Healing Nigeria

Nigeria's National Health Act

2011-06-04T12:17:00.000-07:00

Read "Hope for Health in Nigeria" published by the Lancet:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60791-5/fulltext?rss=yes

Hope for Health in Nigeria

"Celebrations are afoot in Abuja. On May 19, the two Houses of the Nigerian National Assembly finally passed the National Health Bill into law, after 7 years of inaction and procrastination. The controversial bill, which promises to provide all Nigerians with a basic minimum package of health services, was originally proposed in 2004 and passed in May, 2009, before being withdrawn for bureaucratic reasons. It has effectively lain untouched since. The Nigerian Medical Association estimates that 7 million children and 385 000 mothers have died in the interim.

As the most populous country in Africa (one in four Africans live in Nigeria), providing universal health care is no easy task. But even allowing for the difficulties posed by providing health care to a large population, the country still underperforms. Life expectancy at birth averages just 54 years for both sexes. Maternal mortality is 608 per 100 000 livebirths, and the mortality rate for children younger than 5 years is more than double the global average at 157 per 1000 livebirths. Nigeria is the only country in the African continent to have never eradicated poliomyelitis, and only 3% of HIV-positive mothers receive antiretrovirals. Just 6% of the country's gross domestic product (GDP) is spent on health and there are enormous inequalities in its allocation between the rich and poor areas of the country.

The bill provides a framework for the regulation and provision of national health services, defines the rights of health workers and users, and stipulates guidelines for the formulation of a national health policy. Its promises will not change everything for Nigerians, but the bill does allow them to finally hold the government to account for their right to health, including equitable access to care. Never before has there been such momentum towards making a real commitment to improving health in this country..."

Complete Piece available at:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(11)60791-5/fulltext?rss=yes

President Goodluck Jonathan
Reuters

National Health Insurance Scheme Act: Forthcoming Amendment

2009-12-19T15:37:00.001-08:00

In a previous blog posting (http://ireh-iyioha.blogspot.com/2009_05_01_archive.html), we asked readers to consider the implications of a mandatory health insurance scheme for Nigeria. Indeed, there have been speculations about whether the Scheme is "mandatory" or "voluntary" due to the wording of the Act. Perhaps, the executive secretary of the Scheme was thinking along with us. The Vanguard of Nov. 17, 2009 (yes, that's a month ago, but this is for those who didn't read this item) reports that the Act is to be amended to include a recommendation, amongst others, that the Scheme be mandatory. Read the full report:

Social health insurance: “Amended NHIS Act ‘ll make participation compulsory”
http://www.vanguardngr.com/2009/11/17/social-health-insurance-%E2%80%9Camended-nhis-act-%E2%80%98ll-make-participation-compulsory%E2%80%9D/

Going Bankrupt Over Medical Expenses: Any Protection Under the Nigerian NHIS?

2009-12-18T17:36:00.000-08:00

In researching on National Health Insurance, I have come across a growing body of significant research on 'medical bankruptcy' in the United States. In two major studies conducted in 2001 and 2007 (http://download.journals.elsevierhealth.com/pdfs/journals/0002-9343/PIIS0002934309004045.pdf), Professors Warren Elizabeth, David U. Himmelstein MD, Deborah Thorne, PhD, and Steffie Woolhandler MD, MPH outlined a nexus between medical problems and rising healthcare costs and a significant percentage of bankruptcies in the US.

The Arguments
Universal coverage through a national health insurance scheme can still leave many families exposed to astronomical healthcare costs. According to the authors, "many health insurance policies prove to be too skimpy in the face of serious illness" (http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.63v1). While there are dissenting views - as it is expected in the world of academia - on the exact impact of medical costs on bankruptcy filers in the US, what is important is that the research establishes that medical costs contribute to the overall incidence of bankruptcy in the US. Nowhere could this be truer than in a new Nigeria that now boasts of a National Health Insurance Scheme.

Implications of the Above Arguments - the Nigerian Situation
The above discussion implies that the existence of a national health insurance scheme - which is by all accounts an excellent initiative - is itself not a buffer against financial distress arising from the costs of medical care. In my work on the Nigerian national health insurance scheme (NHIS) (http://papers.ssrn.com/sol3/papers.cfm?abstract_id=1016661), I critique the Scheme's benefit package. While covering common and arguably inexpensive medical conditions, the Scheme (http://www.nhis.gov.ng/) effectively under-insures patients for those chronic, debilitating health conditions which are part of the major problems that plague Nigerian families. While Nigerians don't typically file bankruptcy claims as often as corporations do, yet it is common knowledge that "bankruptcy" whether applied as a legal or basic term is fitting for the experiences of Nigerians afflicted with serious medical problems.

As I highlighted in a previous post on the need to focus on the content of care alongside the form, Nigerian health policymakers can take a look at this and other related scholarship and answer the question that many Nigerians are silently asking: Do we need this FORM of national health insurance?

US Healthcare Reform and Integrative Medicine: Any Lessons for Nigeria?

2009-08-14T09:00:00.000-07:00

Dr. Andrew Weil, founder and director of the Arizona Center for Integrative Medicine, was on Larry King Live on August 12. He shared his views on the US healthcare reform process, suggesting that integrative medicine - careful attention to the "content of care" - is the way forward for America's healthcare system. Transcript:

WEIL: I have a somewhat different perspective. I think that unless we change the content of health care, any attempt at reform is doomed. Any system we set up, whether it's single payer or universal coverage, is going to be taken down by uncontrollable costs. We have to lower the costs of health care. And the kind of medicine that we now practice is not sustainable because it relies on expensive high-tech solutions.

BLITZER: So what does that mean to change the content?

WEIL: So I think the trick is to figure out how do we get these costs down? The first step is prevention, obviously. But, secondly, we have to train physicians and other health professionals to use low-tech interventions for common health problems.

BLITZER: Give me an example.

WEIL: Well, you know, I wrote a recent blog about the treatment of GIRD -- gastroesophageal reflux disease. The standard way of managing this is to give proton pump inhibitor drugs. These are expensive drugs that suppress acid production in the stomach. They may be useful for some people. They're not intended for long-term use. There are simple measures -- dietary adjustment, use of natural products like EGL, a licorice extract, which increases the mucous coating in the stomach.

The problem is our physicians are not trained to use these less expensive, low-tech interventions. And this is what we should be doing first, before we go to the expensive kinds of medicine that we now use for everything.

BLITZER: What responsibility, in your opinion, do physicians out there have for this problem, as you see it?

WEIL: Well, I think, it's up to physicians to learn these other ways of dealing with disease. You know, physicians are as discouraged and angry as patients today. And great numbers of physicians are leaving the practice of clinical medicine because they've lost their autonomy. They're very discouraged that what's done in medicine today is dictated by policies of reimbursement, not really by science, not really by evidence or good physician's judgment. So I think, you know, there's enormous discontent among both physicians and patients. This is a huge problem. And we can't change it just by trying to give more people access to the present system. The present system is a disaster! It doesn't work! We have to -- I'll just repeat, we have to change the content of health care, the nature of what we do in medicine and health care, if we're going to have a sustainable system..........
....

Are there any lessons for Nigeria in Weil's views? Can Nigeria afford to continue pursuing a healthcare approach that is certainly unsustainable?

Read and learn more about Dr. Weil's work and approaches to healthcare at:

Arizona Center for Integrative Medicine:
http://integrativemedicine.arizona.edu/

Official Website:
http://www.drweil.com/

Ask again: Are there lessons for Nigeria here in these sites?

On Nigeria's NHIS

2009-05-09T15:20:00.001-07:00

An article, which recently appeared on the website of the Nation (http://www.thenationonlineng.com/dynamicpage.asp?id=82844) discusses the problems of Nigeria's National Health Insurance Scheme. We reproduce this truly incisive piece below. As you the read the piece, we ask you to ponder over how a mandatory medical insurance scheme would fare under the Nigerian State. We emphasize 'mandatory' because there's been a few arguments regarding whether or not the Scheme is mandatory. This argument stems from the choice of words in the enabling Act. For a discussion of this, see Dr. Felicia Monye's paper: "An Appraisal of the National Health Insurance Scheme of Nigeria" available at: http://pdfserve.informaworld.com/291083_770885140_768126581.pdf

Troubled National Health Insurance Scheme

In 1999, the then Nigerian government, under Decree 35, mooted the idea of a National Health Insurance Scheme (NHIS), to replace the existing 'cash and carry' health-financing system which makes it compulsory for every health-seeking individual to pay money instantly before and after treatment in the hospitals and clinics across the country. Thereafter, the scheme existed, only in the imaginations of its progenitors. In June 2005, former President Olusegun Obasanjo, did an official flag-off. Sadly till date, means of quality healthcare services is still far away from the reach of most Nigerians even as millions are not aware that a health social security systems exist; yet, many more suffer needless deaths. Joke Kujenya examines the relevance of the scheme since its 'celebrated' take-off.

Few people expected their lives to suddenly take a sad twist. Akinwunmi Olowu, 34, was definitely not one of such. He was a perfectly healthy young man through his teenage years. He had gone through the secondary and higher institutions with the usual hurdles of life to grapple with. He had also done the National Youth Service Corps (NYSC) scheme with fewer hassles. The young dude was about to settle down to begin to enjoy the life he had laboured well to build for himself when abruptly, just about Christmas of 2008, he took ill. In a quick response, his aged parents rushed him to the hospital and there the bombshell was dropped: ‘Your son is suffering from the End-Stage Renal Failure (ESRF).

Thereafter, a scan of his kidneys showed they had shrunk and were no longer doing the job they were supposed to do. He was then told that he had to go on dialysis immediately and would remain on it until he was able to raise the sum of N6million to obtain a kidney transplant. As the medication commenced at the Gbagada General Hospital, the dialysis, including other treatment, cost him and his aged parents about N80, 000.00 on a weekly basis. Soon after, they ran out of means and had to run to Nigerians for help through the assistance of the media.

Akinwunmi’s story was published with a plea that he needed N6million to embark on a life-saving mission to India for the transplant. Sadly, the young man waited in vain for the help that never came till he died in his mother’s arms on Friday, April 17, 2009.

Life, since Little Faith Sunday, 8 years of age, began dialysis was barely recognisable for her. Small in years as she was, she would place her hand under her chin and look, lost in thought.

When asked what she was thinking; she would shake her little head in despair and then sigh deeply, before she would whisper, nothing. Faith also suffered from kidney failure and needed to get her health back with just N2.5million. Prior to the publication of her appeal in one of the dailies to Nigerians for help, Faith was admitted at the Dialyzer Specialist Hospital, along Oshodi-Express Road, Lagos, where her young parents paid N25, 000 weekly for dialysis. Only one Nigerian heeded her plea with the sum of N10, 000 till Faith died, also in the arms of her young mother in the evening of Tuesday, April 7, 2009.

On the television, in the radio and newspapers, daily appeals for health support flood the airwaves. As the number of Nigerians suffering from one ailment or another grows by the day, many have begin to wonder how the National Health Insurance Scheme (NHIS), a health social security project initiated by the Nigerian government is supposed to help an average citizens.

As such, many have strongly argued that, more urgent than before, the need for the three tiers of government to come to the aid of the generality of the citizens in providing the expected health support through the NHIS has become more apparent.

The complete piece is available at:

http://www.thenationonlineng.com/dynamicpage.asp?id=82844

Appalling State of Healthcare in Nigeria

2009-04-27T13:19:00.001-07:00

The title of this piece is at once an overstatement as it is an understatement, for two reasons. First, I assume that there is a health sector that concerns itself with healthcare delivery in Nigeria. But given my knowledge of modern healthcare delivery schemes in health sectors in other countries, the word "healthcare" becomes a misnomer and an overstatement in the context of discussing Nigeria's health sector.

Second, the title rates what the officials of both the federal and state health ministries in Nigeria term "healthcare" as "appalling". If you indeed classify what we have as healthcare, then it is an understatement to score it "appalling". It is therefore for want of a worse grade that I have awarded this. Now, I proceed on this score: that I assume ours is a health sector designed to facilitate the delivery of healthcare services and, two that it is in a very bad state.

Curiously, who does one call on if a country's health sector is in a "bad state"? Anything in bad state urgently need the attention of a health practitioner but in this case, the system itself is afflicted.

I consider it a malady requiring an immediate declaration of a state of emergency that:
one Saminu Turaki, former governor of Jigawa who unofficially and recklessly stole from the treasury and now a senator, was involved in an auto crash, sustained a bone fracture and has now being flown to Singapore for treatment with taxpayers' money. It is bad enough that the legislator, who while on a frolic of his own since he was coming from a wedding (which is not one of the enumerated functions of a federal law maker in the Nigeria Constitution), has to be flown abroad for medical care with all the so-called medical centers of excellence in Nigeria. More nauseating is the knowledge that we are paying for a mere bone fracture treatment that could have been confined to one of Igbobi, Kano or Enugu Orthopaedic hospitals! Even alternative medical practitioners in my village could heal that bone for just the price of an organic fowl!

In other climes, where healthcare- whether private or public- is a reality, bone fracture patients are not flown abroad. I understand this could be due to political expediency or some show of camaraderie being that the accident victim is a member of the ruling party, but it is also a damning report on the health sector in Nigeria. A very boastful government of the day would have gleefully cease the opportunity to market itself by calling on the best hospital in Nigeria to treat the senator if indeed any of our hospitals could be rated as such!

We, thus, have a long way to travel on the road to the "pretentious" institution of an affordable and accessable healthcare system for Nigerians. One can imagine the total resignation to fate of the authorities of the National Hospital, Abuja and the many teaching hospitals in Nigeria who have to contend with politicians and our leaders' lack of faith in their ability to provide treatment for simple medical problems like bone fracture. I'd be worried if they are not complaining by right.

Since the focus of this blog is health related issues, there are plans by me to develop a definitive guide to healthcare delivery in Nigeria. My only concern is that Prof. Osotimehin and his acolytes in the ministry of health may never read it.

Dearth of Doctors: Farming without Implements

2009-04-27T09:10:00.000-07:00

As Nigeria's Federal Ministry of Health prepares to draft the "National Health Policy" meant to facilitate delivery of health care to Nigerians, it has become necessary to draw the attention of ministry officials, in particular the minister for health and stakeholders in the health sectors (Nigeria Medical and Dental Association) to the disturbing yet continuing trend of unmitigated outflow of healthcare practitioners to foreign climes. Men and women without whose involvement in the sector the national Health policy would begin on a wrong footing.

For reasons of poor remuneration and harsh working conditions, the lot of the Nigerian professional- be he/she a medical doctor, legal practitioner, an engineer or a pharmacist- upon qualification necessitates seeking better remuneration and good working environment anywhwere these could be guaranteed. The result being that, in the early to late nineties, Nigerian medical doctors flooded Ireland in search of a better lease of life. Today, there is a sizeable number of Nigeria-trained health professionals in the United Kingdom plying their trade for want of gainful employment in Nigeria.

Just last week, a friend's spouse- an Olabisi Onabanjo University- trained pharmacist- relocated to Canada to commence practice as a Pharmacist. Attendance in a bridging programme she presently attends confirms that at least five Nigeria-trained health professionals migrated to Alberta ( just one of the 10 provinces in Canada) in the past five months. At an average of one health professional per month, the loss of the health sector in Nigeria has become the gain of other countries who not only value but need them. And which country does not?

But it is not all rosy for our migrating professionals; at least going by accounts- reported and anecdotal- emanating from many quarters. Regulatory agencies in some countries now perceive of a threat by the influx of Nigeria professionals. See this report: http://www.sunnewsonline.com/webpages/news/abujareports/2009/apr/27/abujareports-27-04-2009-001.htm

At a time when our health sector desperately require the services of these highly prized professionals, health officials seem less concerned about the continuing loss of those trained and used to delivering tropical medical care. Even right now, an industrial action in the Imo State health sector threatens the lives of thousands of sick residents of the State. Maybe it needs emphasising that there can not be a meaningful, workable healthcare delivery strategy without the participation and good remuneration of health professionals.

Towards A Collaborative Conception of Health Governance

2008-11-24T20:57:00.000-08:00

On Saturday the 22nd of November, I presented a paper at the "African Studies Symposium" organized by Professor Gloria Onyeoziri, one of the University of British Columbia's finest professors. Professor Chidi Oguamanam, an Assistant Professor of Law researching on an impressive range of issues including "traditional medicine", environmental law and biodiversity conversation, biotechnology (in health and agriculture), intellectual property, et al. was the keynote speaker. Professor Chidi Oguamanam is the director of the law and technology institute at Dalhousie University. He spoke on the place of traditional medicine in international law and emphasized the need for "bio-partnership" between the West and the global South in the development and sharing of resources from the developing world's biodiversity and "traditional medicine" resources.

It was by every means an inspiring gathering of scholars. There were deep insights into a broad range of issues, touching on healthcare, migration and brain drain, the concept of indigeneity and Nigerian writing.

My talk was on the need for a new direction in healthcare governance in an age of increasing deficit in healthcare delivery. I advocated for a collaborative conception of health governance, a governance model that involves cooperation between diverse actors in the society – allopathic physicians, private/public actors both within and outside the healthcare system, indigenous healthcare providers, etc. Collaborative governance will involve welcoming experts beyond biomedical actors to provide input into health systems management/governance.

Collaborative governance is essentially a governance model that pulls resources together from every sector to advance a collective goal. There are enough problems with the medical industry today, in terms of access to healthcare, including geographical discrepancies in access, affordability and availability of allopathic medicines to warrant a broader conception of not just medicine, health and treatment, but also of who manages our health system.

I concluded my presentation with the contention that the challenges posed by the healthcare problems of the developing world demand multicultural, multilateral and multifaceted approaches. Interestingly, David Eboh's article, entitled "Shifting The Paradigm Of Leadership In Nigeria's Healthcare Management" captures some of the merits in a broader conception of health governance...

This is the link to Eboh's article:
http://www.independentngonline.com/oped/article02?publication=081121

For more on Collaborative Governance, see this paper by Donahue John of the John F. Kennedy School of Government at Harvard University:

http://www.hks.harvard.edu/m-rcbg/CSRI/publications/workingpaper_2_donahue.pdf

“The essence of collaborative governance is a new level of social/political engagement between and among the several sectors of society that constitutes a more effective way to address many of modern societies’ needs beyond anything that the several sectors have heretofore been able to achieve on their own. Our sense of the increase of this phenomenon led us to believe this subject needed to be systematically explored.”
- Frank A. and Denie S. Weil

*Professor Chidi Oguamanam is the author of Indigenous Knowledge in International Law: Intellectual Property, Plant Biodiversity and Traditional Medicine (Toronto: University of Toronto Press, 2006).

GRADUATE SCHOLARSHIPS IN REPRODUCTIVE & SEXUAL HEALTH LAW AT THE UNIVERSITY OF TORONTO

2008-11-19T14:57:00.000-08:00

There is a dearth of health law and policy experts in Nigeria as we know. Luckily, there are excellent health law and policy training programmes in many North American universities. One outstanding school offers a unique learning experience in one area of health law and policy. The Faculty of Law at the University of Toronto offers unique Graduate Scholarships in its International Reproductive and Sexual Health Law Programme. The scholarship enables lawyer activists from developing countries to undertake the Master of Laws (LL.M.) Programme at the University of Toronto's Faculty of Law and pays for full tuition, travel expenses and offers a stipend for living expenses.

As a proud graduate of this university, I can confidently say that the training at the University of Toronto Faculty of Law is first class. Having taken courses with the administrators of the programme who are worldclass experts and leaders in the health law field, I can attest to this.

If you are interested, the application deadline is February 16, 2009. The programme is asking for outstanding lawyers who are committed to advancing
reproductive and sexual health law in their own developing countries and/or
regions.

Further Information:
4-page brochure:
http://www.law.utoronto.ca/documents/reprohealth/gradscholarships.pdf
More about the scholarships:
http://www.law.utoronto.ca/visitors_content.asp?itemPath=5/12/12/0/0&contentId=413

Application information:
http://www.law.utoronto.ca/prosp_stdn_content.asp?itemPath=3/7/0/0/0&contentId=263

Abstracts of theses by past graduates:
http://www.law.utoronto.ca/visitors_content.asp?itemPath=5/12/12/0/0&contentId=1621

Website of the International Reproductive & Sexual Health Law
Programme:
http://www.law.utoronto.ca/programs/reprohealth.html

Please spread the news!

Still on Alternative Medicine...by Felix Obi

2008-09-02T01:53:00.000-07:00

I have not been too keen to participate in the alternative medicine discourse in Nigeria due to the high sparks that are elicited by both sides of the divide. As a health practitioner trained in a conventional medical institution,at least I have my own little pinch of negative bias about traditional medicine. But as a Nigerian who grew up in a rural village in Eastern Nigeria, I also saw some benefits of traditional medicine. My grandfather was a 'dibia'...a traditional medicine doctor' who practised his art till his ancestors (so to speak) invited him over. My eldest uncle who took over the practice as a young man told us how our grandfather appeared to him in a dream and took him round the neighbourhood, to identify the different herbs and shrubs that he used to cure different ailments. And my uncle would take us along to the spots to dig up the roots or pluck leaves of the herbs whenever he wanted to prepare the 'concoctions' and remedies for his clients. Sometimes we helped him to pound the dried roots, which are sometimes bioled to drain out the medicinal contents.

I would lie if I say the remedies didn't work. Just that so many of them were more bitter than bitterleaf, so to speak. We knew when the guys who had gonnorhea or other STDS came around...the consultation is done in utter secrecy and hushed tunes to protect the 'integrity' of the client, but because I and my cousins were conversant with the different combinations, we put one and two together to decipher their differential diagnosis! There was little or no ritual...like incantations and killing of fouls as part of the treatment plan, as the killing of fouls and goats were strictly a religious affair though traditional medicine is a part of the African Traditional Religion.

My uncle died in 2006 years ago at the age of 90 but none of us in the family continued with the family tradition. We have two medical doctors and a physiotherapist in the extended family but none of us took up the pains to identify the herbs and shrubs that uncle used to heal so many of their ailments. As an undergraduate, I had told myself I'd study those leaves and send them to labs for biochemical analysis but I never did...and that repository of medical knowledge from my grandfather went down the way of the tomb...which Dr. Myles Monroe said is the richest place on earth!

I was in Lagos with a Japanese Team much of August to discuss with Lagos State Ministry of Health on how to design a project to strengthen the quality and spread of maternal and child health services at the primary and secondary care levels. We had discussions with Dr. Bunmi Omoseyindemi, the Chairman of the Lagos State Traditional Medicine Board...a LUTH-trained medical doctor who branched into traditional medicine. He shared extensively on the plans made by the board to train and retrain practitioners. We interviewed Traditional Birth Attendants (TBAs) whom he had trained in anatomy, physiology and basic hygiene and other procedures. He prepared standardized modules for the lectures which all the practitioners must go thro before they are certified by the Board. After the 8weeks training, the TBAs are sent to collaborating General Hospitals in Lagos for clinical posting where they work under the supervision of midwives and trained nurses to gain knowledge on how to improve their practise. We read commendation letters from the MDs of the hospitals stating how the TBAs acquited themselves during their postings.

Such efforts should be commended even though the premise upon which traditional medical practise is based slightly might differ from the empirical base of orthodox medicine. Dr Bunmi has elaborate plans on how he plans to integrate traditional medicine into the health system of Lagos State, despite the challenges and snags on the way.

Felix Obi is a Health Expert with the Japan International Cooperation Agency, Abuja, Nigeria.

Alternative Medicine: A Desperate Agenda

2008-08-27T16:33:00.000-07:00

I have not been kind to my blog in recent times. I apologize. Many reasons account for this: my doctoral research, travelling - first to the UK as one of the presenters at an international conference on the development of health law and policy in both the United Kingdom and Canada and then to multiple Canadian provinces; I have also been tied up with meetings and consultations... And today, as I read Chikwe Ihekweazu's piece entitled "Are You Sick" available at
http://nigeriahealthwatch.blogspot.com, one of those meetings came to mind. In June I was one of the discussants at a round table conference in British Columbia. The conference was designed to discuss Natural Substances and Methods as Adjuvants to Standard Treatment for Cancer. The conference came to a close with all discussants including prominent researchers, donors and financiers of health research from the University of British Columbia, Simon Fraser University, InspireHealth (Canada's foremost integrative cancer care centre), and the Hecht, Michael Smith, and Canadian Breast Cancer Foundations calling for the establishment of a Centre of Excellence on Complementary and Alternative Medicine Research in British Columbia. Ihekweazu's paper did more than remind me of this important conference. It also reminded me to address some issues raised by a friend and colleague in response to my post titled "Another Imperial Outlook on Health".

Ihekweazu's piece, beautifully written as usual, questions the unregulated practice of alternative medicine. He asks those pertinent questions that need to be asked: a question about regulation, a question about practice and implicitly malpractice standards, and indeed a question about patient safety.

Like Ihekweazu acknowledges, the problem with alternative medicine is the medley of issues, emotional and otherwise, involved in its discussion. However, there is a reason why this has been so. The alternative medicine debate is emotive because of its interconnection with the colonization debate, which scholars are beginning to point out. Post-modern theorists and socio-legal scholars viewing issues through post-colonial lenses are reassessing the historical hierarchy between science and non-western forms of knowledge. Pro-alternative medicine scholars have attempted to show that the present hierarchy of knowledge systems, especially medical knowledge, has everything to do with a colonial heritage in which the medical creativity of peoples of the third world and developing countries have always been rated poorly by the West.

But we are talking about medicine and about life. So, scholastic discussions aside, I believe the most important issue we should be addressing is how to make the best of different medicines - allopathic or alternative - work for the good of health consumers. However, this discussion should in no way start with criticism of alternative medical systems. Ihekweazu's questions, while fundamental to the debate, have to be preceded by the political will to look more closely at the benefits and disadvantages of alternative medicine. We should first ask: how do we create a stronger and more independent Nigerian healthcare system? How do we use alternative medicines to increase access to healthcare in Nigeria? How can we use alternative medical practitioners to fill the gaps created in our healthcare system by migrating Nigerian doctors doing well in the diaspora? In what ways can we use alternative medicines for preventative care so as to reduce the incidence of critical health conditions? How did Cuba achieve the great historical feat of having a strong and functional healthcare system by merely relying on its own (and only its own) home grown medical resources for many years? Cubans invested in healthcare that is holistic and preventative and has created one of the most effective healthcare systems in the world: http://www.yesmagazine.org/article.asp?ID=1733. How come the visit of Americans to alternative practitioners were more common than visits to primary care physicians in recent studies? (425 million visits versus 338 million to registered physicians: D.M. Eisenberg, et al., "Unconventional Medicine in the United States: Prevalence, Costs and Patterns of Use"/National Health Interview Survey (2002)) How is it that American private health insurance companies and some Canadian provinces are providing coverage for some alternative medicines? How come Canadian and American health consumers are suing and invoking the Canadian Charter and the constitution to assert their right to have access to the alternative medicines of their choice? How is it that alternative medicine is being studied in American medical schools, with a research division at Harvard Medical School? Shouldn't we, dear Nigerians, be looking inwards as well in the search for greater access to healthcare?

I say deperate situations require desperate measures. But once we have asked ourselves these important foundation questions, then we can invite the law - indeed Ihekweazu's questions are medico-legal questions - yes, we can invite the law to mandate regulation, to ensure that the appropriate regulatory Agencies are efficient, to protect the citizens... Today, the malpractice rules for alternative medicine are not clear. Scholars are skewed between arguing for the application of scientific standards to alternative medicine or devising a unique set of rules for these medicines. The legal positions are very interesting, but they are a discussion for another day... One thing is sure: rules must be formulated with the co-operation of all the relevant parties to the debate: alternative practitioners, doctors, health policy-makers, and of course, health lawyers. Until a spirited and pro-active debate is underway, it will not be enough to simply criticize the practitioners who are taking advantage (sadly so) of Nigeria's frail healthcare system and regulatory structure to practice their art.

The friend of mine, Idowu Ohioze, who had sent a comment to my inbox about my earlier posting on this issue had asked: "Would alternative and traditional medicines system, once institutionalised, provide cheap alternative channel to Nigerians, in the real sense of the world (sic)? Can it, as presently administered, lend itself to rid us of, say, cancer in all it forms? Wouldn't we still need western medicines? Why then do we advertise traditional medicines as the do-all-be-all of healthcare in Nigeria?" Idowu's very important question was the subject of discussion at the roundtable conference at British Columbia in June. Researchers from both the United States and within Canada are proving this is possible. At Inspirehealth, Canada's foremost integrated cancer care centre, cancer patients are given a longer lease on life through the combined efforts of allopathic and alternative practitioners (http://www.inspirehealth.ca). I had a meeting with the co-founder of the centre last week where I learnt some more about the benefits of integrated medicine. Over 5,000 patients have benefited from the centre's research-informed natural approaches to health. The patients have been guided to integrate these approaches into their cancer treatment and recovery. All at no cost as the services are free and funded by the provincial government. Again, this is an issue of political will. So, while we hope that the government will take up the task, some of us have submerged ourselves in this research, to find answers to the questions posed in this posting and raised in Ihekweazu's Health Watch.

Alternative medicine is a desperate agenda: Like Ihekweazu rightly mentions, people are vulnerable. With the increasing difficulty in accessing and affording conventional medicines, many unqualified alternative (and indeed allopathic practitioners) will continue to prey on unprotected citizens. Detoxifying the Nigerian healthcare system of unqualified practitioners, however, should not be an isolated agenda. We must ask ourselves: how do we use what we have in combination with what Western medicine has offered to increase access to healthcare in Nigeria?

Read Chikwe Ihekweazu's piece at: http://nigeriahealthwatch.blogspot.com

Nigeria's All New Health Bill: Another Imperial Outlook on Health?

2008-06-03T13:00:00.000-07:00

The new Nigerian Health Bill is out. This should be very good news for the millions of Nigerians who have waited long to see this day. Sadly, there are millions who have not seen this 'great' event, millions sent to an early "homecall" by Nigeria's ailing healthcare system. Today, June 3, 2008, I think of these Nigerians who are the testimony of the failures of our healthcare system. I think of them as I remember Patricia Eromon Iyioha nee Okokhere, my mother who withstood incessant malaria attacks, but fell to a doctor's deadly prescription.

Yes, the Health Bill is born. But should we roll out the drums? Should we rejoice over a Bill that, for all intents and purposes, may end up like Nigeria's stale Acts in the archives? I have struggled to be excited; I have pleaded with my falling spirit to rise up and cry Victory! A Saviour Act is on its way to be born! But one look at the Bill and my heart is falling...

I have been searching for some concrete provision regarding the strengthening of our traditional healthcare systems. I am searching - and frantically hoping - to find some paragraph emphasizing Nigeria's need to develop and standardize our traditional health and pharmaceutical industry - an industry utilized by 60% Nigerians, and our diverse "ethnopharmacological" knowledge [much as I detest using the term with its derogatory undertones] largely deplored as native knowledge.

There has to be some provision that douses my anxiety, that tells me Nigeria knows that the world is researching and deliberating on the need to strengthen traditional healthcare systems based on myriad studies evidencing the medical progress that can be achieved from these systems when carefully managed.

Historically, African traditional medical knowledge and approaches to disease have been underrated as unscientific (Aginam Obijiofor: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=319162). This imperialist conception of traditional healthcare systems has been internalized by modern African states. Today, the conception is manifested in health policy initiatives, at both the international and national levels, which exclude this sector of the medical industry. Yet, the annals of history and research would reveal that many great advances in pharmaceutical innovation have a direct link to our supposed unscientific and rural knowledge systems (Ikechi Mbeoji (Global Biopiracy, Patents, Plants and Indigenous Knowledge (Vancouver: UBC Press, 2005).

Learned Nigerian scholars, like Professor Aginam, have drawn attention to the neglect of the contributions that our medical culture can make to global healthcare issues. Aginam has remarkably drawn the world's attention to the very important tension between WHO's health policies and initiatives and African ethnopharmacological knowledge systems. In the area of malaria control, Aginam rightly argues that multilateral health policies suffer a "regime deficit" because of the sad exclusion of our knowledge systems from international strategies directed at addressing global and non-global healthcare problems.

For Heavens sake, I am searching for a line that tells me Nigeria appreciates its own natural healthcare resource(s) and intends to nurture and protect it against biopiracy - the invasion of our traditional societies and the appropriation of our medical knowledge systems by western pharmaceutical companies.

Oh! Mother!
Today I found a line. One lonesome, isolated and nugatory phrase:

S.1 (2) paragraph (h): traditional and alternative health care providers.

OH! And what does it say?

The National Health System shall include traditional and alternative health care providers.

There's one more tired phrase under s. 6 (2) (l): The Technical Committee of the National Council on Health will require one representative from the registered health professional associations, including trado-medical practitioners.

Victory! It has all the hallmarks of exclusion. Some knowledges are better than others... It's a lonesome path to medical greatness...

Suggested Readings

Kenneth L. Leonard, "African traditional Healers and Outcome-contingent Contracts in Health care" Columbia University Working Paper (http://search.ssrn.com/sol3/papers.cfm?abstract_id=229475)

Ikechi Mgbeoji, “Patents and Traditional Knowledge of Uses of Plants: Is a Communal Patent Regime Part of the Solution to the Scourge of Biopiracy?” Indiana Journal of Global Legal Studies 9 (2001): 163.

Ikechi Mgbeoji, “Beyond Patents: The Cultural Life of Native Healing and the Limitations of the Patent Sytem as a Protective Mechanism for Indigenous Knowledge on the Medicinal Uses of Plants”; available online at: http://cjlt.dal.ca/vol5_no1/pdfarticles/mgbeoji.pdf

Ikechi Mgbeoji, Global Biopiracy: Patents, Plants and Indigenous Knowledge (Vancouver: UBC Press, 2005).

Obijiofor Aginam, "From the Core to the Peripheries: Multilateral Governance of Malaria in a Multi-Cultural World" (Chicago Journal of International Law, Vol. 3, No 1, Spring 2002).

C. Oguamanam, “From Rivalry to Rapprochement: Biomedicine, Complementary Alternative Medicine (CAM) at Ethical Crossroads” (2006) 18:3 Health Ethics Committee (HEC) Forum 245-263.

Akin Makinde, African Philosophy, Culture and Traditional Medicine (Ohio University Press, 1998).

Ireh Iyioha, "Informed Choice in Alternative Medicine: Expanding the Doctrine Beyond Conventional Alternative Therapies" ICFAI Journal of Healthcare Law, Vol. 5, No. 2, 2007. Available online at: http://papers.ssrn.com/sol3/papers.cfm?abstract_id=959769

Health Monitor: Traditional Medicine: Our Culture, Our Future
Available at: http://www.afro.who.int/press/periodicals/healthmonitor/jan-jun2003.pdf

ABOUT THE PICTURE
Source: http://www.prometra.org/Library.WHO-AFRO.html

The map of Africa denotes African ownership of African Traditional Medicine.
The medicinal plant, rose-colored pure flower represents the main raw materials used in traditional medicine.
The green background of the map of Africa denotes the rich African biodiversity.
The blue color surrounding most of the African continent represents the bodies of water, which surround most of Africa, and are additional sources of some traditional medicines.
The golden ring which houses all the other elements is a reflection of the golden competitive advantages that African Traditional Medicine offers with potential impact on the health, economy and development of African communities.

Nigeria and HIV/AIDS: (En) Forcing a Legal Relationship

2008-02-28T22:10:00.000-08:00

In the last few years, Nigeria has been in the news in relation to claims of discrimination against people living with HIV/AIDS. Curiously and quite sadly, the discrimination has been in the hands of health professionals. (See below the link to the study conducted by Vincent Iacopino et al. from the organization Physicians for Human Rights, in collaboration with researchers from Policy Project–Nigeria and the Center for the Right to Health).

Writing about AIDS from any perspective, legal or otherwise, is curiously not as easy as it would seem. A confrontation with ethical questions and issues of discrimination in the context of HIV/AIDS engenders questions bordering on social and natural justice; any dicussion of peoples and situations in this framework cannot be easy. The narrative does transcend the legal or intellectual discourse.

The fight against HIV/AIDS and all its appurtenances in Nigeria is one that has been fought from multiple platforms: from the policy level to the medical, from media advocacy to NGO participation. It is common knowledge that the legal has not been the dominant platform in Nigeria. However, it should not be particularly difficult to engender a legal relationship between Nigeria and the scourge if we follow the lead provided by legal and media writings, the decided cases (albeit few), advocacy groups, including NGOs, etc.

The primary legal and ethical questions to be addressed range from Consent to testing procedures, Legality of Mandatory Testing (often couched as mandatory but not compulsory) as both a requirement for job offers, educational admissions, etc., Confidentiality in relation to health records, the availability of Pre- and Post-testing Counselling, Discrimination on the ground of the status, etc. Other ethical-legal issues include stigmatization, health inequities both within and between the genders and human rights abuses (with particular reference to the impact on women living within the stereotypical construct within which they are conscripted), which increase the prevalence of the scourge.

Notably, other legal grounds of challenge exist within the discourse on the legal rights of people living with HIV/AIDS. Besides the issue of stigma and discrimination in public spaces, other legal challenges can be brought against government policy decisions (health policies or otherwise) which negatively affect the rights of people living with HIV/AIDS. The lack of cohesive and justiciable laws on both the fact of discrimination and the scourge itself is another site for legal challenge.

Nigeria's National Policy on Aids provides a useful list of legal and ethical issues
to be addressed in the area of HIV/AIDS in Nigeria. Researchers and scholars can refer to pages 16 and 17 of the Policy available online at http://www.nigeria-aids.org/documents/NationalHIVPolicy.pdf for an overview of these issues some of which I have highlighted above.

The articles below speak to some of these issues. Emuakpor's paper addresses discrimination against people living with HIV/AIDS in both the courts and the clinics. The author concludes that the "HIV/AIDS epidemic has evolving legal issues and ramifications".

Aniekwu picks on gender and human rights dimensions of HIV/AIDS, a dimension that is often unemphasized in scholarly writings on this issue in Nigeria. HIV/AIDS with its links to human rights abuses disproportionately affects women. A critical legal analysis such as that provided by Aniekwu opens up an avenue for discourse.

Oziengbe addresses the question: "Can Persons living with HIV/AIDS testify in Court?" Without knowledge of the circumstances against which this author writes, this question - posed by the Nigerian Vanguard - may appear to be an odd one. Yet, it flows from empirical facts of the experiences of many people living with HIV/AIDS in Nigeria.

Finally, there is an excerpt from Tan Lyn writing from China on Nigeria's promise to enact a law backing HIV and Malaria drugs. Ahmed Abdulkadir, special adviser to the Nigerian president, in an interview conducted during the anti-malaria conference in China's southern Guangzhou city is reported as affirming that: "We will try to have the legislation passed. We've done all administrative work, it's at the final stage. We will send it to the national assembly so it can be passed... We will dismantle all those barriers so that our local industries are able to produce all of these drugs, all ACTs and all ARVs." Abdulkadir heads a taskforce to produce the drugs.

It is yet another (legal) promise of hope for healthcare in Nigeria. Whether this promise will translate to reality is a question whose answer lies in the future.

How Do Nigeria's Health-Care Personnel Treat Patients with HIV/AIDS?
Vincent Iacopino et al.

People living with HIV/AIDS (PLWA) face many forms of stigma and discrimination. This is the case in whichever country they may live, as has been shown in a number of previous research studies. In addition to experiencing unfair treatment in their families, communities, and places of work, PLWA may encounter discrimination from health-care professionals. This can interfere with effective prevention and treatment. Discriminatory practices in the health-care sector may also appear to legitimize other forms of discrimination against PLWA.

Vincent Iacopino and colleagues from the organization Physicians for Human Rights, in collaboration with researchers from Policy Project–Nigeria and the Center for the Right to Health (also in Nigeria) investigated the problem in Nigeria. With a population of roughly 130 million, Nigeria is home to one in 11 of the 40 million PLWA worldwide. Around 6% of adult Nigerians are thought to be HIV-positive, and there will be an estimated 310,000 AIDS deaths this year. The indications are that infection rates will increase. Until now, little has been known about the nature and extent of discrimination against patients with HIV/AIDS in Nigeria...

http://www.pubmedcentral.nih.gov/picrender.fcgi?artid=1176243&blobtype=pdf

Stigmatization and discrimination: HIV/AIDS and the law in Nigeria
Scott-Emuakpor RE.

Abstract
The quality of life of people living with HIV/AIDS is less commonly researched as it should be. Much as we know about the disease and its progression, little is known of the regression of human rights. We hypothesize that the early diagnosis of HIV infection and openness about an individual's HIV status is most vital for effective prevention and care. HIV-related stigma and discrimination remains an enormous barrier towards effectively containing the spread and prevention of the epidemic. We observe that the Constitution of the Federal Republic of Nigeria guarantees fundamental human rights. In addition, Nigeria has ratified some international and regional human rights instruments relating to HIV/AIDS. However, there is currently no specific legislation on HIV/AIDS. Human rights violations are widespread, ranging from common place non-consensual HIV testing to the arrest and containment by quarantine of all AIDS patients by the military administrator of a state or the ruling of a High court judge to a plaintiff who had tested HIV positive, that she not be allowed to give evidence, unless a medical expert satisfied the court that her presence would not endanger the lives of other people in the courtroom. The victims of these human rights violations have no recourse in the courts of law in Nigeria because the law courts which are supposed to uphold the rule of law and enforce it when necessary, are perpetuating the very violations for which redress is being sought in the first place. These factors undermine effective prevention, care and support. We recommend continued education to challenge stigmatization and discrimination. The Government needs to expedite its response to HIV/AIDS human rights related issues, implement policies and enact legislation. It is our conclusion that the HIV/AIDS epidemic has evolving legal issues and ramifications.

http://gateway.nlm.nih.gov/MeetingAbstracts/102281323.html

Gender and Human Rights Dimensions of HIV/AIDS in Nigeria
Nkoli I. Aniekwu

Abstract
Until very recently, researchers paid little attention to sex or gender issues in HIV/AIDS. When differences between females and males on health matters were considered at all the focus was clearly on women's reproductive lives and not on factors affecting the spread of the disease. There was hardly any consideration of the influence of inequalities on the spread of HIV/AIDS and on outcomes of infection between the sexes. Hitherto, health policies and programmes focused on biological aspects of diagnosis, treatment and prevention. In this paper, the author seeks to provide an understanding of the social factors as well as identification of the capacity of human rights to develop an effective response to the disease. It is a gender perspective on human rights with specific implications for women in the context of HIV/AIDS.

http://links.jstor.org/sici?sici=1118-4841(200212)6%3A3%3C30%3AGAHRDO%3E2.0.CO%3B2-G#abstract

Anti-Discrimination Law in Nigeria
John Oziegbe

Abstract
The constitutional provisions against discrimination are hardly justiciable. John Oziegbe makes a case for HIV carriers in places of work The Black's Law Dictionary (Eight Edition), defined discrimination as a practice that confers privileges on certain class or that denies privileges to a certain class because of race, age sex, nationality, religion, or handicap or differential treatment, especially a failure to treat all persons equally when no reasonable distinction can be found between those favoured and those not favoured. Recently, the Vanguard News paper on its Law and Human Rights page x-rayed the frustrations, embarrassment, predicament and the worst form of discrimination faced by People Living With HIV/Aids (PLWHA). That report was titled "Can a PLWHA testify in Court?" This report was necessitated by the recent ruling of the Court of Appeal Lagos in an Appeal brought by a HIV/AIDS patient (Appellant) who was dismissed from her place of work and sought to challenge the wrongful dismissal.

http://www.justiceinitiative.org/db/resource2?res_id=102740

Nigeria to enact law to back malaria, HIV drugs
Tan Ee Lyn

Nigeria is in the final stages of passing a law that will allow local drugmakers to produce more life-saving medicines for its people to fight malaria and HIV/AIDS...

The country has 14 companies making anti-retroviral drugs (ARVs) to control HIV/AIDS and eight companies producing artemisinin-based combination therapies (ACTs) to treat malaria, but production levels are far from sufficient...

http://www.alertnet.org/thenews/newsdesk/B708301.htm

Medical Negligence in Nigeria

2007-11-09T20:04:00.000-08:00

On November 8, 2007, I woke up pursuing the day's business - from last minute revisions of the readings for the day's Ph.D seminar to making urgent calls in preparation for my flight to Toronto where I was to be conferred with the Master of Laws degree at the University of Toronto. The convocation was scheduled for November 16th. In the midst of all that, I failed to notice that this was not just another day. It was not until a few minutes after midnight that I recalled I was called to the Nigerian Bar on November 8th. In the quiet of the night, I took my mind back down memory lane, to life in Nigeria as a law student, struggling with the textbook rules of Tort, Contract and Evidence Law. I had particular interest in Tort, for the primary reason that I could spot potential tortous actions everywhere I turned. From the churches erected beside residential homes to the man selling panasoanic products to commuters stuck in a traffic jam and to the deposit of sand in front of my family house by some company truck. Then, there was the topic on negligence, which again held a lot of attraction for me because private research had shown just how broad and significant the topic is in law. Thus, poring over the texts of M.A. Jones' Medical Negligence, I knew I had found what I wanted to do for graduate studies. I was not thinking of practicing in that area. Though it seemed like an attractive option when mother died in the hands of a doctor who had made mistakes a farmer treating a patient would have avoided, yet my paramount interest was to discover the legal rules applicable to medical interventions. My firm belief is that in the midst of the evils of medical paternalism, health sector mismanagement, and lack of access to care which Nigerians in their millions suffer daily, what is paramount is to search for options, to advocate for change. The pursuit of change will of course involve the identification of the hardships that Nigerians suffer.

However, in disagreement with Dr. Chamberlain Peterside (Ph.D.) who authors one of my postings below, it is not enough to draw up a list of the "crimes" of the Nigerian healthcare system. The question that needs to be answered through research, dialogue and medico-legal scholarship is: "what is to be done?" Peterside writes on Nigeria's healthcare system and the strain on human capital in honour of a late brother. Hoping that the outburst brings relief, it is important to implore Nigerians who are as well-placed as Dr. Peterside to use their remarkable talent in providing answers to the question posed above. For someone who is as well-placed in the financial industry, Peterside would make an impact by helping to study Nigeria's health economy. Surely, something can be done.

In the next article, H.A. Olaniyan of the Department of Jurisprudence and International Law at the University of Lagos, writes on liability for medical negligence in Nigeria. The article was published in the Nigerian Journal of Health and Biomedical Sciences.

Finally, I have provided a link to the abstract of an article of mine on how medical negligence is addressed under Nigeria's budding National Health Insurance Scheme. The work, which is currently under review, evaluates the provisions of the National Health Insurance Act on the issue of adverse results of medical intervention. I compared the merits of the system of no-fault compensation operative in some foreign jurisdictions with that of the malpractice system operational in Nigeria.

WHAT A HEALTH CARE SYSTEM? …NIGERIA’S MEDICINE AND STRAIN ON HUMAN CAPITAL

Chamberlain Peterside

Time and again we have seen where even the well-heeled in society couldn't survive, due to lack of immediate care, malpractice or focus on the wrong ailment. These are all attributes of a dysfunctional health sector that needs immediate fixing. Recently the UN rated Nigeria very high in terms of infant mortality and low chances of women surviving during child labor. Numerous statistics say a great deal about the deplorable condition, revealing that average life expectance in Nigeria has declined precipitously over decades to late 1st-century levels of Europe (40-45 years). Per capita heath care expenditure or as percentage of gross domestic product (GDP) is one of the lowest in the world. You only need to look at the chart below that compares healthcare indicators in some of the poorest countries in the world to understand the sense of urgency ...

http://nigeriaworld.com/feature/publication/peterside/031907.html

Liability for Medical Negligence in Nigeria
Abstract

H.A. Olaniyan

The paper discusses professional negligence of Medical Practitioners and other Medical allied staff in the light of the general law of Negligence, the Rules of Professional Ethics of Medical and Dental Practitioners in Nigeria, the decisions of the Medical and Dental Practitioners Disciplinary Tribunal (MDPDT) and of the Appellate or Superior Courts of Nigeria.

Keywords: medical negligence, Nigerian law, duty

Nigerian Journal of Health and Biomedical Sciences Vol. 4(2) 2005: 165-175

http://www.ajol.info/viewarticle.php?id=24489

Nigeria's Health Insurance Scheme and Claims in Adverse Consequences of Medical Intervention: Civil Liability or No-Fault Compensation?

Ireh Iyioha

Abstract:
Inequitable distribution of health facilities, inflationary cost of healthcare services and inaccessibility to existing infrastructure have been some of the serious challenges to the survival of the working class Nigerian. There are the everyday emergencies that have ended in fatality because of the prerequisite of down payments before treatment even in public hospitals. Nigerians have also greatly suffered the consequences of medical negligence in silence. In an attempt to reverse the deplorable state of medical intervention, Nigeria's Federal Government recently established the National Health Insurance Scheme, thus overcoming decades of pessimism over its birth due to its checkered history. Today, the Formal Sector Social Health Insurance Programme is a social health security system in which the healthcare of employees in the formal sector is paid for from funds created by the contributions of employees and employers.

This work examines the parameters laid down by the National Health Insurance Act to address the adverse results of medical intervention. It compares the merits of the system of no-fault compensation operative in some foreign jurisdictions with that of the malpractice system operational in Nigeria.

The argument is for a system - whatever its appellation - of strict accountability.

Keywords: Medical Negligence, Malpractice Litigation, No-fault Compensation, Nigerian National Health Insurance Scheme

http://hq.ssrn.com/submissions/MyPapers.cfm?partid=730295

Nigerian Writings on Health Law and Policy

2007-10-31T00:22:00.001-07:00

This is a follow up from my last post on the emerging field of health law and policy in Nigeria. While surfing through the web in search of new legal articles, I came upon some of N.I. Aniekwu's papers. Nkolika Ijeoma Aniekwu is a lecturer at the department of public law, University of Benin. While I did not take any of her courses in my undergraduate days at the University of Benin, I was nonetheless interested in her writings. She is one of several firm voices in the reproductive and sexual health debate in Nigeria. She brings in a legal insight into otherwise highly medicalized issues. I have a link to one of her pieces below. It makes an interesting reading:

Legalizing Cairo: Prospects and Opportunities for Reproductive Rights in Nigeria
by N.I. Aniekwu
Until quite recently, many Nigerians considered reproductive and sexual rights as issues for discussion only by pro-abortion and liberal feminist groups! Considering the typical African traditional values and societal norms generally associated with female sexuality, and in view of the fact that many viewed reproduction and sexual practices as very private issues, it was more or less seen as 'taboo' to advocate reproductive rights ...

Full Article:
http://www.codesria.org/Links/Publications/bulletin1_06/page49-51-aniekwu.pdf

Health Law and Policy in Nigeria: A Field in Conception

2007-10-24T23:38:00.000-07:00

The idea of a blog on health law and policy in Nigeria has been a dream waiting to be born since September 1st 2006, when I first moved to Canada to get a Master of Laws Degree in Health Law and Policy. In Canada, I realized that the dearth of health law and policy experts was not just a Nigerian problem. Canada was also in search for lawyers trained in health law and policy.

Naturally, settling into a field as broad as healthcare law was no easy task, considering the absence of any background training in this area in many Nigerian universities. Nonetheless, it was interesting to begin an intensive study of the myriad issues in the field through the lens of both Canadian and Nigerian law.

Health law and policy is a field that is still developing in many legal systems. Thus, it has been variously described as lacking its own organizing principles to set it apart as a distinct field. Gregg Bloche, writing on the Invention of Health Law, has described the field as a "chaotic, dysfunctional patchwork". For Mark Law and Carl Schneider, the "field grows by accretion" and as such lacks a "unifying idea or animating concern". The field embraces several other fields of law and distinct disciplines such as economics, tort law, contract law, insurance law, etc.

Hall in The History and Future of Health Care Law: An Essentialist View has asserted that the field should be recognized by its essential features which distinguish its legal features from those of other fields. These features include the experience of being a patient, the professionalism of health care providers, the treatment relationship between patients and providers and the existential stakes of medical care. Others are the nature of medical practice and the high cost of care and wide variability of need. Having identified these six features central to medicine and its practice, Professor Hall posits that these features give health care law its distinctive quality and are the foundation of the field’s doctrinal and interdisciplinary complexity.

However, the question that remains to be answered is whether these essential features provide the organizing principles needed to make health law and policy a distinct field of law; for, while on the surface Hall's essential features provide strong reasons why health law ought to be a field of law, these features remain reliant on a methodology or systemic framework that would bind the several distinct parts of health law and policy together and make it a truly coherent field.

Needless to say, the field is still evolving in Nigeria. There is as yet no coherent body of law to be described as medical law or health law and policy. However, it is doubtless that recent developments in the health sector in the country have set in motion the parametres for the development of this field. For example, the institution of the National Health Insurance Scheme has spurred several literature reviews, both in the field of law and associated disciplines. The publication of the Traditional Medicine Policy and the gradual movement towards a (formally recognized) pluralistic healthcare system has also generated literature reviews outlining both the feasibility of such movement and its legal and ethical implications. Another subject gaining attention is medical negligence, and there are myriad articles already published on the topic by Nigerian scholars. Then, we have emerging writers on AIDS and human rights law. Reproductive and sexual health law is yet another field carving out its own space in the Nigerian legal system. Presently, a journal on reproductive rights, The African Journal of Reproductive Rights (AJRR) is underway. The journal, which will focus on sexual and reproductive rights, women's rights, gender discrimination, gender equality, gender violence, gender empowerment, maternity rights, harmful traditional practices, international legal frameworks on reproductiverights and related issues, has a Nigerian as its editor. Today, we have Nigerians in prestigious schools in the West studying for Masters and Doctoral degrees in Health law and Policy. You will also spot a Nigerian professor specializing in health law and policy in many Western Universities. Thus, I can confidently say Nigeria is slowly moving towards a solid new field of law to be christened Nigerian Health Law and Policy.

Healthcare in Nigeria is an engaging topic. The narratives and statistics on the state of healthcare in the country are overwhelming. The issues we have had to deal with have ranged from the problem of access and affordability to the migration of health professionals to the West. Persistent health inequalities fuelled by workforce shortages, maladministration of health professionals, geographical discrepancies in access to healthcare, and the rising out-of-pocket expenditures for consumers have made healthcare inaccessible to a large percentage of the population.

What role can law and policy play in effecting a change in this narrative? Will an analysis of healthcare in Nigeria through the lens of law introduce a new turn to the dismal narrative? As a disclaimer, it is important to state clearly that this blog is not all about law; it is interdisciplinary and therefore accommodates a fairly broad range of policy issues, commentaries, etc. On this inaugural issue, I have posted below a few links to some interesting articles on healthcare in Nigeria.

Ensuring Effective, Qualitative, Affordable and Accessible Health Care for All Nigerians Beyond 2007
By Felix-Abrahams Obi

Nigeria trains and develops human resources for health, but loses them to other sectors within the country and abroad due to relatively higher remuneration, welfare and motivation packages... There is a loud disconnect between policy making process, research activities and ownership of research agenda by key stakeholders ...

Full Article: http://www.nigeriansinamerica.com/articles/1708/1/Ensuring-Effective-Qualitative-Affordable-and-Accessible-Health-Care-for-All-Nigerians-Beyond-2007/Page1.html

Restoring Health To The Agenda, A Matter Of Life And Death
By Ike Anya

In this piece, as a network of Nigerian public health professionals, we put forward our analyses of some of the issues that should be paramount in the health agenda for the next 4 years...

Full Article: http://www.nigeriansinamerica.com/articles/1693/1/Restoring-Health-To-The-Agenda-A-Matter-Of-Life-And-Death/Page1.html

NIGERIA: Local ARV manufacturers want state support

LAGOS, 12 October 2007 (PlusNews) - Local manufacturers of antiretroviral (ARV) drugs are calling for the government to increase tariffs on imported anti-AIDS medicines, and discourage aid agencies and foreign governments from donating free drugs, to help them continue producing medicines for Nigerians living with HIV.

Full article:http://www.irinnews.org/Report.aspx?ReportId=74766

NIGERIA: Construction of hundreds of local health centres suspended

DAKAR, 24 August 2007 (IRIN) - Recently-elected Nigerian President Umaru Musa Yar' Adua has suspended the construction of 774 healthcare centres throughout his country, drawing questions on how his administration plans to tackle the increasingly dire health care situation in Africa’s most populous nation. "Whatever the rights or wrongs of the suspension of the contract… the fact remains that Nigeria has in recent years spent less of its budget per capita on healthcare than any other African government,” Ben Foot, programme director for Save the Children in Nigeria said.

Full article: http://www.irinnews.org/Report.aspx?ReportId=73917

NIGERIA: Children dying needlessly from measles and other preventable diseases

One of many efforts to vaccinate Africans LAGOS, 11 July 2007 (IRIN) - Measles is a preventable disease yet when it strikes in Nigeria it finds a ready pool of victims most of whom are children. In June more than 50 children died while another 400 were hospitalised in Nigeria’s northeast Borno state following a measles outbreak.

Full article: http://www.irinnews.org/Report.aspx?ReportId=73203