The Bill and Melinda Gates Foundation says it has committed two million dollars to the Nigerian Basic Health Care Provision Funds to fast-track implementation by the government toward the realisation of Universal Health Coverage (UHC).
Dr Paulin Basinga, the Deputy Nigerian Country Officer of the foundation disclosed this on Wednesday in Abuja during a visit by officials of the National Institute for Policy and Strategic Studies (NIPSS).
The NIPSS paid a study tour on the foundation and Development Research and Project Centre (dRPC) which is under the Partnership for Advocacy in Child and Family Health (PACFaH ) @scale project.
Basinga described the money that was donated by the foundation as a strategy that would allow money to flow from the Central Bank of Nigeria (CBN) account down to primary health care facilities.
He explained that the 2014 National Health Act stipulates that one per cent of the nation’s consolidated revenue should be channelled toward funding basic healthcare provision fund that would guarantee access to health by all.
However, he lamented that till date the policy has not been implemented.
He further noted that the organisation has signed a Memorandum of Understanding (MoU) with the government to enable it meet its commitment of buying vaccines among other consumables that would drive UHC.
Basinga identified funding as a major gap in the realisation of UHC.
He said there was need to build a stronger PHC system in the country to ensure preventive and curative measures of diseases at the community levels.
Basinga flayed the present funding of healthcare system in the country by channelling more resources to the tertiary and secondary health levels.
He urged the government to make strategic legislation to funding UHC.
“Through this legislation, funding priority will be geared toward revitalisation of primary healthcare system thereby reducing the nation’s disease burden and death rate.
“If the nation has strong primary healthcare system the health needs of 90 per cent of Nigerians will be addressed.
“We are excited in this journey toward UHC and we have been stirring the government to build a stronger PHC system through improved funding among others so that the UHC can be a reality,’’ he said.
Basinga identified the six building blocks of UHC as financing, facilities, human resources, commodities, religious and community leaders as well as data.
He emphasised that in order to drive UHC there was need for facilities to be situated in places where they can easily be accessed by all the pregnant women and children, among others, without hitches.
According to him, commodity must be readily available at all times like the test kits and treatment for malaria and typhoid, among other diseases.
He further noted that the capacity of health workers at the health facilities must be built to adequately meet the health needs of the populace.
He however called for collaborative efforts by philanthropists, civil society organisations, individuals and policy makers to ensure realisation of UHC to guaranty accessible, affordable and quality healthcare services for all irrespective of status.
AVM Dahiru Sanda, the Leader of NIPSS delegation, said their tour of the organisations was for the participants to be abreast with the relevance of the organisations in to funding of UHC delivery in the country.
Sanda identified the theme for their study tour as “Funding UHC delivery in Nigeria”.
“These organisations are key funders of UHC delivery and our focus is on framework and challenges they have in funding healthcare delivery in the country,’’ Sanda said. (NAN)
GE Healthcare Advancing Universal Health Coverage in Ghana
GE Healthcare’s Eyong Ebai, General Manager West Central & French Sub-Sahara with Hon Alexander K. K. Abban Ghana’s Deputy Minister of Health, Farid Fezoua President & CEO GE Healthcare Africa and Sulemana Abubakar, CEO GE Ghana during Ghana Healthcare Dialogues event. Source: GE
A key highlight of the event was the unveiling of GE Healthcare’s new budget-conscious ultrasound system, the Versana Essential
ACCRA, Ghana, June 12, 2019 – GE Healthcare has kicked-off a two-day “Healthcare Dialogues” event in Ghana, bringing together public and private sectors’ industry stakeholders including policy makers, healthcare professionals, decision makers, academia, investors and financing institutions to drive conversations around innovative sustainable healthcare solutions to help progress Ghana’s Universal Health Coverage (UHC). Under the theme of Elevating Healthcare through Collaborations, key topics to be discussed include Structuring Innovative Healthcare Financing Solutions; Ghana’s Vision for UHC; the Future of Radiology with Artificial Intelligence (AI); Healthcare Technology Innovations, among other topics.
A key highlight of the event was the unveiling of GE Healthcare’s new budget-conscious ultrasound system, the Versana Essential. It has excellent image quality and can be used by obstetricians and gynecologists, family and general practice physicians, and clinicians in a number of other specialties, making healthcare accessible to promote maternal healthcare in Ghana. It also comes with local product and clinical training backed with GE’s solid aftersales service to help healthcare professionals gain comfort and proficiency with the system to enhance patient care.
“Promoting health for all is key in accelerating Ghana’s vision for Universal Health Coverage,” said Eyong Ebai, General Manager, GE Healthcare West Central Africa & French Sub-Sahara Africa. “Through collaborations, continuous investment in sustainable healthcare solutions and capacity building, GE Healthcare will continue driving access to quality and affordable healthcare in the region.”
Ghana has been recognized for its commitment to address barriers to health care services and attainment of UHC by 2030 by providing formal support to its vulnerable population through its National Health Insurance Scheme (NHIS). In 2018 https://bit.ly/2ZnK1yV, NHIS had increased to about 11 million people from the 1.3 million memberships at inception in 2005, representing 38% of Ghana’s population. In addition, the healthcare system engages over 4,000 public and private providers and accounts for about 85% of its internally-generated fund.
“We are proud to host the GE Healthcare Dialogues in Ghana and provide a platform for the industry stakeholders to advance the country’s healthcare agenda,” said Sulemana Abubakar, CEO GE Ghana. “This is a testament of our role as a global leader with local presence, to drive better outcomes for people in the markets in which we operate.”
GE started its operations in Ghana in 2010 with only 5 employees and has grown to 100+ employees currently 90% Ghanaians, with two offices in Accra and Takoradi. Through strategic partnerships and localization commitments, GE is supporting co-creation of solutions to tackle key challenges in Healthcare, power and oil & gas to help improve life for the people of Ghana. GE Healthcare in collaboration with the Ministry of Health and the Ghana Health Service is also training and equipping healthcare professionals at the primary healthcare level with over 500 portable ultrasound machines across 125 of Ghana’s 216 districts. As a result, 1.5 million expectant Ghanaian women are expected to benefit from the initiative by 2020.
Engaging community healthcare workers in addressing primary healthcare crises in Nigeria
Image credit: VON
We are currently facing a primary healthcare crisis in Nigeria and speedy intervention is needed to salvage and enhance access to health care for our ever growing population.
Community health workers have the potential to enhance primary care access and quality, but remain underutilised in Nigeria.
A WHO report by Uta Lehmann and David Sanders from the School of Public Health University of the Western Cape, says;
‘The use of community health workers has been identified as one strategy to address the growing shortage of health workers, particularly in low-income countries. Using community members to render certain basic health services to the communities they come from is a concept that has been around for at least 50 years. There have been innumerable experiences throughout the world with programmes ranging from largescale, national programmes to small-scale, community-based initiatives’ (Evidence and Information for Policy, Department of Human Resources for Health Geneva, January 2007)
It is common knowledge that we do not have trained physician associates or assistants in primary care facilities to support medical doctors in providing primary care services; rather what we have in some communities are quacks, people parading themselves as medical doctors with no medical qualification what so ever.
But I don’t see any reason why we should not welcome the idea of training physician associates or assistants to fill in the gap for medical staff shortage, when other developing and developed countries that have better healthcare systems do have them.
In Nigeria we do not have enough doctors per population or geographical area, This is the time to train up more community health care workers as this would help in the much needed awareness creation and community based interventions for managing long term conditions, reducing childhood illnesses due to lack of immunisation. Trained birth attendants will also help reduce maternal mortality and community nursing care will reduce infant mortality.
In a typical medical centre in the UK for instance, healthcare assistants, advanced nurse practitioners, health trainers, clinical pharmacists or prescribers, work alongside doctors to provide patient centered care. This helps to reduce the work load on the doctors as these other clinicians and allied health workers have enough training and experience to manage long term conditions and participate in triage system.
In the UK, a lot of research has been done and there are calls to increase the health work force in the National Health Service (NHS) through the utilisation of community-based lay workers.
Below is an extract from a research published in the journal of Royal society of medicine curated by Dawn O’Shea:
‘’Introducing a workforce of community-based lay health workers in the NHS could address current general practitioners (GP) workload demands, while improving clinical outcomes, according to research published in the Journal of the Royal Society of Medicine.
In the 1960s, programmes in the US funded members of the community provide a bridge between patients and health care providers. By facilitating appointment-keeping and increasing medication compliance, community health workers improved access to and quality of health care, while reducing costs.
In Brazil, community health workers receive basic training in disease identification and monitoring, immunisation, screening and health promotion. They support patients with medication adherence and chronic disease monitoring and liaise proactively with GPs and practice nurses…..
The authors conclude that systematic integration of community health workers at scale in the NHS could be an effective and a rapidly implementable approach to the current primary care workload crisis’’.
(Hayhoe B & al. | J R Soc Med | 4 Oct 2018 from Dawn O’Shea | UK Medical News | 8 Oct 2018)
Another important area where the community healthcare workforce could be utilised effectively is emergency care or first aid. In most public and private places in Nigeria, there are no ambulance or paramedic services; having well trained community first aid responders would go a long way to save lives in times of emergency for example; cardiac arrest, collapse, and respiratory distress. Having a health unit manned by well-trained first aid responders in all public places like markets, motor parks etc is highly essential.
Healthcare provision anywhere in the world is capital intensive but we can start from the basics; we can reduce the burden or costs in secondary healthcare provision especially in our public hospitals if we lay more emphasis on patient health education and encourage people to engage in healthy living and self-care. Integrated healthcare practice at all levels is an efficient way of providing patient centered care where every member of the healthcare team contributes their quota.
Community healthcare workers are well placed to offer advice on healthy living and self-care in the language people of a specific demographic area would understand.
Hypertension, Chronic Kidney Disease, Type 2 diabetes mellitus, malaria, HIV/AIDs are among the diseases that could be prevented or well managed through patient education and lifestyle advise.
The role of health education cannot be overemphasized. For instance, there is still some form of stigma around epilepsy in some areas in the country; where people who are epileptic are believed to be possessed by some sort of evil spirits, in an unfortunate event of epileptic fits in public places, patients are not well cared for and objects like spoon etc. are inserted into their mouths in the believe that it keeps the airways open, this could be a choking hazard and has made recovery time worse for some patient. Community healthcare workers could perfectly fill that gap of providing basic health education and public health enlightenment.
In conclusion, addressing the primary healthcare crises in Nigeria is no mean feat, but we need to look at the issue holistically, it involves a multifaceted, public and private partnership, but the Government has to lead on this through the inaction of relevant laws and provision of training programmes, monitoring and evaluation etc.
Without health, life is not life; it is only a state of languor and suffering.
Clinical Pharmacist/UN SDG Advocate
The benefits of medicines optimisation and patient centred care in disease management outcomes and the role of the pharmacist.
According to the Royal Pharmaceutical Society ‘Medicines optimisation represents that step change. It is a patient-focused approach to getting the best from investment in and use of medicines that requires a holistic approach, an enhanced level of patient centred professionalism, and partnership between clinical professionals and a patient’.
I believe medicines optimisation is about ensuring that patients receive the right kind of medication at the right time and medicines use review is a step towards the direction in achieving this. It focuses on making patients get the best out of their medicines.
Evidence has shown that a good number of medicines prescribed end up not being taken due to lack of concordance and compliance.
My experience in community pharmacy with patient returned medication has shown that patients who do not understand the rationale for prescribed medication are more likely not to use the medication.
Also medication which are preventative in nature are at a higher risk of non-compliance as patients do not see the immediate benefits of taking such medication.
A lot of work needs to be done in the area of patient education and information provided through medicines use reviews.
The gains of patient entered care cannot be overemphasised, all medical needs have to be tailored to the individual patient, considering their personal circumstances, other co-morbidities, and sometimes frailty comes into consideration for some elderly patients as well.
There has been a drive for more social prescribing, motivational counselling and interventions for patients who have suffered medical emergencies or patients with long term conditions. Evidence has shown that non-pharmacological interventions have a major role to play in achieving overall general health and wellbeing.
Social prescribing and befriending services can help curb loneliness especially in the elderly as loneliness contributes to depression and could make dementia related symptoms worse.
Outcome in healthcare delivery has seen some improvements when patients have been through some social prescribing when their domestic needs are met and they at least have some form of social life and social activity, this leads to improved wellbeing and mood which in turn contributes remarkably to the disease management outcome.
Pharmacist led medication review tend to be more in-depth ,capturing all the essence of patient centred care as it offers more time for the patient to ask medicines related questions which enhances concordance.
Factors such as wrong medication formulation could deter a patient from taking their medication; for instance a patient with swallowing difficulties would benefit from having solid medication forms converted to liquid preparations or orodispersible forms where appropriate.
Also the use of multiple dosage eye drops in the case of a glaucoma patient could be impaired if the patient is suffering from Parkinson’s disease or arthritis, as the patient is not able to instil drops into the eye. Such patient would benefit from an eye dropper device or single dose eye drop preparation.
It is during the medication review process that such issues are discussed and problems of non-compliance solved.
In the course of completing a medication review with one of my patients, It came to light why patient’s chronic obstructive pulmonary disease (COPD) was not well managed .This patient happened to be visually impaired and was unable to read the small typed instructions on the dispensing label and so assumed tiotropium capsules needed to be swallowed whole and not inserted into the inhalation device.
After I offered education, guidance and support to this patient, the patient was able to use her inhaler as intended and her COPD symptoms were well controlled eventually. In this case a possible COPD exacerbation or even hospital admission was prevented.
Medication reviews are needed to highlight issues of blood monitoring, therapeutic drug monitoring for medicines that require special monitoring; like methotrexate, diuretics, digoxin etc.
Annual blood tests are routinely checked because if dosage regimens are not adjusted or vital blood checks are not made, this may lead to increased harm to the patient or even death.
Multidisciplinary team approach is needed where every member of the health care team contributes their expertise in patient centred care.
Integrated health care approach will enhance delivery of outcomes. Clinicians need to work together to ensure adequate measures are put in place and everyone contributes their own quota for effective healthcare delivery.
The role of the pharmacist in medicines optimisation and patient centred care cannot be overemphasized.
Adaku Efuribe is a Clinical Pharmacist and Independent Prescriber (specialising in pain management and general medicine).She is a United Nations Sustainable Development Goal Advocate and continues to advocate for better healthcare systems for all.