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Engaging community healthcare workers in addressing primary healthcare crises in Nigeria

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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.     

Francois Rabelais

 

Author:

Adaku Efuribe

Clinical Pharmacist/UN SDG Advocate

 

Health

Why smoking waterpipe tobacco aka shisha is harmful to your health | Adaku Efuribe

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I wish to draw attention to a public health issue that has become popular in the major cities of Nigeria which is shisha smoking. It is worthy of note that using shisha also poses the same risks as cigarette smoking. I have decided to write this article to create some form of awareness about shisha.

Few days ago, I watched a youtube interview which featured a popular Nigerian artist and throughout the interview the artist engaged in a shisha smoking session which was quite shocking to me.

Following the recent issues emanating with codeine and tramadol abuse among youths in Nigeria,

The federal ministry of health has to up their game in educating the general public on the harmful effects of social substances that are dangerous to health.

There are mixed messages regarding shisha coming from uninformed people that do not understand the ingredients that make up shisha.

The other day I read a comment on social media made by a young Nigerian lady ; advising people that there is nothing wrong with shisha and using it is a way of taking nutritional supplements,

The lady went on to say shisha is mixed with vitamins and minerals and those who engage in smoking it are getting their daily vitamins and minerals.

Her comment had hundreds of likes from people who are as uninformed as her.

The World Health Organisation (WHO) fact sheet on waterpipe tobacco smoking states that -Waterpipe smoke is toxic. Laboratory analyses of waterpipe smoke reveal measurable levels of carcinogens (including tobacco- specific nitrosamines, polycyclic aromatic hydrocarbons [PAH], volatile aldehydes like formaldehyde, and benzene), and toxicants such as nitric oxide and heavy metals. Additionally, the burning charcoal generates high levels of carbon monoxide.

Systematic reviews of existing research point to significant associations between waterpipe smoking and lung cancer, periodontal disease and low birth weight . More recent data suggest probable associations with oral, oesophageal, gastric and urinary bladder cancer, as well as chronic obstructive pulmonary disease, cardiovascular disease, stroke, chronic rhinitis, male infertility, gastro-oesophageal reflux and impaired mental health.

Shisha smoking is becoming popular among artists and some celebrities in Nigeria. This is a worrisome trend as such people could easily influence their fans and followers into smoking it as well.

As a clinician I don’t see anything classy in engaging in risky behaviors that could endanger ones health and probably shorten life span.

I care about the health of Nigerians and any little information as regards to self care and healthy living would help especially in this day and age where our healthcare sector is a reflection of system failure in all quarters.

A lot of people believe that smoking shisha is safer than smoking cigarettes but this is not true unfortunately.

The key facts about shisha show that it is even more risky and harmful to health than cigarette smoking.

The British Heart foundation advises that shisha smoking – also called hookah, narghile, waterpipe, or hubble bubble smoking – is a way of smoking tobacco, sometimes mixed with fruit or molasses sugar, through a bowl and hose or tube. (BHF)

Please see below key facts about shisha from a publication by the British Heart Foundation (BHF) to learn more:

‘What is in a shisha pipe?

Shisha pipes use tobacco sweetened with fruit or molasses sugar, which makes the smoke more aromatic than cigarette smoke. Popular flavourings include apple, plum, coconut, mango, mint, strawberry and cola. Wood, coal, or charcoal is burned in the shisha pipe to heat the tobacco and create the smoke because the fruit syrup or sugar makes the tobacco damp.

When you smoke shisha, you and anyone sitting near you are breathing in smoke which releases toxins including carbon monoxide and heavy metals –reducing your body’s ability to carry oxygen around in your blood.

How harmful is shisha smoking?

Traditionally shisha tobacco contains cigarette, tobacco so like cigarettes it contains nicotine, tar, carbon monoxide and heavy metals, such as arsenic and lead. As a result, shisha smokers are at risk of the same kinds of diseases as cigarette smokers, such as heart disease, cancer, respiratory disease and problems during pregnancy.

It’s difficult to say exactly how much smoke or toxic substances you’re exposed to in a typical shisha session. People smoke shisha for much longer periods of time than they smoke a cigarette, and in one puff of shisha you inhale the same amount of smoke as you’d get from a smoking a whole cigarette.

The average shisha-smoking session lasts an hour and research has shown that in this time you can inhale the same amount of smoke as from more than 100 cigarettes.

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Some people mistakenly think that shisha smoking is not addictive because the water used in the pipe can absorb nicotine. In reality, because only some of the nicotine is absorbed by the water, shisha smokers are still exposed to enough nicotine to cause an addiction.

Is herbal shisha safer?

No it isn’t. Shisha, herbal or otherwise, usually contains tobacco. Fruit or herbal flavours do not mean the product is healthy. Even if you use tobacco-free shisha, you’re still at risk from the carbon monoxide and any toxins in the coal or charcoal used to burn the shisha.

Second hand smoke is also a worry. If you’re smoking with other people or in a public place and the shisha includes cigarette tobacco, it’s likely you’ll breathe in their second hand smoke too’’ (BHF).

Now that you know the key facts about shisha, I expect you to make an informed decision whether to use shisha or not considering the risks and associated diseases.

Healthy living is the greatest gift you can give yourself, why not choose health!

 

Author

Adaku Efuribe is a United Nations Sustainable Development Goal Advocate with expertise in medicines management, health promotion and integrated healthcare

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Telehealth: the game-changer for healthcare in Africa

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The statistics remain grim; nearly half of the world’s population still lacks access to essential health services, and each year at least 100 million people are pushed into poverty in the attempt to pay for access to these services.

Those figures should be an anomaly, but are the stark reality – and the fact remains that many of the people who fail to get much-needed access to care live in Africa. Emerging economies typically bear the brunt of a lack of access because of gaps in the availability of services and citizens battling to afford even the most basic healthcare.

The challenge of having such a high number of the continent’s people unable to access even basic healthcare, which is a fundamental human right is increasingly being offset by the introduction of solutions borne from rapid technological advancement – innovations that are removing traditional barriers to access.

One such innovation is telehealth – or telemedicine – which is the remote diagnosis and treatment of patients through the use of telecommunications and digital technology such as mobile devices and computers.

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Telehealth as a viable solution in the quest for access to care

Telehealth has quickly gained itself a reputation as an effective solution to help achieve the goal of universal health coverage. The industry has grown exponentially and it is predicted that it will be worth approximately $89 million globally by 2023.

This growth can largely be attributed to telehealth’s benefits, which have been widely felt wherever it has been adopted. By enabling healthcare professionals to diagnose and treat patients without needing to see them face-to-face, telehealth effectively helps lower the costs of delivering healthcare services.

Telehealth also has the potential to overcome shortages of healthcare professionals by increasing access to specialists in bigger and more well-equipped medical centres, hospitals and academic institutions. This has far-reaching consequences in places such as Africa, where patients often have to walk long distances or catch multiple forms of transport before they even get the chance to join a long queue to see a medical professional – a reality I have often witnessed myself. I believe telehealth is a big step in the right direction of overcoming this challenge and I am heartened by the encouraging signs of its uptake in Africa.

All telehealth requires is access to a mobile device and internet connection, which has proved to be a massive area of growth in Africa.

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Mobile has helped Africa leapfrog many of the challenges the continent faces – ranging from accessing financial services to education – so it comes as little surprise that subscriber penetration reached 444 million in 2017 and is expected to hit 634 million by 2025.

More than just being mobile, though, African citizens are making the move to smartphones and mobile broadband: from 250 million people with smartphones and 38 percent of all connections being mobile broadband at the end of 2017, this will accelerate to 690 million smartphones and mobile broadband connections sitting at 87 percent by 2025.

These millions with smartphones and mobile broadband connections are able to access life-changing – and life-saving – services, such as telehealth solutions.

Creating opportunities for access to healthcare is at the forefront of my vision and innovations like telehealth excite me. This shift has led to a proliferation of platforms and apps that open up access to care.

There are multiple kinds of apps that allow people to talk to or text doctors, get daily health tips and find out what their symptoms can mean, or which help people living with specific illnesses – such as diabetes – manage their disease. And these apps have widely proven to not only improve access to care, but also to ultimately improve the patient experience.

In fact, our latest Future Health Index (FHI) research has shown that a third of South African healthcare professionals say that their patients’ experience has been positively impacted by telehealth in the past five years. It has also indicated that 38% of South Africans are open to remote consultations for non-urgent care – showing the potential of telehealth as a tool to provide care.

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Targeting poor and underserved communities

There are additional examples of telehealth solutions that have been implemented specifically to improve access and provide healthcare services to the poor and those living in remote, rural areas.

In Kenya, for instance, 450 healthcare providers have partnered with M-TIBA, a mobile service that allows people to send, spend and save money specifically for healthcare, to provide mobile ultrasounds for over 100 000 patients.

Kenya also launched its national telemedicine initiative for the poor and marginalised in rural areas in 2015. The initiative helps patients and healthcare providers in rural areas to use video conferencing to interact with experts at the country’s biggest referral hospital, Kenyatta National Hospital. This not only helps with diagnosis and treatment, but also with training and research.

In South Africa, the Impilo Initiative also helps give access to care in rural areas, but focuses specifically on women and girls and providing pre- and post-natal care. Established in 2018, it equips community health workers with smartphones and tablets to facilitate virtual doctor’s appointments.

Although there are no formal statistics on hand to reflect exactly how many patients these two initiatives have positively impacted, I have seen enough telehealth solutions in action to know that they make a tangible difference in the lives of the people that need it most.

Philips too, for example, has numerous telehealth solutions that we have piloted in Kenya that we can see are making a real difference in underserved communities. The Philips Foundation, for instance, is supporting a number of projects that explore the use of mobile ultrasound technology at primary care level to enhance availability of affordable services in the underserved communities and remote areas of Kenya.

One such project is called “Mimba Yangu”, in collaboration with the Centre of Excellence in Women and Child Health of the Aga Khan University, which is currently looking into the feasibility, impact and costs of quality antenatal care and examining if ultrasounds before 24 weeks of pregnancy, as recommended by the World Health Organisation (WHO), will result in better health outcomes for mothers and babies.

Together with Amref International University, the Philips Foundation is also testing the viability of ultrasound in the business models of midwives. These projects look, in particular, at our Lumify and Philips Mobile Obstetrics Monitoring (MOM) solutions.

The Lumify uses a smartphone-based mobile app and portable ultrasound to help both healthcare professionals and mothers. Medical professionals are able to deliver care wherever it is needed even in the most remote locations, while mothers are able to see clear and high-quality images of their unborn babies. This means that patients can be treated at the point-of-care with a greater chance of success because of faster and more accurate diagnosis and treatment. We pride ourselves on this innovation as we work towards reducing mother and child mortality rates on the continent.

The Philips Mobile Obstetrics Monitoring (MOM) solution, meanwhile, is a scalable telehealth platform that allows midwives to remotely monitor patients from hospitals or home through data collected from physical examinations and then shared to the centralised MOM server. This data can then be used to determine if a pregnancy is high-risk so that immediate care can be provided.

MOM has been used successfully in Indonesia – which, like most African countries, is an emerging market. I personally witnessed its efficacy as the pilot was run during my time as the Head of the Philips consumer business in Indonesia. In this pilot study, detection of very high-risk pregnancies increased threefold and zero maternal deaths were recorded. There was also a 99 percent reduction in anaemia from the first to the third trimester through enhanced patient management. These results are testament to the impactful difference our innovations are making.

It’s clear then that telehealth presents a clear opportunity for Africa, where nearly 700 women die of pregnancy-related causes every day. Research by the WHOhas shown that at least two thirds of mothers and children can be saved with cost-effective interventions and solutions like the Lumify and MOM – making it critical to introduce them to these countries to avoid preventable deaths.

These examples clearly show the immense potential of telehealth to drive widespread access to essential healthcare services – making it critical for healthcare providers to continue to implement these solutions at scale to give citizens across the African continent the healthcare they deserve.

Article by Jasper Westerink, CEO Philips Africa

SOURCE: https://www.linkedin.com/pulse/telehealth-game-changer-healthcare-africa-jasper-westerink-2e

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Cyclists raise sh1.7b for health in Uganda

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The cyclists some in their 60’s and above started the gruelling race in Luweero

Not often in Uganda does a cycling race raise over a billion Shillings in one week. But this is what happened last week as AMREF Health Africa in Uganda in partnership with AMREF Flying Doctors in the Netherlands held their second fundraising event in Uganda.

The event (Africa Classic) that started on June 23 had 58 cyclists from the Netherlands covered 600km through 7 districts of Uganda, ending at the Imperial Resort Beach Hotel in Entebbe on Saturday.

ome of the cyclists ride towards the finish line at akiwogo in ntebbe hoto by ichael subuga
Some of the cyclists ride towards the finish line at Nakiwogo in Entebbe. Photo by Michael Nsubuga

The cyclists some in their 60’s and above started the gruelling race in Luweero, Nakasongola, Masindi, Hoima, Kibaale, Kiboga, Mubende, Mpigi before finishing in Entebbe.

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A cheque amounting to Euros 413,920 (sh1.7b) was presented to AMREF Group CEO Dr Githinji Gitahi who was in the company of country director at Amref Health Africa in Uganda Abenet Leykun Berhanu, at the end of the race.

According to Githinji, the AMREF office in the Netherlands organises the riders after each one of them gets involved in fundraising up to 5000 euros each.

he cyclists going through one of the villages during the frica lassic hoto by ppo arsijns
The cyclists going through one of the villages during the Africa Classic. Photo by Eppo Karsijns

He said the money is used to support different health interventions in Africa through the provision of health care to communities that are not near health centres, especially improving lives of women and children in disadvantaged communities across the country.

“We are focused on improving lives of women and children; some of the money is going to train midwives and we are also going to ensure more children get immunized through more outreach services; we have been doing this but now we are going to increase on those services,” Githinji said.

Berhanu said last year 70 cyclists participated in the first race which raised 503,806 Euros (sh2b)

“We use the same funds to build the capacity of community health workers and public health facilities including hospital and providing other health services,” Berhanu noted.

Article first appeared at: https://www.newvision.co.ug/new_vision/news/1502792/cyclists-raise-sh17b-health-uganda.

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