this setting, the WHO has made it a necessity in its Mental Health Gap Action Programme (mhGAP) launched in 2008. This initiative harnesses “evidence-based technical guidance to scale up service provision and care in countries for mental, neurological and substance use disorders.”

As if not done with that, in 2014, the international body launched the first WHO World Suicide Report tagged ‘Preventing suicide: a global imperative’. Those who know better say that the publication was aimed at raising awareness beyond bars in the areas of the importance of public health, and make suicide prevention a topmost issue on the universal health agenda. Developing countries like Nigeria are being supported by the body and given foster mapped out for formidable suicide prevention methodologies.

The WHO is of the view, suggesting that, “Stigma, particularly surrounding mental disorders and suicide, means many people thinking of taking their own life or who have attempted suicide are not seeking help and are therefore not getting the help they need.

“The prevention of suicide has not been adequately addressed due to a lack of awareness of suicide as a major public health problem and the taboo in many societies to openly discuss it. To date, only a few countries have included suicide prevention among their health priorities and only 28 countries report having a national suicide prevention strategy.”

The United Nations body adds, “Suicide does not just occur in high-income countries, but is a global phenomenon in all regions of the world. In fact, 75 per cent of global suicides occurred in low- and middle-income countries in 2012.

“Suicide is a serious public health problem; however, suicides are preventable with timely, evidence-based and often low-cost interventions. For national responses to be effective, a comprehensive multi-sectoral suicide prevention strategy is needed.”

It is hoped that Nigeria, as among the WHO Member States, will work in line with the WHO Mental Health Action Plan 2013-2020, dedicated towards reducing the suicide rate globally to 10 per cent by 2020.

Odimegwu Onwumere is a Poet and Writer based in Rivers State. E-mail: apoet_25@yahoo.com

Selective Laws against Nigerian Women Reproductive Rights

By Odimegwu Onwumere

Stephen Luka and Justina Dusu have been locked in a romantic bliss for years. They have always been on top of their affair. Many who have been watching them, felt they were destined for each other. But, that was not to be. The real test of their love affair came when Justina missed her period. That development did not go down well with Stephen. He was not the Romeo watchers thought him to be. He felt terribly bad since Justina broke the news of her pregnancy to him.

Apparently not ready to father a child yet, he pushed for abortion. But unsafe abortion is outlawed in Nigeria. For Elizabeth Dwyer of Women & Girls Hub, a group concerned about the plight of women, “Nigeria’s abortion law is based on the same 1861 Offences Against Persons Act that governs Northern Ireland’s rules.”

Last February, at a Jos High Court, Stephen’s lover-girl who resides at Foron, in Barkin-Ladi Local Government Area of Plateau State, literally shocked the world when she alleged that the lover-boy killed her sister for refusing to undergo an unsafe abortion.

That has been the tragedy of many young women across the country. And according to Dwyer, “Each year, Nigerian women undergo 1.25 million abortions, with nearly all performed clandestinely, resulting in 500,000 health complications.

“Restrictive abortion legislation bans the procedure except when prescribed by a doctor to save a woman’s life – in a country that has such low contraceptive access, only 10 per cent of married women use birth control.”

Over the years, connoisseurs have been claiming that unsafe abortion has become one of the major factors that cause maternal deaths in Nigeria. They have, therefore, been agitating for the individualisation of family planning (FP) services in the country that prides itself as the giant of Africa.

Those who know better say unsafe abortion causes irremediable damage to the women. In Nigeria, many are of the view that it is an act of infringing on women’s reproductive rights since abortion is technically not legal in the country.

In search of a way out of the reproductive gender gap in the country, on August 17, 1991, Campaign Against Unwanted Pregnancy (CAUP) was launched. It is a multi-disciplinary initiative focusing attention on the health problems of women caused by unsafe abortion in Nigeria.

Since then, the political environment in Nigeria has been a complex and volatile one, with strong religious and ethnic tensions and a very conservative public attitude towards abortion. For instance, Post Abortion Care (PAC), a group concerned with women’s reproductive right in the country, says it’s so bad that reproductive rights of women are not respected in the country. Reproductive rights activists have been warning against what they described as ‘’archaic laws’’ on abortion in Nigeria.

Often, health agencies talking about unsafe abortions, are accused of operating measures to promote unwholesome behaviour in the country. The United Nations Population Fund (UNFPA) was caught up in a hullabaloo of orchestrating promotional abortion movement for young ladies who were liberated from Boko Haram, some two years ago.

It was reported that Nigeria was not support of abortion. Many sensitisation campaigns have been held in this regard, but the authorities have not deemed it wise and right to make abortion a legal issue. In October 2015, media men were trained on “Women’s Sexual Reproductive Health and Rights” for three days in Abuja, Nigeria’s capital city.

Hauwa Shekarau, a lawyer, says the training workshop was aimed at enlightening people on sexual and reproductive health and rights of women. “The abortion law in Nigeria is restrictive and it is only permitted to save the life of the woman if she is in a danger. But those that do not fall under this legal restriction are left to their own devices.

“Also, the cost of carrying out this procedure is high, and those who are not economically empowered resort to quacks, making unsafe abortion the most silent and persistent cause of maternal mortality in Nigeria,’’ she says.

A consultant obstetrician and gynaecologist at the University Teaching Hospital, Gwagwlada, Dr. Godwin Akaba said at a public presentation, “lack of family planning tools is one of the leading causes of maternal mortality, as it results into unintended pregnancy, which could lead to unsafe abortion.

“The magnitude of maternal mortality and morbidity represents perhaps the greater social injustice of our time. Our ability to address these preventable causes of maternal mortality is but a symptom, a tragic symptom of a larger social injustice of discrimination.”

Dr. Ejike Orji of Association for Advancement of Family Planning, (AAFP), sufficed to what Dr. Akaba added, “Unsafe abortion is dangerous with such resultant effects like ‘bleeding, infections and infertility’ in most cases.”

Since September 2015, the UN has bared its stance, saying that Nigeria should rescind her abortion laws because it’s part of setbacks in furthering abortion and sexual rights for adolescents in Africa.

“The UNFPA told Nigeria to take back its reservations on “sexual and reproductive health” and “reproductive rights” in a new UN development agreement,” said a UN report. It is hoped by opinion leaders that the authorities should see abortion beyond the scope of religion, politics and culture.

For them, “advocacy efforts need to address not only visible power, i.e. the making and enforcing of formal laws and regulations, structures, authorities, institutions and the procedures of decision-making, but also how and by whom the agenda is set.

“The latter includes the ways in which powerful people and institutions maintain their influence, by controlling access to decision-making and excluding and devaluing the concerns and representation of less powerful groups.”

Odimegwu Onwumere is a Poet and Writer based in Rivers State. E-mail: apoet_25@yahoo.com