Dr. Uzodinma Adirieje

NIGERIA’S ELUSIVE PEACE AND AFRICA’S LOOMING REFUGEE CRISES

2012-01-01T22:59:00.000-08:00

- By

DR. UZODINMA ADIRIEJE
P.O. Box 8880, Wuse, Abuja, Nigeria
Ph: +234 803 472 9505
Blog: http://uzodinma-adirieje.blogspot.com
Email: uaadirieje@yahoo.com

ABSTRACT

Nigeria is the most populous country in Africa, tenth largest in the world, and home to
about 20% of Africa’s population. In her 51 years of post-independence life, the
country has witnessed scores of violent agitations and conflicts with the
attendant morbidity and mortality, and devastating toll on the barely existing
infrastructure. The unresolved struggle for the control of political and
economic power or ‘resource control’ among Nigerian elite is tearing the
country apart, and has deliberately incapacitated/impoverished the civil
society. Need one re-state that the greatest threat to peace and security is a
hungry, deprived and impoverished citizenry? Nigeria’s socioeconomic and
security situations have continental implications for the rest of Africa. The
imperative of peace as an essential ingredient for democracy and overall
development can never be overemphasized. The last opportunity to take
appropriate actions is about to be lost.

INTRODUCTION AND BACKGROUND

From the incessant kidnapping of oil workers and citizens in Niger-Delta, to brutal
murder of a 70-year-old woman and her 74-year-old husband alongside their
grandchildren in Plateau; from the rape and defilement of a 60-80 year-old
grandmother by a 17-year-old boy in Opi-Enugu, to the planting and detonation
of bombs in three churches in Mubi Adamawa; and from the several bomb attacks
and deaths of thousands in Yobe and Borno, to the bomb attacks in Mogadishu
Army Barrack and Nigeria Police Headquarters in Abuja; the Nigerian landscape
has in the last ten years, witnessed monumental increases in violence, conflicts
and extra-judicial murders, even though the country is not officially at war.
Peace, in every sense of the word, has become increasingly elusive for the
government and citizenry.

Peace – for the purpose of this piece – is a state of mutual harmony between people
or groups, manifesting as the normal freedom from civil commotion and violence
of a society…a state of public order and security.

As a reminder, Nigeria is the most populous country in Africa, tenth largest in
the world2, and home to about 20% of Africa’s population, but
occupies only about 3% of the continent’s surface area. Her development indices
as reported by the World Bank3, include a literacy rate of 60% among
her population of 155 million estimate in 2009, life expectancy of 47 (male)
and 48 (female), income per capita $1,140, while 83.9% of the citizens live on
below $2 daily. Our indices3 on the Millennium Development Goals
(MDGs) include: 27.2% prevalence of under-5 malnutrition, 138 per 1,000
under-five mortality rate; 840 Maternal mortality rate per 100,000 live births,
3.1% HIV prevalence, a tuberculosis (TB) incidence of 300 per 100,000 while
only 32% have access to improved sanitation facilities. Our oil continues to
boom, but the citizens continue to groan under poverty, unemployment, drastic
recession and lowered standards of living for the majority of the citizens.
With a total area of 923,768km2, Nigeria's national boundaries result from her
colonial history and cut across a number of cultural and physical boundaries.
North-south distance within the country could reach 1,040km while its east-west
counterpart stands at about 1,120km.

WHEN THERE IS NO PEACE

In her 51 years of post-independence life, Nigeria has witnessed a 30 months
fratricidal civil war, long-drawn years of military coups and imposed
rulership, years of political agitation by the national Democratic Coalition
[NADECO] and pro-democracy groups, persisting agitations by the Movement for
the Survival of Ogoni people [MASOP], violent agitations by various Niger-Delta
groups including the infamous Movement for the Emancipation of Niger Delta
[MEND], agitations by the Movement for the Actualisation of the Sovereign State
of Biafra [MASSOB] , and lately the Boko Haram insurgence in the North. Along
with these, violent agitations frequently violent inter and intra-communal
feuds have become commonplace, with the attendant morbidity and mortality, and
devastating toll on the barely existing infrastructure in the affected
communities.

It has been noted that violence of various forms - robbery, hostage taking,
kidnapping, murder, rape, even political, ethnic, religious - are presently
threatening the very existence of our country, and assuming scary dimensions. A
very small portion of the national earnings are available to governments at the
local and state levels where the majority of the citizens dwell, as reflected
in revenues sharing formula. As a result, sub-national struggles for equity
have become possible avenues to perpetrate the activities of organized criminal
syndicates that deal in oil and arms, and kidnap oil workers. Gradually but
steadily, Nigeria has become a theatre of insecurity, featuring widespread
criminal and group/gang violence, and unrestrained corruption and compromised
vigilantism; which are readily scripted through low capacity and accountability
of relevant national institutions, security apparatus and relevant stakeholders
in the combat of violence. Nigerian governments, political parties, security agencies, judicial establishments, vigilante groups, civil society leaders, perpetrators of crimes/violence, their
victims and citizens constitute the theatre audience.

The World Bank3 reports that an estimated 250,000–300,000 barrels of Nigeria’s
oil, valued at more than US$3.8 billion, are stolen each year through “oil
bunkering”. Due to the lucrative nature of these violent activities and
laisser-faire situation, local gangs and political groups have become
increasingly drawn into them. The recent arrest and arraignment of a serving
Senator of the Federal Republic of Nigeria in connection with the bombings and
destructive activities of Boko Haram, is a case in point. It is believed that similar
implications exist across the length and breadth of the country. Even in some
places where conflict has ended, recovery and creation of resilient
institutions have not been given due attention, while the weakness of
governance in post-conflict environments has attracted trans-regional violence.
The spread of the bombing activities of Boko Haram from Borno to other
regions/zones in Nigeria is a good example.

It is believed in many circles, that political, ethnic and religious obstacles
continually emerge to impede diligent law-making against these heinous acts,
and investigations and prosecution of identified/reported violence and crimes;
while the overall capacity of the judicial system to successfully and
conclusively prosecute these cases in a timely manner, leaves much to be
desired. In its Transnational Organized Crime Threat Assessment for West Africa3,
the United Nations Office on Drugs and Crime has also alluded that “law
enforcement officials can be offered more than they could earn in a lifetime
simply to look the other way”, in the face of these threats to peace. Each of
Nigeria’s estimated 360 ethnic groups is a culturally distinct society
characterised by unique dialect/language, value systems, normative behaviour,
and expectations from the Nigeria Project. Each brandishes a peculiar way of
life, mode of dress, values, food and food habits, cultural predispositions and
mechanisms or patterns of socialising among its members; with own systems of marriage and family organization. Good thing is, that continuous cross-ethnic interactions have led to exposures to different social, politico-economic and environmental circumstances, and are
now gradually narrowing our primordial differences in culture, language, gender
and religion.

In the opinion of this writer, Nigeria’s persisting crises are political and
economic. The unresolved struggle for the control of political and economic
power or ‘resource control’ among Nigerian elite is tearing the country apart.
This struggle has consistently been sustained through deliberate deployment of
the many roadblocks to a strong democracy in Nigeria, including conflicts
triggered by political competition and resource utilisation; official corruption
that is usually treated with kid-gloves; the weakening of civil society through
marginalization and deprivations of the capacity and resources to effectively
engage with government and advocate for change; government institutions that refuse
to established meaningful partnerships with citizens or the private sector and
lack the capacity to carry out their own mandates; and increased militarization
and monetization of politics. By consistently deploying anti-poor socio-economic
policies and practices, the government ensures a regime of persisting poor
social and economic indicators across the country, in order to continue to
undermine the civil society’s capacity to positively engage the democratic
process at the levels.

MAKING PEACE POSSIBLE AND WORKABLE

The Nigerian government’s understanding/concept of and effort at ensuring peace in
the country is reflected in the 2012 annual budget recently presented to the
National Assembly by His Excellency President Goodluck Jonathan. In sectoral
allocations, the government allocated about 20 per cent of the total budget to
‘security’. This amount is higher than the total/combination of the sums allocated
to Education, Health, Agriculture, Transport, Housing, Science and Technology,
and Communication and ICT, in the same budget.

In the opinion and understanding of this writer, a government that allocates more
of its budget to security than social sector, is technically in a state of war…,
and in the absence of external aggressions, is at war with its own people. It
is when a country is at war that it allocates less of its resources to directly
impact on the socioeconomic needs of its citizenry. Nigeria’s 2012 budget
includes an increase of 100-150 per cent in cost of fuel heaped on the citizens,
without any provision for higher earnings or more social services for the
workforce. Need one re-state that the greatest threat to peace and security is
a hungry, deprived and impoverished citizenry? Have we forgotten so soon, that
it is poverty that compels citizens to give up their lives and embark on
suicide bombings for mere hundreds of thousands of naira? Governments must stop
playing the ostrich, and get bothered by the immense lack of trust from the
citizenry, extreme poverty among the majority of our people, mutual suspicion
among the leadership at the highest levels, and consequent violence of
destructive proportions engendered on the polity.

As noted by Pope Paul VI in one of his encyclicals4, “it is not hard to see that (violence and conflicts are) often due to the lack of far-sighted official policies or to the pursuit
of myopic economic interests, which then, tragically, become a serious threat
to creation”. To combat this phenomenon, economic (policies) need to consider
the fact that “every economic decision has a moral consequence”. In apparent
recognition of the importance of peace, the Roman Catholic Church in 1967
introduced the commemoration of the World Day of Peace on January 1, the feast
of the Solemnity of Mary, Mother of God. It is a day when the Popes make
magisterial declarations relevant to the social doctrine of the Church, and important
statements on the United Nations (UN), human rights, women's rights, labor
unions, economic development, the right to life, international diplomacy, and
peace in the Holy Land, globalization and terrorism. The UN also commemorate
same day as Global Family Day.

NEXT STEPS AND EXPECTATIONS FOR NIGERIA

The imperative of peace as an essential ingredient for democracy and overall
development can never be overemphasized. The Nigerian Government needs to deliberately
and systematically engage in genuine dialogue with all disgruntled groups, with
a view to providing honourable solutions to their grievances. The country will
benefit from addressing the critical needs of the poor, who constitute a
majority of the citizenry, but remain maginalised and uncared-for in the conception
and implementation of government’s sociopolitical and economic agenda/policies.

It is time to systematically promote genuine integration and harmonious co-existence of our people and (re)introduce civic education and moral instructions in schools to instill discipline as a way of curbing social vices in the society. Government is urged to ensure transparency
in all its dealings, and routinely assess the quality of services rendered by
those entrusted with the responsibilities of public offices. An equitably
forthright justice system, a fair distribution and allocation of economic and
social amenities/resources/opportunities, and sincerely implemented massive
re-orientation of the inhabitants of our multicultural society towards
nationalism as against ethnic nationalism, shall reduce the chances of
conflicts associated with the persistent do-or-die struggle for political and
economic power among the elite.

The country should establish strategies and processes to deliberately empower the civil
society, political associations and the private sector to participate in national,
state, local government and community planning and budgeting, monitor financial
flows, and engage in stronger and broader collaboration with the government and
development partners; so as to reduce sources of tension, conflict and violence
in the national life, as well as engender a robust early-warning conflict
resolution systems. This will also empower the civil society to hold elected
officials accountable at all times, and be at the head of the vanguard for conflict
mitigation across the land.

CONCLUSION AND LAST-LINE

In Nigeria, institutionalized socioeconomic inequities and man’s inhumanity to man have given rise to numerous and persistent threats to peace and authentic integrated national
development. Following a recent conflict in Nigeria’s Adamawa State, Brigadier General Y.N. Nwaoga, the Brigade Commander of 23rd Amour Brigade Yola, led heads of security agencies in the state on Christmas homage to the State Governor, where he noted that “there is no peace where there is suspicion and mistrust”. It is time for the global world to note that
the conflict and violence due to suspicions, mistrust and corruption in Nigeria
can blossom into full-scale national conflict and create continental refugee
crises for Africa, if not justiceably, urgently and effectively
controlled/stopped.

But…as this piece was being put together, Boko Haram has claimed responsibility for
exploding a bomb in St. Theresa’s Catholic Church in Madala, near Abuja; where Christians
were praying for Nigeria in worship on Christmas Day of 2011; killing scores of
worshippers, possibly wiping out whole families and generations, and keeping in
the fore, the challenge of achieving peace in the world’s largest black
democracy. Same day, two other bombs exploded in Jos and in office of the State
Security Services in Damaturu. His Excellency President Goodluck Jonathan has
already given his now-regular/usual verbal assurances for the security of
everyone through the media.

Nevertheless, peace and security still remain elusive in Nigeria; and in the words of one Nigerian who listened to the President’s assurances, this is still the case of “they talk, we die”.

REFERENCES

1. The World Bank. World Development Report 2011
2. The Library of Congress. Nigeria - The Society and Its Environment, Country Studies
Program, http://www.mongabay.com/reference/country_studies/nigeria/SOCIETY.html,
accessed on 24.12.2011
3. The World Bank. World Development Report 2011
4. His Holiness Pope Benedict XVI. If You Want to Cultivate Peace, Protect Creation;
message for the celebration of the World Day of Peace, 1 January 2010

Rio+20 Count me in

2011-12-23T20:03:00.000-08:00

DEMOCRACY AND THE CRISES IN NIGERIA’S HEALTH SECTOR

2010-09-28T13:10:00.000-07:00

DEMOCRACY AND THE CRISES IN NIGERIA’S HEALTH SECTOR
By

DR. UZODINMA ADIRIEJE
P.O. Box 8880, Wuse Abuja, Nigeria
Ph: +234 803 472 9505;
Blog: http://uzodinma-adirieje.blogspot.com/
Email: uaadirieje@yahoo.com

BACKGROUND

After the failures and collapses of previous efforts at enthroning democracy, Nigeria once more embraced the government of the people by the people and for the people, in the twilight of the20th century. May 2010 marked ten years of unbroken democracy in the country, the longest period of civilian rule since the country was granted political independence by the British on the first day of October 1960. These last ten years have witnessed relative peace, with changes in the economy occasioned by steady growth, a large reduction in external debt, and structural reforms of the financial and telecommunications sectors. That these changes have significantly rubbed off positively on the standard of living of the majority of the citizens is quite debatable. As the world marks the international democracy day on 15 September and Nigeria prepares to roll out the drums to commemorate her fiftieth independence anniversary, it is worthwhile to discuss the country’s health situation over the last decade.

In ‘Democracy and Mental Health: the Idea of Postpsychiatry’ (7), Pat Bracken explained democracy as being about ordinary people having control of their lives and that this is a bigger issue than who is allowed to vote; when, where and for whom. In 1918 - some one hundred years ago, while addressing a meeting of the American Public Health Association on the subject of ‘Democracy and Public Health Administration’, the then President of the Association Dr. Charles J. Hastings said, “under our present public health administrations, we require people to conform to certain regulations. We endeavor to teach them how to live. We tell them that plenty of nutritious food, fresh air and sunshine are the best and only reliable remedies for tuberculosis and other wasting diseases. We insist on mothers nursing their babes, assuring them that by doing so they give their infants ten chances to one that they would have if artificially fed... What our nations require is a fitter race, and what every individual is entitled to is the development of the best, mental and physical, of which he is capable; and no government is worthy of being called a democracy that does not make this possible (8). The World Health Organisation (WHO) defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity" (3). Therefore, improving the health of the worst-off can improve a country's aggregate performance in health, and her health and development indices. Democratic institutions are expected to affect health positively through policies and actions that translate to universal access to high quality health services and products that improve the lives of the citizenry (2).
Health care provision in Nigeria is a concurrent responsibility of the three tiers of government in the country. However, because the country operates a mixed economy, private providers of health care also play visible roles in the country’s health care delivery. The federal government's role is mostly limited to coordinating the affairs of the university teaching hospitals, while the state government manages the various general hospitals and the local government focus on primary health care and dispensaries.
This paper takes a look at how the actions and inactions of the players in Nigeria’s present democratic set-up have impacted on the country’s persistent health crises in the last ten years. Certainly, a country's democratic structure affects virtually every aspect of society, including health (1).
POOR BUDGETARY ALLOCATIONS TO HEALTH AND POOR HEALTH INDICES

A review of the 2010 and 2005 World Health Statistics published by the World Health Organisation (WHO) shows that although Nigerian government’s general expenditure on health as a % of total government expenditure has marginally increased over the years, from 4.2% in year 2000 (12), down to 3.2% in 2002 (11), and up to 6.5% in 2007 (12), this has consistently fallen short of the 15% that was recommended by the African Union in the Abuja Declaration of 2001 (15). This picture is replicated in most of the Federal Capital Territory, the thirty-six States of the Federation, and their Local Government Areas. On the other hand, during the same period, the governments of Ghana and South Africa allocated well over 10% of their annual expenditure to health.
Nigeria’s health indices and those of Ghana and South Africa also reflect very similar trends. As revealed by the WHO, in 2003, these three countries had under-five or U-5 mortality rates of 198, 95 and 66 respectively (11), while the same index was 186, 76 and 67 respectively in 2010 (12). The U-5 MR is the probability of a child born in a specific year or period dying before reaching the age of five, and is usually expressed per 1,000 live births. Over the same period also, Nigeria’s averaged life expectancy increased from 47.5 years in year 2000 (11) to 49 years in 2008 (12). Life expectancy is the number of years a person is expected to live as determined by mortality in a specific geographic area. The country’s adult HIV prevalence also improved from 5.4% in 2003 (11) to 3.1% in 2007 (12).
Although no single factor can be attributed with improvement in health of the country, Nigeria’s marginal improvements can be largely attributed to the increase in health expenditure over the preceding years. These improvements would surely increase if the expenditures on health are increased to the level recommended in the Abuja declaration.
Unfortunately, the country’s maternal mortality ratio or MMR – a critical measure of the state of health of every country – took a leap for the worse during this period, increasing from 800 in year 2000 (11) to 1,100 in 2010 (12). The MMR represents the annual number of deaths of women from pregnancy-related causes per 100,000 live births. Sadly too, both the boost given to primary health care by the late Professor Olikoye Ransome-Kuti, and the impetus given to health sector reforms by Professor Eyitayo Lambo, appear to have run into mucky waters. Indisputably, the tenures of both men as Ministers of Health in Nigeria had been our most glorious in the last twenty-five years.
POOR DISEASE SURVEILLANCE AND MANAGEMENT MECHANISMS
The relationship between democracy and health outcomes was also the focus of recent research interest (9). With an estimated 158 million people in 2010 (16), Nigeria is the most populous country in Africa. In the health sector, progress has been slow and many challenges remain: from weak health systems to tackling HIV/AIDS; from improving immunization coverage (which in the past has impeded the global goal of eradicating polio) to implementing the new International Health Regulations (IHR); from achieving the Millennium Developmental Goals (MDGs) to preparing for pandemic flu. In many communities of the country, critical infrastructure that support health e.g. water, good sanitation and electricity are still lacking; while health facilities remain dilapidated…waiting for GAVI, the Global Fund, Bill and Melinda Gates, PEPFAR, World Bank and other donors and multilateral/bilateral partners. At the same time, workers in many government health institutions occasionally ‘down tools’ over unpaid entitlements. Yet, we are just five years away from 2015; the magical year for the MDGs. Government officials still readily go to health institutions in other countries for their health care needs at the expense of tax payers. Shouldn’t we do better?
Just as this essay was being prepared, it was reported on ‘Aljazeera’ television that eight hundred persons have been killed by Cholera in Nigeria. According to Ihekwazu and Anya (9), in northern Nigeria in 2003, concerns about vaccine safety, i.e. rumours that the polio vaccine caused sterility, led to a halt in polio immunization. This led to the resurgence of the disease in Nigeria, and the re-infection of several neighbouring countries, setting back the entire global eradication programme. While the last two years have witnessed a renewed response with reinvigorated vaccination campaigns, the disease has persisted and Nigeria remains one of four countries in which the circulation of the wild poliovirus has never been interrupted, recording very high numbers of confirmed polio cases in 2006 and 2007. Routine immunisations for other vaccine preventable diseases remain unsatisfactory. Outbreaks of measles, for which a cheap, safe and easily administered vaccine has been available for two decades, continue to occur with unacceptable mortality rates.
When the avian influenza hit some birds in Nigeria in 2006, it was a panicky country and confused health system that we all saw. Anxiety mounted the air as explanation and information were not readily provided. It took a whole five weeks for the disease to be confirmed, after several avoidable losses of birds had occurred. As the disease spread, our health system found it difficult to cull thousands of chickens and responded too late. The persisting weaknesses in our health system came to the fore all too soon.
THE RIGHT TO HEALTH

In the words of Professor Michael Reich in ‘Democracy and Health’, democratization involves a process of political change that increases the degree of peaceful competitive political participation in the governmental system and enhances political and civil liberties at the same time (5). After more than a decade of continuous democracy in Nigeria, citizens are not yet assured of the right to health which is a civil liberty. Indeed, one of the several causes of increased mortality and morbidity among the citizenry is lack of access to basic health care.

One of the reasons for this situation is that the National Health Bill which was introduced in the national assembly about five years ago in order to bridge the constitutional lacuna created by the absence of a valid provision for health in Nigeria’s current constitution, is yet to be passed into law by the parliament and submitted to the President for accent. In fact, a recent Nigerian Tribune newspaper report quoted the Chairman of the Health Committee of the Nigeria’s Federal House of Representatives as having said that that the Health Bill is yet to go through a third reading in the House (6). The Senate had only passed it in May 2010. That this Bill is still hovering in the chambers of the National Assembly five years after its introduction, speaks volumes of the importance our democracy attaches to the citizens’ wellbeing. As it is now, nobody yet knows when it will become law and benefit the majority of Nigerians. Similar things can be said of other legislative instruments and actions required to provide better health for all Nigerians. The anti-stigma Bill designed to end stigma and discrimination against persons living with and or affected by HIV and AIDS has been lying within the legislative houses for years now…un-passed! The right to basic health care as envisaged in the draft bill, is still denied the citizens.

ACCESS TO BASIC HEALTH CARE
The World Health Organisation (WHO), in its 2008 World Health Report emphasized that the fundamental step a country can take to promote health equity is to move towards universal coverage, and provide universal access to the full range of personal and non-personal health services they need, with social health protection. Even the National Health Insurance Scheme has been established to enhance the pooling of pre-paid contributions collected on the basis of ability to pay, and using these funds to ensure that services are available, accessible and produce quality care for those who need them, without exposing them to the risk of catastrophic expenditures (14). Even this has its limits as to what health care services are accessible to various shades and levels of subscribers within the scheme. It still does not promise or offer access to health care needs for all citizens.
Looking at the Nigerian situation, one may be compelled to agree with Franco A et al (10) when they posited that the level of inequality within a country may be an important determinant of health, and therefore that the potential confounding effect of wealth and its distribution within a country should be taken into account in assessing the impact of democracy on health. The differential access to health care in Nigeria, even in public health institutions like the National Hospital and various teaching and specialist hospitals, is a ready example. Majority of the citizenry cannot afford the cost of services in these hospitals, and die as a result of lack of care.
Writing in African Security Review journal, David Zounmenou opined that in almost all constitutions across the world, one of the most important requirements for any candidate in a presidential election is a clean bill of health delivered by a competent and honest medical institution (4). Zeroing in on Nigeria, the most recent event is the prolonged illness of our former President, his trip to Saudi Arabia for treatment and most embarrassingly, the inability of the Nigerian health system to sustain his health upon return, despite that fact that his health condition was already known, and Nigeria has the resources to provide the best care possible. One does not need to dwell on all the tissues of lies, contradictions and confusions that characterized his sickness and unfortunate death. While it lasted, neither the government officials, nor health care managers could tell Nigerians the truth about the President’s health condition. Nigerians had to rely on the cable news network for updates on the health of their leader. The wonder is: what will be the fate of the next Nigerian of any status who comes down with the same illness as the former President? Even with the experience of the former President’s illness, can our health system handle a similar case now? Will the next person who comes down with the same illness die?

WHAT SHOULD BE HAPPENING

Franco A, Álvarez-Dardet C and Ruiz MT report that welfare state policies have been associated with health benefits in people from countries belonging to the Organisation for Economic Cooperation and Development (10). There are countries in our region and in the developing world with fewer resources than Nigeria, but have managed to build health systems that guarantee universal and equitable access, that are collective and participatory, and at the same time ensure efficiency, effectiveness, and quality. As we celebrate our 50th independence anniversary and World Democracy Day, Nigeria, with its huge population – projected to be 326 million people and fifth largest in the world by 2050 (16), cannot afford to continue to pay lip service to the provision of universal health care for all its citizens/inhabitants.

The following demands have become pertinent:
1. that the National Health Bill for an act to provide a framework for the regulation, development and management of a national health system and set standards for rendering health services in the Federation, and other matters connected therewith, be passed and signed into law forthwith; and States should subsequently domesticate this law for timely implementation of its provisions;
2. that Nigeria should lead other African countries in allocating at least 15% of her annual budget to health at Federal, State and Local Government levels; and set immediate, medium and long term targets for her health and development indices, with an effective monitoring and evaluation mechanism in place;
3. as the January 2011 elections approach, stakeholders in Nigeria’s health and development sector should rally to put health strongly on the political agenda, and receive firm commitments for health, from the candidates and political parties; and
4. the Honourable Minister of Health should lead in giving fresh impetus to Health Sector Reforms and freely accessible universal primary health care in the country.

Ultimately, it is only a healthy population that can ensure the economic development in a stable democratic environment that we all hope for, and should seek.

REFERENCES
1. Ruger JP. Democracy and health, QJM: An International Journal of Medicine, Vol. 98, Issue 4, pp. 299-304
2. Mashaw JL, Marmor TR. Can the American state guarantee access to health care? Ruger JP. Democracy and health, QJM: An International Journal of Medicine, Volume 98, Issue 4, pp. 299-304
3. WHO. Constitution of the World Health Organization- Basic Documents, Forty-fifth edition, Supplement, October 2006
4. Zounmenou D. Nigeria: Yar'Ardua's Health and the Agony of Nigeria's Democracy, African Security Review, Vol 19 No 1; Online publication date: 22 March 2010
5. Reich M. Democracy and Health: An Overview of Issues Presented in Four Papers, Data for Decision Making Making Project, Harvard School of Public Health, January, 1994
6. Oguntola S. House of Reps to hold hearing on residency training, Tribune Newspaper (Nigeria), Thursday, 19 August 2010
7. Bracken P, Thomas P. Democracy and Mental Health: the Idea of Postpsychiatry, BMJ 2001; 322:724
8. Hastings CJ. Democracy and Public Health Administration, Am J Public Health, Vol. IX, No. 2, February 1919, pp 81-86
9. Anya I, Ihekweazu C. Democracy in Nigeria: the challenge of infectious disease control, J Infect Developing Countries 2008; 2(2):151-153.
10. Franco A, Álvarez-Dardet C, Ruiz MT. Effect of democracy on health: ecological study, BMJ 2004; 329 : 1421 doi: 10.1136/bmj.329.7480.1421 (Published 16 December 2004)
11. World Health Organization (WHO). World Health Statistics 2005, pp. 9-40
12. World Health Organization (WHO). World Health Statistics 2010, pp. 20-40
13. UNAIDS. AIDS Epidemic Update 2009, p. 19
14. WHO. Primary Health Care – Now More Than Ever, World Health Report 2008, p. 25
15. African Union. Abuja Declaration on HIV/AIDS, Tuberculosis and other Related Infections, http://www.un.org/ga/aids/pdf/abuja_declaration.pdf, accessed on 13 September 2010
16. Population Reference Bureau. 2010 World Population Data Sheet, p.2

Resume of Dr. Uzodinma ADIRIEJE

2008-05-08T07:53:00.000-07:00

Resume

DR. UZODINMA (Uzo’) ADIRIEJE

April 2008

Acronyms/Abbreviations/Keys:

FMoH: Federal Ministry of Health
UNAIDS: United Nations Aids Control Programme
CIDA: Canadian International Development Agency
DfID: UK Department for International Development
UNICEF: United Nations Children’s Fund
UNDP: United Nations Development Programme
HERFON: Health Reform Foundation of Nigeria
PATHS: Partnerships for Transforming Health Systems
NHSF: Nigerian Health Systems Forum
NHC2006: 2006 Nigeria National Health Conference
WHO: World Health Organisation
ILO: International Labour Organisation
NACA: National Agency for the Control of AIDS
ENHANSE/USAID: Enabling National HIV/Aids Response in the Social Sector/ United States Agency for International Development
ICASA: International Conference on Aids and STIs (sexually transmitted infections) in Africa
NHIS: National Health Insurance Scheme
PPP: Public-Private Partnerships
EC: Delegation of European Commission
NMA: Nigerian Medical Association
PSN: Pharmaceutical Society of Nigeria
NANNM: National Association of Nigeria Nurses and Midwives
NACHPA: National Association of Community Health Practitioners
NESG: National Economic Summit Group
HMCAN: Health and Managed Care Association of Nigeria
CCMDs: Committee of Chief Medical Directors of Federal Teaching and Tertiary Hospitals
AGPMPN: Association of General and private Medical Practitioners of Nigeria
AN: Advocacy Nigeria
CAN: Christian Association of Nigeria
NSCIA: Nigerian Supreme Council for Islamic Affairs
NCWS: National Council of Women Societies
NURTW: National Union of Road Transport Workers
NASCP: National AIDS Control Programme

BRIEF DESCRIPTION OF EXPERIENCES AND EXPERTISE/COMPETENCES

EXPERIENCES

Dr. Uzodinma Adirieje is a primary health care practitioner, professional programs/projects manager, writer/columnist and community leader. He is involved in Health Systems Research, Advocacy, Communications, Documentations and Community outreaches; including policy analyses and assessments/M&E. His areas of active work include Public-Private Partnerships, HIV/AIDS, Maternal & Child Health, Blindness Prevention, Nutrition, Health Sector Reforms, Conferences, Aging, Human Rights & Community Development. He has received post-graduate trainings/courses in Managing Organisational Change for Strategic Transformation, Basic Health Economics, Leadership Skills Development, Health Care Financing and Health Insurance Systems, Projects Planning and Proposal Development, Monitoring and Evaluation, Programmes Management, Evidence-based Health Writing, and Cyberwar, Netwar and the Revolution in Military Affairs - Real Threats and Virtual Myths. He is the Advocacy & Communications Manager and HIV/AIDS Specialist/Adviser at Health Reform Foundation of Nigeria (www.herfon.org), and sSecretary of the 2008 Nigerian National Health Conference. He has participated in varying capacities in several projects/programmes including Project Coordinator, ‘Study of Impact, Challenges and Long-Term Implications of Antiretroviral Therapy (ART) Programme in Nigeria [2007]’; Report writer/Documentation consultant, Nigeria HIV/AIDS Summit (2007); Secretary, Nigeria National Health Conference 2006 and 2008 (www.ngnhc.org); Principal Investigator and UNAIDS/ILO/UNDP consultant on 'PPP and HIV/AIDS in Nigeria' (2004); Principal Investigator, Study of Diabetic Retinopathy in Lagos, Nigeria (2000-2002); etc. Dr. Adirieje is a Key Correspondent, Health and Development Networks (2002-present); Country Focal Point and member International Advisory Board of AIDS-Care-Watch Campaign (2006-present); Columnist, Daily SUN newspaper (2004-present) and Founder/moderator, icasa2005forum online (2004-present). He was Editor-in-chief, Orsu LGA Directory and who’s who; President General, Imo State Towns Development Association Lagos (2005-2008), President, ISTDA Cooperative Ltd, and governing council/life member, Nigeria-Britain Association. Uzo’ was Resource Centre Manager (2005-2007), HERFON; Programs Manager, 14th Int’l Conference on AIDS and STIs in Africa (ICASA 2005); Programs Director/Secretary General, Afrihealth Optonet Association (1995-present); Executive Director, Optonet International (1995-2005); Executive Coordinator, Afrihealth Information Projects (1995-2004), and Clinical Services Director, Adirivision Clinics Ltd (1990-2004). Uzodinma is a member of a handful of local and international professional bodies including Nigerian Institute of Management (NIM), Chartered Institute of Personnel Management of Nigeria [CIPMN], The Impact Alliance, American Diabetes Association, International AIDS Economics Network, etc. He has more than 40 (forty) articles/essays/publications to his credit, most of which are available on the Internet. He has received a handful of honours and awards including the chieftaincy title of Ahaejiejemba of Amaruru (2005), Presidential Recognition for Membership Growth from the President of Rotary International [worldwide] (1996), Distinguished Service Award from the Governor of Rotary International District 9110 (1994), Merit Award from Iganmu and Council of Chiefs Lagos State (1996), among others. Email: uaadirieje3@gmail.com; Mob: +234 803 472 5905

COMPETENCES/ EXPERTISE

Professional Manager, Experience in working with International Development Partners/Funders and Multilateral and Bilateral International agencies including UK Department for International Affairs [DFID], World Bank, Canadian International Development Agency [CIDA], ENHANSE/United States Agency for Int’l Dev (USAID), Japanese International Development Agency (JICA), Partfinder Int’l, Family Health Int’l, Society for Family Health (SFH), Federal Ministry of Health, National Agency for the Control of AIDS (NACA), etc.
Itinerary Planning and Management, Arrangement and Covering/Reporting of Meetings, Speechwriting and Drafting of Correspondence, Handling Travel Arrangements and Protocol, Secretarial Functions
Proficient in the use of MS word, PowerPoint and Excel; Have excellent typing skills and comfortable speed with accuracy; mostly work/type straight on the computer without written drafts
Health System & Development Projects Management specialist involved in Research, Mobilization/Advocacy, Communications & Documentation/Writing, Reviews, Policy Analyses and Assessments/M&E;
Focus on Public-Private Partnerships, HIV/AIDS, Health Sector Reforms, MCH, Blindness Prevention, Nutrition, Conferences, Aging, Human Rights and Community Development;
Electronic dissemination of information on research, programs, publications, etc through mass e-mails and listserv postings;

PERSONAL INFORMATION AND CONTACT ADDRESSES

Full names: ADIRIEJE, Uzodinma Akujekwe [Dr.]
Date of Birth: 25 February 1964
Place of Birth: Amaruru 473123, Orsu LGA, Imo State, Nigeria
Nationality: Nigerian
Sex: Male
Marital Status: Married
Postal address: P.O. Box 8880, Wuse Abuja, Nigeria
Residential address: House 29, FHA Estate, Lugbe, Abuja
Phone: 0803 472 5905
E-mail: uaadirieje3@gmail.com
Blog: http://uzodinma-adirieje.blogspot.com
CAREER OBJECTIVE
To passionately and continuously contribute to the sustainable improvement of the standards of living of persons and communities affected by or at risk for diseases, disasters, ignorance, underdevelopment and or poverty; years of continuous post-graduate experience (1990-present).
PROFESSIONAL EXPERTISE AND COMPETENCES
Professional Manager, Health System & Development Projects Management specialist involved in Research, Communications & Documentation/Writing, Reviews, Mobilization/Advocacy, Policy Analyses and Assessments/M&E; with focus on Public-Private Partnerships, HIV/AIDS, Health Sector Reforms, MCH, Blindness Prevention, Nutrition, Conferences, Aging, Human Rights and Community Development. Electronic dissemination of information on research, programs, publications, etc through mass e-mails and listserv postings. Itinerary Planning and Management, Arrangement and Covering/Reporting of Meetings, Speechwriting and Drafting of Correspondence, Handling Travel Arrangements and Protocol, Secretarial Functions. Proficient in the use of MS word, PowerPoint and Excel; Have excellent typing skills and comfortable speed with accuracy; mostly work/type straight on the computer without written drafts
QUALIFICATIONS

MPH (in view), MBA HRM (in view), MNIM (2001), ACIPM (1996), O.D. [Doctor of Optometry] (1988)

EDUCATION, COURSES AND TRAININGS
§ 2007 – Managing Organisational Change for Strategic Transformation, Nigerian Institute of Management, Abuja, Nigeria, 5-9 November 2007
§ Masters of Public Health (MPH), University of Staffordshire, UK [ongoing]
§ Master of Business Administration (MBA), National Open University of Nigeria [ongoing]
§ 2007 – Basic Health Economics Course, May-June 2007, World Bank Institute Washington
§ 2006 – Leadership Skills Development Training for the Revitalisation of Immunisation Services in Nigeria, Abuja Nigeria, 31 July - 1 August 2006
§ 2006 - Health System and Health Insurance Schemes Study/Capacity-Building Workshops/Tour of Brazil, Sao Paulo and Brasilia, 13-21 May 2006
§ 2006 - Project Planning and Proposal Development Course, Abuja, Nigeria, 24-28 April 2006, Management Strategies for Africa (MSA)
2006 - Monitoring and Evaluation using Peer participatory Rapid Health Appraisal for Action (PPRHAA), a Training of Trainers’ Course, Jos, Nigeria, April 4-12 2006, DFID/PATHS
2005 - Programmes Management Training, Abuja, Nigeria; by Shocklogic Global (UK) Ltd, 2005
2004 - International Health Writing Course on Evidence-Based Health Care, Lagos, Nigeria, BMJ West Africa and AMREF, 2004
2002 - Cyberwar, Netwar and the Revolution in Military Affairs - Real Threats and Virtual Myths, Trento, Italy, 3-13 August, International School of Disarmament and Research on Conflict (ISODARCO), 2002
1992-2001 - Nigerian Institute of Management: Professional Manager (MNIM)
1992-1996 - Chartered Institute of Personnel Management of Nigeria: Associate (ACIPM)
1982-1988 - Imo State University, Okigwe: O.D. (Doctor of Optometry), 1982-1988
1982 - Federal School of Arts and Sciences, Ondo: Lower Six, 1982
1976-1981 - Eziachi Secondary School, Eziachi: General Certificate of Education (GCE), O’ Level, 1976-1981
1971-1976 - Community Primary School 1, Amaruru: First School Leaving Certificate (FSLC), 1971-1976

Representative Projects Management Experiences (most recent, then backwards):

Position in Team & Dates
Organisation(s)/
Group(s) / Person(s) Assisted
Financing Organisation(s)/ Group(s)/Person(s)
Brief Description of Project/Assignment
National Consultant, Final Documentation of Nigeria HIV/AIDS Summit 2007, Jun ‘07
NACA; LOC Nigeria HIV/AIDS Summit 2007
World Bank/National Agency for the Control of AIDS (NACA)
1. Provide support in rephrasing and editing of various print and electronic materials (including all scientific documents) on issues presented at the Nigeria HIV/AIDS Summit
2. Develop strategies and co-ordinate activities that promote the documentation and packaging of the activities of the summit in a format acceptable to NACA
3. Support in the production of the final Summit report.
Member, Editorial Board, June 2007-present
Journal of Infection in Developing Countries
P. Cappuccinelli
Salih Hosoglu
David J. Kelvin
Peter Mason
Iruka Okeke
Salvatore Rubino
Abiola Senok
John Wain
1. Writing research papers, research notes, state-of-the art review articles, manuscripts, articles and opinions
2. Writing state-of-the-art review on the research field
3. Editing research papers, research notes, state-of-the art review articles, manuscripts, articles and opinions
4. Participating in Board meetings and other assignments
Project Coordinator, Study of Impact, Challenges and Long-Term Implications of Antiretroviral Therapy (ART) Programme in Nigeria [2007]
HERFON, DFID, NASCP, CSOs, GoN
HERFON
Coordination of the study of the massive roll-out of ARVs in Nigeria in order to:
1. Under-study the Nigerian ARV program structures and processes
2. Ascertain the number of persons on the ART and the services rendered to them
3. Identify gaps that are specific to the planning, procurement, distribution and usage of ARVs across the country
4. Ascertain the effectiveness, efficiency and quality of service of the program
5. Study the long term financing implication of the Nigerian ARV scale-up and identify strategies for the suitability of the National ART program

Secretary, Nigeria National Health Conference, Sept 2006 – Jan 2007
Nigeria National Health Conference (NHC2006)
DFID, ENHANSE-USAID, HERFON, CIDA, WHO, UNICEF, FMOH, etc
1. Coordinating the activities of the NHC2006 secretariat, liaising with and supporting stakeholders, managing the implementation of the conference activities and secretariat/staff, developing the conference program and monitoring its implementation, and providing technical and secretarial support to the conference’s subcommittees and participants/clients
2. Serve as Secretary of the Conference’s national Steering Committee
3. Provide technical support to subcommittees of the NHC2006
Conference Coordinator; August – September 2006

The Partnership (PPP) for the Nigerian National Health Conference [NHC2006]
National Assembly, HERFON, DfiD, FMoH, CIDA, ENHANSE-USAID, Professional Associations and Civil Society Organisations
Coordinating the organization of the NHC2006, liaising with stakeholders and participants/clients during its preparations and activities, managing the implementation of the conference activities and secretariat/staff, developing and monitoring the execution of the conference program, and providing technical and secretarial support to the conference’s subcommittees

Project Coordinator; Dec 2005-July 2006
Federal Government of Nigeria, National Health Insurance Scheme (NHIS) and its Stakeholders
Health Reform Foundation of Nigeria (HERFON)
Coordinating the Health Insurance Capacity-Building and Study tour of the Brazilian Health System and Institutions by Nigerian stakeholders including members of the National Assembly, Representatives of Federal Ministry of Health (FMoH), Board and management of the NHIS, Change Agents, representatives of Health Maintenance Organizations (HMOs), NHIS Providers, Consumers, Civil Society and media; organizing post-tour conference and writing/producing tour report (published, July 2006)
Team Leader; April 2006
Catholic Archdiocese of Jos, Nigeria
Partnership for Transforming Health Systems (PATHS) and DfID
Conduction of the first-ever monitoring and evaluation (appraisal) of the services of Mandela Clinic, K-Vom, Plateau State, using the Peer participatory Rapid Health Appraisal for Action (PPRHAA) tool; covering patient-care management, internal management, finance and equipments, output and services, and community and client views of the health centre; and provided report and recommendations for the improvement of the services of the clinic
Project Coordinator; November 2005 – Feb 2006
HERFON
UK DFID
Operationalisation of an independent Health Resource Centre at HERFON {Budget: core component of a GBP3.4 million grant}
Project Director;
April 2004
National Union of Road Transport Workers (NURTW), Aguda Motor park, Lagos
Afrihealth Optonet Association
Conducted eye health awareness and vision screening exercises in liaison with the World Health Organization [WHO] on ‘Vision Care for Road Safety’ - a World Health Day Project; at Aguda Central Motor Park, Surulere Lagos, for commercial bus and taxi drivers and market persons
National consultant; Dec 2004 - May 2005
National Action Committee on AIDS (NACA)
UNAIDS/ILO/
UNDP

Situational Assessment for a National Framework for
Private Sector Response and Public-Private Partnerships on HIV/AIDS in Nigeria, 2005

Moderator/
Founder; 2003-present
International Conference on Aids and STIs in Africa [ICASA 2005]
Afrihealth Information Projects/
Afrihealth Optonet Association
ICASA 2005 forum: An email forum for the exchange of HIV/AIDS views and news/information between stakeholders, for the purpose of ensuring that the objectives of the International Conference on Aids and STIs (sexually transmitted infections) in Africa [ICASA 2005], Abuja, Nigeria are completely realised.
Columnist, ‘Current Concerns’; 2004-present
Daily Sun Newspaper, Nigeria
Sun Publishing Company and Afrihealth Information Projects
Writing/producing regular features and/or series of articles in Daily SUN newspaper, with focus on health and development, including letters from readers, answers to readers' queries, etc.
Project Coordinator; December 2003 – September 2004
Arewa and Migrant Moslem Community, Isolo Lagos
Afrihealth Information Projects and Arewa Joint Action Committee
HIV/AIDS control and impact mitigation enlightenment/advocacy campaigns in the predominantly Muslim Arewa Community, Isolo Central Mosque, Lagos; 2004

Principal Investigator; Jul 2000-Jun 2002
Optonet International/AOA
American Diabetes Association
Study of the Prevalence, Management Practices and Preventive Strategies of Diabetic Retinopathy in Lagos State, Nigeria
Projects Director; Feb 1997 – Dec 2002

Optonet International/Afrihealth Optonet Association
Task Force Sight and Life, Switzerland
Using Advocacy and Immunisation Opportunity to control Vitamin A deficiency Diseases(VADD): projects featuring VAD talks, IECs, advocacy for using immunisation as opportunity for vitamin A fortification and vitamin A capsule supplementation, in 7 Rural Communities and 8 Children’s Schools in Lagos State; and provision of awareness for the vitamin A rich foods that abound in and around the community (Badagry, Alausa, Kirikiri, Egbe, Isheri Olofin, Ijeshatedo & Aguda)
Principal Investigator; Jan 2002– Dec 2002

Optonet International/Afrihealth Optonet Association
Child Health Foundation (CHF), USA

Developing a food based dietary guideline for the control of vitamin A deficiency diseases (VADD) in Lagos using available and affordable local food materials [study carried out in 5 Rural Communities and 8 Children’s Schools in Badagry, Alausa, Kirikiri, Egbe & Isheri Olofin]
Jan 2000–Dec 2001
Afrihealth Information Projects /
Afrihealth Optonet Association
Thrasher Research Foundation, USA

Developing a food based dietary guideline for the control of maternal anaemia in pregnancy in Lagos State using available and affordable local food materials [study carried out in 5 Rural Communities and 8 Children’s Schools in Badagry, Alausa, Kirikiri, Egbe & Isheri Olofin]

Employment Record (most recent, then backwards):

Dates
From - To
Employer’s name
Position held
Reason for leaving
September 2007 - Present
Health Reform Foundation of Nigeria [HERFON]
Advocacy & Communications Manager, Head of Advocacy & Communications Dept, and HIV/AIDS Advisor/Focal Person
Still on the job
November 2005 – September 2007
Health Reform Foundation of Nigeria [HERFON]
Resource Centre Manager & Head of Resource Centre/Programs Dept
Promoted & re-assigned
July 2005 -October 2005
International Conference on HIV/AIDS and STIs in Africa 2005, Abuja, Nigeria (ICASA 2005)/Society for AIDS in Africa (SAA)
Programmes Manager/Head of Programs Dept

To work as the Manager, Health Resource Centre of DfID-funded Health Reform Foundation of Nigeria (HERFON)

January 2005 - June 2005

International Conference on HIV/AIDS and STIs in Africa 2005, Abuja, Nigeria (ICASA 2005)/Society for AIDS in Africa (SAA)
Programme Officer

Upgraded to Programs Manager/Head of Programs Dept
Feb 1997 – Dec 2004

Optonet International & Afrihealth Information Projects/Afrihealth Optonet Association (AOA), Lagos
Projects Coordinator
To work as the Program Officer, ICASA 2005
Jan 1991 – Jan 1997

Adirivision Clinics Limited, Lagos

Clinician

To work as the Projects Coordinator of Optonet International & Afrihealth Information Projects, Afrihealth Optonet Association (AOA), Lagos
Jan–Dec 1990
C-Bright Eye Centre, Lagos

Optometrist

To establish a clinical practice
Sept 1988 – Aug 1989
General Hospital, Takum
Optometrist (compulsory National Service)
Completed National Service

MAJOR RESPONSIBILITIES AND ACCOMPLISHMENTS IN VARIOUS WORKING, PROFESSIONAL AND COMMUNITY SERVICES POSITIONS

October 2007-present: Advocacy & Communications Manager/HIVAIDS Advisor, Health Reform Foundation of Nigeria [HERFON] (in no particular order):
MAJOR RESPONSIBILITIES:
Planning and managing all the Foundation’s advocacy initiatives/activities with governments, development partners, civil society organisations, etc
Overseeing the information and communications, including the the writing/drafting of correspondences, position papers, press releases, media announcements, speeches, papers, presentations, communiques, etc
Supervising the Foundation’s website and its contents
Producing the Foundation’s bulletins and newsletters
Coordinating the National Health Conferences activities
Managing the membership activities of the foundation, including membership development, policies, briefings, enquiries, etc.
Coordinating and managing the Foundation’s media activities/engagements and working with the media
Serving as the foundation’s HIV/AIDS Adviser/Focal person

August 2006-January 2007: Secretary, Nigerian National Health Conference 2006
MAJOR RESPONSIBILITIES:
Planning and managing all the programmes and activities of the conference
Mobilising and liaising with Federal Ministry of Health, development partners, local NGOs and other stakeholders for the conference
Supervising and supporting the conference staff and consultants
Providing technical support to the National Steering Committee, as Secretary
MAJOR ACCOMPLISHMENTS:
Coordinated the activities related to the 2006 National health Conference
Developed the conference’s programme for the consideration of the National Steering Committee
Managed the Secretariat of the Conference
Served as the Secretary of the National Steering Committee for the Conference
Provided support to the conference’s subcommittees [Technical, Programme, Finance, Communication & Media, and Accommodation, Transport & Security]

November 2005-September 2007: Resource Centre Manager, Health Reform Foundation of Nigeria [HERFON] (in no particular order):

A. MAJOR RESPONSIBILITIES:
Managing all the health and technical programmes of the orgnisation
Supervising and supporting the officers in charge of Research, Advocacy & Communication and ICT;
Overseeing the activities of the library
Assisting the Executive Secreatry/CEO in the perfromance of his official internal and external engagements
MAJOR ACCOMPLISHMENTS:§ Successfully initiated and secured the donation of a 40-feet container of health and science education books and 50 (fifty) pieces of desktop computers from Books for Africa, USA; for distribution to all the State and FCT Branches of HERFON, and use in the HERFON Resource Centre library§ Successfully initiated and enrolled HERFON into Health InterNetwork Access to Research Initiative (HINARI) of the World Health Organisation (WHO)§ Prepared HERFON’s 2006 and 2007 (annual) organizational work plans and budgets, supervised programs/projects staff, monitored and reported on programs/projects activities, achievements and outcomes of the Foundation to the Executive Secretary/CEO§ Drafted and prepared the 2006 organisational annual report§ Drafted, prepared and made the following presentations on behalf of the Executive Secretary:
“Health Sector Reform as It Affects Primary Health Care”; Capacity building workshop for Primary health Care Practitioners in Ondo state to improve their performance and enable them present a position paper to the State government, Association of PHC Practitioners of Ondo State, Akure, 17 May 2007
“Mobilizing Resources for Better Child Health - the Health Sector Reform Approach”; 38th Annual General and Scientific conference of the Pediatric Association of Nigeria (PAN), Nnewi, 22-27 January 2007
“Nigeria National Health Conference – Background and update”; Nigerian Health Systems Forum, Abuja, 6 November 2006; and at the Annual Conference of Pharmaceutical Society of Nigeria (PSN), Abuja branch, 8 November 2006
“Concept and Tenets of the Change Agent Movement (CAM)”, Birnin Kebbi, 24 August 2006
“The Place of the Doctor in Health Sector Reform (HSR)”; Annual General Meeting (AGM) of the Nigerian Medical Association (NMA), Abuja Branch, 3 August 2006
“Leadership in the Nigerian Health Sector: the challenges before the Nigerian Medical Association (NMA)”; Annual General Meeting (AGM)/Scientific Conference of the Nigerian Medical Association (NMA), Cross River State, Calabar, 11 August 2006§ Supervised the establishment/take-off of the HERFON Health Resource Abuja and its commissioning by Nigeria’s Hon Minister of Health Professor Eyitayo Lambo on 19 February 2006§ Conducted the first-ever appraisal of the activities of the Mandela Clinic, K-Vom, Plateau State, covering patient-care management, internal management, finance and equipments, output and services, and community and client views of the health centre; and provided report and recommendations for the improvement of the services of the clinic§ Coordinated and participated in the Health Insurance Capacity-Building Tour of Brazil’s Health System by Nigerian stakeholders including members of the National Assembly, Representatives of Federal Ministry of Health (FMoH), Board and management of the National health Insurance Scheme (NHIS), Change Agents, representatives of Health Maintenance Organizations (HMOs), NHIS Providers and media, 12-20 April 2006
Severally represented the Executive Secretary/CEO and the Foundation at internal and external engagements as directed§ Managed and supervised the activities of 5 officers and 3 other members of staff of HERFON’s Resource Centre Dept§ Drafted organizational letters and replies§ Drafted and read the resolutions of HERFON 2005 AGM (in Bauchi) and 2006 Stakeholders retreat (in Abuja)§ Drafted the Communiqué of the 2006 Nigeria National Health Conference (NHC2006)
Drafted and read the Goodwill message of HERFON’s Executive Secretary at the 38th Annual General and Scientific conference of the pediatric association of Nigeria (PAN), Nnewi, 22-27 January 2007
Communicate and disseminate information to members and Change Agents
Prepare Terms of reference (TORs) and other guidelines for HERFON’s consultants and activity protocols
Serve as secretary of HERFON’s BoT subcommittees on the Review of the Constitution, Branding, Curriculum development, etc.
Drafted HERFON’s IEC materials and web homepage information
Represents HERFON and the Executive Secretary at the following external assignments:
i. Member, Technical Committee for the Final Drafting of Nigeria’s Health Systems Strengthening Funding/Support Proposal/Application to the Global Alliance for Vaccines and Immunization (GAVI), 2007
ii. Nigeria Health System Forum
iii. PATHS Federal Working Group
iv. National Planning Committee, 50th National Council on Health§ Drafted the following personalities’ speeches for the NHC2006:i. His Excellency President Olusegun Obasanjoii. Honourable Minister for Health professor Eyitayo Lamboiii. Chairman of NHC Steering Committee Senator I.S. Martyns-Yelloweiv. Chairman, Board of Trustees, HERFON, HRH Dr. Haliru Yahayav. Executive Secretary HERFON, Dr. Ibrahim Oloriegbe
2005 - Programs Manager, International Conference on AIDS and STIs in Africa (ICASA) 2005 (January-October 2005)
§ Maintained an excellent working relationship with counterparts within the Federal Ministry of Health, UNAIDS, UNIFEM, WHO, World Bank, SACAs, USAID, JICA, Pathfinder International, CDC, and other implementing partners, local groups/organizations and stakeholders to ensure effective coordination, support and management of ICASA 2005 programs§ Communicated effectively with plenary speakers, session chairs/co-chairs, roundtable, skills-building and satellite meetings participants and abstract submitters and all presenters§ Maintained communication and cooperation with abstract reviewers§ Defined conference’s abstract categories and poster groupings§ Downloaded abstracts and other conference data, captured abstract submissions, allocated reviewers to abstracts and communicated with abstract submitters§ Organized and supported meetings of the International Scientific Committee and the local Scientific sub-committee and the final abstract selection meetings; including the presentation of top abstracts for oral sessions or posters§ Created conference sessions
1995-2004 - Executive Coordinator (Research & Development), Afrihealth Information Projects/Afrihealth Optonet Association, and Executive Director, Optonet International

Successfully implemented a UNAIDS/ILO/UNDP-funded ‘Study/Situational Assessment of Public Private Partnership (PPP) for HIV/AIDS in Nigeria’ 2004-2005; as a consultant
Coordinated an enlightenment/advocacy campaign and delivered a moving speech delivered at an HIV/AIDS control campaign for the predominantly Muslim Arewa Community, Isolo, organized jointly by Afrihealth Optonet Association and Arewa Joint Action Committee (AJACOM), at the Isolo central Mosque, Lagos; 2004
Conducted eye health awareness and vision screening exercises in liaison with the World Health Organization [WHO] on ‘Vision Care for Road Safety’ - a World Health Day Project; at Aguda Central Motor Park, Surulere Lagos, for commercial bus and taxi drivers and market persons, 2004
Investigated the ‘Prevalence, Management Practices and Preventive Strategies of Diabetic Retinopathy in Lagos State, Nigeria’; with a US$117, 000 grant from the American Diabetes Association, 2000-2002
Organised 3 Vitamin A Deficiency Control/Prevention outreaches/Projects in Isheri-Olofin, Lagos; including the distribution/administration of Viatmin a capsule and provision of awareness for the vitamin A rich foods that abound in and around the community, 2000
Organised 4 Vitamin A Deficiency Control/Prevention outreaches/Projects in Kirikiri, Lagos; including the distribution and administration of Viatmin a capsule and provision of awareness for the vitamin A rich foods that abound in and around the community , 2000
Developed a Food-Based Dietary Guideline for the Control of Maternal Anemia in Pregnancy in Urban Poor and Rural Communities in Lagos, 1999-2001
Implemented 3 Eye Care and Community Health Development Programmes in Egbe, Lagos, 1999
Organised 2 Family Health, Population Education, and Nutritional Blindness Outreaches, Orile-Iganmu, 1998
Facilitated/organized 1 Vitamin A Deficiency Control/Training workshop for community leaders, patent medicine dealers, local government personnel and community health workers in Badagry, Lagos , 2001
Organised 4 Vitamin A Deficiency Control/Prevention outreach Projects in Badagry, Lagos; including the distribution/administration of Vitamin a capsule and provision of awareness for the vitamin A rich foods that abound in and around the community , 1997-2002
Organised 2 Population Education, family planning Awareness and Eye Care Campaigns, in Egbe, Lagos, 1998
Organised 3 Family Health, Environmental Awareness and Blindness Prevention Projects in Alausa, Lagos, 1998
Organised 3 Child Health/Nutritional Blindness Prevention Programme for the Pupils and Staff of Sanya Primary School Ijesha-tedo, Lagos State, 1998
Coordinated 2 Public Health Intervention/Education Programme at the Yaba Old People’s Home, Lagos State, 1997

1991-2004 - Clinical Services Director, Adirivision (Clinics) Ltd, Lagos

Provided eye care [clinical], blindness prevention and family health services for 4500 persons at Adirivision (Clinics) Ltd, Aguda-Surulere, Lagos, 1991-2004
Provided in-factory/onsite occupational and industrial Vision/Health services for 150 persons (staff and family members) at Nigeria Breweries PLC factory, Iganmu Lagos, 2004
Provided eye care and blindness prevention services for 95 persons at Felin Hospital, Olodi - Apapa, Lagos State , 1995-1998
Provided eye care and blindness prevention services for 79 at Larry’s Clinic, Ebute - Metta, Lagos State , 1995-1997
Provided eye care and blindness prevention services for 200 persons at Rees Hospital, Olodi - Apapa, Lagos State, 1994-1998
Provided eye care and blindness prevention services for 56 persons at Adeb Hospital, Coker-Iganmu, Lagos State, 1993-2004
Provided eyecare and blindness prevention services for 45 persons at Coker Specialist Hospital, Coker-Iganmu, Lagos , 1993-2004
Conducted a research on Eye problems; and provided eye care and blindness prevention services at in Takum Local Government Area of Gongola State, 1988-1989 2005-present – President-General, Imo State Towns Development Association Lagos [ISTDAL] § Produced a 7-page, spiral-bound, full-colour 2007-2008 calendar (the 2nd in the Association’s 21 years existence)§ Produced full-colour season’s greeting cards (the 1st in the Association’s 21 years existence)§ Organised a Poverty Alleviation Project (PAP) for 100 indigent Imo women – mainly widows - resident in Lagos, which has enabled some of them to be owners of small scale businesses today, 2005§ Awarded tuition scholarships to the tune of =N=20, 000.00 each to 9 students of Imo state origin in Lagos schools, 2005§ Increased the nominal attendance to the Associations monthly meetings by 130 percent, causing members to begin to request for an enlarged venue, 2005§ Organised the Association’s annual ‘cultural day’ without borrowing money from any where, as had been the practice, 2005§ Returned accountability and mass participation in the affairs of the Association, and placed it on the part to profitability, 2005§ Established the ISTDA Cooperative, Thrift and Credit Society Ltd as a for the benefit of Imo State people in Lagos, 2005§ Got the ISTDA Cooperative, Thrift and Credit Society Ltd inaugurated by the Governor of Lagos State. , 2006

PUBLICATIONS/WRITINGS

ONLINE RESOURCES
Adirieje, UA. Public-Private Partnerships for Sustainable Community-Based HIV/Aids Advocacy, http://phishare.org/documents/afrihealthoptonet/4313/
Adirieje, UA. Public-Private Partnership and Nigeria’s Development, http://phishare.org/documents/afrihealthoptonet/4267/
Adirieje, UA. XV ‘IAC’: DISCRIMINATION TO SOME OR ACCESS TO ALLhttp://www.procaare.org/archive/procaare/200406/msg00035.php
Adirieje, UA. What Progress Made by 'CCMs' Over the Past Two Yearshttp://www.procaare.org/archive/procaare/200405/msg00007.php
Adirieje, UA. Vitamin A and child deaths in India
http://www.essentialdrugs.org/edrug/archive/200204/msg00080.php
Adirieje, UA. Alzheimer’s disease on our shores
Adirieje, UA. Stigma, HIV/AIDS and disclosure (1)
http://archives.healthdev.net/stigma-aids/msg00134.html
Adirieje, UA. Stigma, HIV/AIDS and Disclosure
http://archives.healthdev.net/stigma-aids/msg00154.html
Adirieje, UA. Putting ‘access to all’ on the HIV/AIDS agenda
Adirieje, UA. Putting ‘access to all’ on the HIV/AIDS agenda (2)
Adirieje, UA. HIV and AIDS: Ensuring Access to All
http://archives.healthdev.net/af-aids/msg01451.html
Adirieje, UA. Health Options for Road Safety In Nigeria
http://www.phishare.org/documents/afrihealthoptonet/1865/
Adirieje, UA. Patent Door Opens for Generic ARVs in Africa
http://archives.healthdev.net/af-aids/msg01132.html
Adirieje, UA. Current concerns: Thailand’s potpourri for Nigeria and HIV/AIDS
Adirieje, UA. Malaria in Africa: A Continuing Scourge, a Litany of Failed Targets
http://www.phishare.org/documents/afrihealthoptonet/1817/
Adirieje, UA. Opening up on ‘HIV/AIDS’ (1)
Adirieje, UA. HIV and AIDS: Ensuring Access to All
archives.hst.org.za/af-aids/msg01451.html

PRINTS

Adirieje, UA. Public-Private Partnership and Nigeria’s Development (2), Daily Sun, Vol. 2 No. 392, 15 February 2005, p. 31
Adirieje, UA. Public-Private Partnership and Nigeria’s Development (1), Daily Sun, Vol. 2 No. 387, 8 February 2005, p. 31
Adirieje, UA. Taming ‘HIV/AIDS’ in Our Higher Institutions, Daily Sun, Vol. 2 No. 382, 1 February 2005, p. 29
Adirieje, UA. HIV/AIDS: Why ‘ICASA’ and ‘NACA’ Must Succeed, Daily Sun, Vol. 2 No. 377, 25 January 2005, p. 27
Adirieje, UA. Nigeria’s Traditional Health Care in Africa (3), Daily Sun, Vol. 2 No. 372, 11 January 2005, p. 27
Adirieje, UA. Nigeria’s Traditional Health Care in Africa (2), Daily Sun, Vol. 2 No. 378, 4 January 2005, p. 27
Adirieje, UA. Nigeria’s Traditional Health Care in Africa (1), Daily Sun, Vol. 2 No. 378, 28 December 2004, p. 27
Adirieje, UA. Health and Human Rights, Daily Sun, Vol. 2 No. 378, 21 December 2004, p. 27
Adirieje, UA. Nigeria’s Twin-‘Wahala’ (2), Daily Sun, Vol. 2 No. 378, 14 December 2004, p. 27
Adirieje, UA. Nigeria’s Twin-‘Wahala’ (1), Daily Sun, Vol. 2 No. 387, 7 December 2004, p. 27
Adirieje, UA. HIV/AIDS and African Women, Daily Sun, Vol. 2 No. 382, 30 November 2004, p. 26
Adirieje, UA. Does Mr. President Know? Daily Sun, Vol. 2 No. 377, 23 November 2004, p. 26
Adirieje, UA. Nigeria’s Economic Reforms in Social Context, Daily Sun, Vol. 2 No. 372, 16 November 2004, p. 26
Adirieje, UA. Much Ado About brain Drain, Daily Sun, Vol. 2 No. 367, 9 November 2004, p. 29
Adirieje, UA. Businesses in the Era of HIV/AIDS, Daily Sun, Vol. 2 No. 362, 2 November 2004, p. 26
Adirieje, UA. The Poverty War in Nigeria (2), Daily Sun, Vol. 2 No. 357, 26 October 2004, p. 26
Adirieje, UA. The Poverty War in Nigeria (1), Daily Sun, Vol. 2 No. 352, 19 October 2004, p. 27
Adirieje, UA. Preventable Blindness and National Economic Productivity, Daily Sun, Vol. 2 No. 347, October 12 2004, p. 21
Adirieje, UA. Twelve Blind persons in One Minute, Daily Sun, Vol. 2 No. 342, 5 October 2004, p. 31
Adirieje, UA. HIV/AIDS: Caring as an Obligation (2), Daily Sun, Vol. 2 No. 337, 28 September 2004, p. 2
Adirieje, UA. HIV/AIDS: Caring as an Obligation (1), Daily Sun, Vol. 2 No. 332, 21 September 2004, p. 23
Adirieje, UA. NEPAD: hope or hype? Daily Sun, Vol. 2 No. 327, 14 September 2004, p. 26
Adirieje, UA. NEPAD: hope or hype? Daily Sun, Vol. 2 No. 322, 7 September 2004, p. 26
Adirieje, UA. African Woman’s Rough Road (2), Daily Sun, Vol. 2 No. 307, 17 August 2004, p. 29
Adirieje, UA. African Woman’s Rough Road (1), Daily Sun, Vol. 2 No. 302, 10 August 2004, p. 29
Adirieje, UA. Alzheimer’s Disease on Our Shores, Daily Sun, Vol. 1 No. 297, 3 August 2004, p. 31
Adirieje, UA. Diabetes on the Prowl, Daily Sun, Vol. 2 No. 312, 24 August 2004, p. 22
Adirieje, UA. Putting ‘Access to All’ on the HIV/AIDS Agenda (2), Daily Sun, Vol. 2 No. 282, 13 July 2004, p. 20
Adirieje, UA. Putting ‘Access to All’ on the HIV/AIDS Agenda (1), Daily Sun, Vol. 2 No. 277, 6 July 2004, p. 26
Adirieje, UA. Thailand’s Potpourri for Nigeria and HIV/AIDS, Daily Sun, Vol. 2 No. 272, 29 June 2004, p. 27
Adirieje, UA. Tobacco and the Rest of Us (2), Daily Sun, Vol. 2 No. 267, 22 June 2004, p. 27
Adirieje, UA. Tobacco and the Rest of Us (1), Daily Sun, Vol. 1 No. 262, 15 June 2004, p. 26
Adirieje, UA. The Global Fund and HIV/AIDS Control in Nigeria, Daily Sun, Vol. 1 No. 251, 1 June2004, p. 30
Adirieje, UA. Opening Up on HIV/AIDS (2), Daily Sun, Vol. 1 No. 246, 25 May 2004, p. 26
Adirieje, UA. Opening Up on HIV/AIDS (1), Daily Sun, Vol. 1 No. 241, 18 May 2004, p. 26
Adirieje, UA. Health Attitudes and Road Traffic Problems, Daily Sun, Vol. 1 No. 226, 27 April 2004, p. 28
Adirieje, UA. Seeds for Nigeria’s Health Needs, Daily Sun, Vol. 1 No. 221, 20 April 2004, p. 28
Adirieje, UA. HIV/AIDS and the Abuja Declaration. Medical Digest: July/August 2001, pp. 9-10
Adirieje, UA. Averting a Water Crisis in Nigeria. Medical Digest: March/April 2001, pp. 26-27
Adirieje, UA. A visit to Alma-Ata. Medical Digest: January/February 2001, pp. 18-20
Adirieje, UA. Female Circumcision (Female Genital Mutilation): 40 Dangerous Effects Parents and Relations Must Know. Afrihealth Information Projects, 1999 (catalogued at the Media/Materials Clearinghouse of the Johns Hopkins University, USA, for worldwide distribution, as M/MC ID#: PL NGA 318)
Adirieje, UA. Nutrition for All Ages - A Pocket Guide. Optonet International, 1999 (catalogued at the Media/Materials Clearinghouse of the Johns Hopkins University, USA, for worldwide distribution, as M/MC ID#: PL NGA 398)
Adirieje, UA. Eye Care and Vitamin A Deficiency Prevention in Egbe, Lagos State. Sight and Life Newsletter 4/1999, pp.18-19.
Adirieje, UA. Sanya Primary School Nutritional Blindness Prevention Project. Sight and Life Newsletter, 3/1998, pp. 11-12
Adirieje, UA. Approaches to Reduce Vitamin A Deficiency in Lagos State, Nigeria. SCN News No. 15, United Nations ACC/SCN, 1997, pp. 29-30.
Adirieje, UA. Evidence of Vitamin A Deficiency within Community Populations in Lagos State of Nigeria. Sight and Life Newsletter 1/1997, Task Force Sight and Life, 1997, pp. 18-19.
Adirieje, UA. Anti-leprosy Vaccines. The Guardian Newspaper, Lagos, 1 August 1996.

CONFERENCES AND WORKSHOPS ATTENDED

2006 – National Health Conference (NHC2006), Nigeria; 28-29 November
2006 – The African Human Resource and Health System Challenges: initiating action and sustaining change [Planning workshop for African CSOs and Regional Economic Communities], Akure, Nigeria, 3-5 August
2006 – National Dialogue on the Revitalisation of Immunization services in Nigeria, National Programme on Immunisation, Abuja, 31 July
2005 - Panellist, at the Inaugural Consultative Meeting of the African Women’s Health Initiative (AWHI), USA/Nigeria; Nicon Hilton Hotel, Abuja, Nigeria; 11-13 January 2005
2003 XIII International Conference on AIDS and STIs in Africa (ICASA), Nairobi, Kenya
2003 Building Key Elements of Effective Governance for HIV/AIDS (UNDP), Nairobi, Kenya
2003 West Africa HIV/AIDS Research Symposium (Harvard School of Public Health), Nairobi, Kenya
2003 Accelerating Implementation of National HIV/AIDS Programs: Lessons learnt from the Multi-country AIDS Programme (World Bank), Nairobi, Kenya
2003 Broadening HIV/AIDS Communication Strategies: moving from messages to dialogue (UNICEF), Nairobi, Kenya
2003 HIV Infected Children Care in Africa, Nairobi, Kenya
2003 From Rhetoric to Action: turning UNGASS to Action (UNICEF), Nairobi, Kenya
2003 Human Capacity Development for an Effective Response to HIV/AIDS (USAID), Nairobi, Kenya
2003 National Conference of NGOs working on Female Genital Mutilation (FGM) in Nigeria (Federal Ministry of Health), Abuja, Nigeria
2002 23rd ISODARCO (International School on Disarmament and Research on Conflicts) Summer School on "Cyberwar, Netwar and the Revolution in Military Affairs: Real Threats and Virtual Myths", Trento, Italy
2001 National Workshop on Female Genital Mutilation, Lagos, Nigeria; Federal Ministry of Health/World Health Organisation (WHO)

PAPERS PRESENTED
2005 ‘Controlling HIV/AIDS Among Mobile Populations in Lagos’ – an oral presentation made at the 14th International Conference on AIDS and STIs in Africa, Abuja, 4-9 December 2005

2005 ‘The State of Women’s Health and Lives in Nigeria: The Imperative of Complementary Traditional Health Care’ - a position/advocacy paper presented at the Inaugural Consultative Meeting of the African Women’s Health Initiative (AWHI), USA/Nigeria; Nicon Hilton Hotel, Abuja, Nigeria; 11-13 January 2005

2004 ‘Controlling HIV/AIDS within the community’ – an enlightenment/advocacy speech delivered at an HIV/AIDS control campaign for the predominantly Muslim Arewa Community, Isolo, organized jointly by Afrihealth Optonet Association and Arewa Joint Action Committee (AJACOM), at the Isolo central Mosque, Lagos;

2003 ‘Education and the Challenge of Regeneration in Orsu Local Government Area’ The inaugural guest lecture at the 2nd ‘Orsu Summit’ held at Orsu Local Government Area (LGA) headquarters, Awo-Idemili, Imo State, Nigeria, 30 December 2003

2001 ‘The Child and the Home’ -a guest speech delivered at the annual general meeting of Parent Teachers Association of Sunshine Nursery/Primary School, Aguda-Surulere, Lagos, 17 November 2001

2001 ‘Philanthropy as a Poverty Alleviation and Development Initiative in Orsu Local Government Area’ – an advocacy paper delivered at the launching of a N2.5million naira Endowment Fund for the Less-privileged, by the Ede-Ukwu Welfare Association, Ajegunle, Lagos, 11 November 2001

2000 ‘Vitamin A as Soldiers of the Human Body’ -a guest speech delivered at the launching of the Vitamin A for Health programme of the Prosuzet Nutrition Foundation, Bariga-Lagos

PROFESSIONAL AND COMMUNITY SERVICE ACTIVITIES (INCLUDING BOARD APPOINTMENTS)

A. Professional Activities

2007-present Business Matters Coordinator, African Network of Professionals (ANoP)

2007-present Editorial Board member, Journal of Infections in Developing Countries (JIDC)

2006-present Publications Reviewer, The Lancet, London

2006-present Member, Advisory Board, AIDS-Care Watch (ACW) http://aidscarewatch.blogspot.com/2006/02/2006-acw-advisory-board.html

2004-present Proposals reviewer, Alzheimers Association, USA

2003-present Key Correspondent, Health and Development Networks (HDN)

2003 One of the 31 “leading African health professionals” who, along with 63 American colleagues, wrote a letter to US President George Bush, urging him to take specific steps to combat the global HIV/AIDS pandemic, suggesting ways in which the United States can help support them in their efforts to address monumental needs created by the AIDS crisis

2003 On-site Reporter, 13th International Conference on HIV/AIDS and STDs in Africa (ICASA) 2003, Nairobi, Kenya; 21st-26th Sept; Health and Development Networks (HDN), Ireland and Thailand

1995-1996 National Publicity Secretary, Nigeria Optometric Association

1993-1994 Secretary, Save Our Sight (S.O.S.) Project; Rotary International District 9110

B. Experience working with/for Federal government, Development Partners and Several Stakeholders:

2007 Represented HERFON in the following committees of the Federal Ministry of Health (FMoH):
i. Meeting of Experts on Health Trust Fund
ii. Committee on Rapid Assessment of the Nigerian Health System
iii. Nigeria’s GAVI-HSS Proposal Production Committee
iv. Technical Committee for the preparation of the Framework for National Health Investment Promotion [NHIP]

2006-present Member (representing HERFON), Nigerian Health Systems Forum; comprising DFID, WHO, UNICEF, CIDA, HERFON, FMoH, ENHANSE-USAID, PATHS

2006-2007 Member (representing HERFON), National Planning Committee, 50th National Council on Health (NCH), Abuja

2006 Secretary, National Steering Committee, and Head of Conference Secretariat, Nigeria National Health Conference (NHC2006); comprising the Senate and House of Representatives, DFID, WHO, UNICEF, CIDA, HERFON, FMoH, ENHANSE-USAID, PATHS, Delegation of European Commission, Nigerian Medical Association (NMA), Pharmaceutical Society of Nigeria (PSN), National President, National Association of Nigeria Nurses and Midwives (NANNM), National Association of Community Health Practitioners (NACHP), National Economic Summit Group, Health and Managed Care Association of Nigeria (HMCAN), Committee of Chief Medical Directors of Federal Teaching and Tertiary Hospitals, Association of General and private Medical Practitioners of Nigeria (AGPMPN), Advocacy Nigeria, Christian Association of Nigeria (CAN), Nigerian Supreme Council for Islamic Affairs (NSCIA), National Council of Women Societies (NCWS).

2006 Member (representing HERFON), National Planning Committee, World Health Day 2006, FMoH, Abuja, Nigeria

2005 Secretary, International Steering Committee , 14th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA 2005), Nigeria

2005 Secretary, National Scientific Committee, ICASA 2005, Nigeria

2004-2005 Member, Communication and Mobilisation sub-committee, National Task Force on ICASA 2005

C. Experience working with/for State government(s):

2005-present President-General, Imo State Towns Development Association Lagos
2002-2004 First Vice President, Imo State Towns Development Association Lagos
1999-2001 Secretary, Scholarship Board, Imo State Towns Development Association, Lagos
1999-2001 Secretary General, Igbo States Development Union Lagos (comprising Abia, Anambra, Ebonyi, Enugu and Imo States)
1999-2001 Secretary General, Imo State Towns Development Association Lagos
1988-1989 Chairman, State Immunization Days Planning Committee, Takum Local Government, Gongola State (now Taraba State)

D. Experience working with/for Local Governments:

1995-1997 General Secretary, Orsu LGA Towns Development Union Lagos

1996 Chairman, Constitution Drafting Committee, Orsu LGA Towns Development Union Lagos

1997 Chairman, Planning/Organising Committee for the Launching of the Orsu LGA Towns Development Union Lagos

1998 Chairman, Orsu Cultural Day Celebrations Committee;

1999-2000 Chairman/Editor in Chief, Orsu LGA Directory and ‘who is who’

E. Experience working with/for local NGO sector and other private
institutions:

2006-present President, ISTDA Cooperative, Thrift and Credit Society Ltd, Lagos

2005 Guest speaker, at the Inaugural Consultative Meeting of the African Women’s Health Initiative (AWHI), USA/Nigeria, Abuja, Nigeria; 11-13 January 2005

2004-present Chairman, Board of Trustees, Future-Hope Community Project, Orsu LGA, Imo State

2004 Facilitator/Guest Speaker, HIV/AIDS Prevention Workshop for the predominantly Muslim Arewa Community, Isolo, organized jointly by Afrihealth Optonet Association and Arewa Joint Action Committee (AJACOM), at the Isolo central Mosque, Lagos

2001 Chairman, Annual Convocation and Prize Giving Day Ceremony, Sunshine Nursery and Primary School Aguda, Surulere

2000 Guest Speaker at the inaugural/maiden Nutritional Blindness and Vitamin A Deficiency of the Prosuzet Food and Nutrition Centre, Lagos, 16 December 2000.

1995-present Trustee/Secretary General, Afrihealth Optonet Association (a national NGO incorporated in the Federal Republic of Nigeria)

F. Community Service Activities:

2005-present Secretary, Amaruru Council of Chiefs

1992-1995 Secretary, Amaruru Development Union, Lagos Branch

1990-1993 Secretary, Ebenasaa-Amaruru Prograssive Union, Lagos Branch

1988-89 Founding President, Rotaract Club of Takum (CB), Gongola State

1985-1986 Secretary General, Students Union Government, Imo State University, Nigeria

2004-present Columnist [‘Current Concerns’ - writes on HIV/AIDS, Health and Development], Daily Sun Newspaper, , Nigeria www.sunnewsonline.com

2000-present, Principal Consultant/CEO, Afrihealth Information Projects (Projects/Programs Consultants)

2003-present, Programs Director/Secretary General, Afrihealth Optonet Association (inc. - national NGO)

2002-present Active member/participant in the following internet discussion forums on HIV/AIDS: af-aids, icasa2005forum, sea-aids, stigma-aids, procaare, eforum, hnn-aids, hnn-chat, community-research

2001-present Member, Editorial Panel, Health Information Forum/WHO; HIF-net-at-WHO, UK

2004-present Member, Communication and Mobilisation sub-committee, National Task Force on the 14th International Conference on AIDS and Sexually Transmitted Infections in Africa (ICASA) 2005

2004-present Chairman, Board of Trustees, Future-Hope Community Project, Orsu LGA, Imo State

1999-present Chairman, Health and Environment Committee, Amaruru (Autonomous community) Development Union, Orsu LGA, Imo State

2003-2005 e-Forum Moderator/Founder, ICASA 2005 email forum [http://groups.yahoo.com/group/icasa2005forum]
EXPERTISE, SKILLS AND COMPETENCES

i. Program/Projects Management, Health Systems Appraisal (M & E), Health/Development Change Management, Private-Sector Engagement, Research, Policy Analysis, Mobilization/Advocacy, Columnist & Community Leadership
ii. Ability to work in a pressure environment and collaborate/communicate with international organisations and local/relevant stakeholders even in
iii. Strong leadership and interpersonal skills, motivation and capacity to work/act with tact and diplomacy in a multi-sectoral/multi-stakeholder project and working with bureaucracy and some State government(s)
iv. Documented/demonstrated good knowledge of the HIV/AIDS epidemic, determinants, impact and technical issues related to care, prevention and access
v. Managerial, organisational, networking and excellent writing/reporting skills
vi. Strong capacity for advocacy and special interest in advancing policy-oriented agenda especially for HIV/AIDS, health and development
vii. Commitment to integrity, hard work, loyalty and respect for diversity
viii. A motivational speaker and team player, with strong ability to communicate, empower people and manage relationships
ix. Excellent capacity for result-oriented strategic thinking and analyses
x. Very extensive experience travelling to, and working with rural and poor urban population/community, with a strong desire/ability to continue to do so
xi. Experience in working in challenging multiethnic environments, adaptability and sensitivity to varying cultures, religious, political and economic issues
xii. Excellent ability to communicate in written and spoken English
xiii. Capacity to deal with conflicting priorities and deliver high quality work on schedule
xiv. Passionate, enthusiastic and strongly motivated to work towards addressing the response to HIV/AIDS in Nigeria and Africa

PROFESSIONAL MEMBERSHIPS

i. Member, International AIDS Economics Network http://www.iaen.org/pronet/index.php?view=detail&id=15113
ii. Full Member, International Ocular HIV Study Group, U.S.A.
iii. Member, Academy for Health Services Research and Health Policy, U.S.A.
iv. Member, Nigeria Optometric Association {MNOA}
v. Member, American Academy of Optometry (AAO), U.S.A.
vi. Member, American Diabetes Association (ADA), U.S.A.
vii. Full Member, Alliance for the Prudent Use of Antibiotics (APUA), U.S.A
viii. Full Member, The International Society for Low-vision Research and Rehabilitation (ISLRR), U.S.A.
ix. Life Member, Nigeria-Britain Association
x. Member, Afrihealth Optonet Association (AOA), Nigeria
xi. Full Member, Nigerian Institute of International Affairs (NIIA)
xii. Member, Nigeria Institute of Management {MNIM}
xiii. Associate, Institute of Personnel Management of Nigeria {AIPM}
xiv. Member, The Impact Alliance http://www.impactalliance.org/ev.php?ID=8055_201&ID2=DO_TOPIC

HOBBIES

Social/Community Work, Public Speaking, Writing, Computing, Tennis, Voluntary/International Services
BIOGRAPHIES
2006 Great Minds of the 21st Century, by American Biographical Institute (ABI)
2006 Igbo Icons, Nigeria
2005 Who is Who in Igboland
2004 Orsu LGA Directory and Who’s Who

AWARDS RECEIVED

2007 International Health Professional of the Year, by International Biographical Centre, Cambridge, England
2005 Man of Achievement Award, by American Biographical Institute (ABI)
2005 Youth of the Year, by Amaruru Youth Forum, Orsu LGA, Imo State
2005 Honourary chieftaincy title of Ahaejiejemba Amaruru, jointly conferred by His Royal Highness, Eze WO Igwe, Ozuo-omee 1 (traditional ruler of Amaruru), the Eze-In-Council of Amaruru autonomous community, and the Amaruru Development Union, Orsu LGA, Imo State, Nigeria
2004 Great Mind of the 21st Century, by American Biographical Institute (ABI)
2003 National Patron, Federation of Orsu LGA Students Association (FOSA)
2002 Patron, Federation of Orsu LGA Students Association (FOSA), University of Nigeria, Nsukka
2001 Service Award, Imo State Towns Development Association (ISTDA) Lagos
1999 Honourary member, Police Community Relations Committee (PCRC),
Orsu Local Government Area
1998 Merit Award; Orsu L.G.A. Towns Development Union Lagos
1997 Merit Award in Community Eye Care, Iganmu and the Council of Chiefs, Lagos
1996 Rotary International Presidential Recognition for Membership Growth, 1995/96
1994 Life Member, Nigeria-Britain Association
1994 Rotary International District 9110 Governor’s Distinguished Service Award, 1993/94

AN ADDRESS PRESENTED BY DR. [CHIEF] UZO’ ADIRIEJE, MNIM, ACIPM (Ahaejiejemba of Amaruru) – 5TH PRESIDENT GENERAL, IMO STATE TOWNS DEVELOPMENT ASSOCIAT

2008-01-30T05:47:00.000-08:00

AN ADDRESS PRESENTED BY DR. [CHIEF] UZO’ ADIRIEJE, MNIM, ACIPM (Ahaejiejemba of Amaruru) – 5TH PRESIDENT GENERAL, IMO STATE TOWNS DEVELOPMENT ASSOCIATION LAGOS (ISTDAL); DURING THE SWEARING-IN OF ISTDAL’S 6TH PRESIDENT GENERAL AND EXECUTIVE COMMITTEE ON 27 JANUARY 2008

[Protocols]

WELCOME

I am immensely delighted to welcome and address you all at this historic occasion. And it is in that light that I congratulate our brand new President General Mazi Tony Ohakwe and his rejuvenated Executive Committee members, about 90 percent of who also served with me – and indeed virtually ran the Association during my tenure.

HOW IT ALL BEGAN

I became a representative of Amaruru Development Union in ISTDAL in May 1996. My tenure as ISTDAL President General officially ended today, 27 January; and I recall that my tenure as Secretary General of ISDTAL also ended on 27 January (2002).

Three years ago this Sunday, I was inducted as the leader of this great Association, along with my Executive members. On that day, our administration gallantly embraced all the assets and liabilities of our predecessor since governance is a continuous exercise, and undertook to harness all the human and material resources possibly available, to provide a compass of development for our members and the large population of Imo people in Lagos and Diaspora. We chose not to cry over any spilt milk, but to focus/concentrate on whatever we could do to improve on what we met on the ground and it paid off.

ON THE MARBLE AND SANDS OF TIME

The following itemize some of our accomplishments within our 3-years tenure:
1. Developed Vision, Mission Statement and core Values for the Association
2. Paid all the debts inherited from our predecessor
3. Awarded the Association’s scholarships to indigenes of Imo State in secondary and tertiary institutions, for the first time in our history (2005 and 2007)
4. Secured financial/material support and empowerment to seventy-two [72] ‘poorest of the poor’ women of Imo state origin, through the provision of sewing machines, grinding machines, clothes, coolers, cash and other valuable household goods that enabled them to start petty businesses of their own, and became job givers instead of job seekers (2005). We acknowledge the support received from Eze Hyacinth Ohazulike, OON, Eze Ndigbo of Lagos State in this regard.
5. Elected Trustees and formally incorporated ISTDAL as a legal entity in perpetuity in the Federal Republic of Nigeria. We are currently awaiting our certificate of incorporation from the Corporate Affairs Commission, Abuja (2006-2007)
6. Established the Istda Cooperative, Thrift & Credit Society Ltd which has been registered by the Lagos State Government, and was formally inaugurated by the last Executive Governor of Lagos State, His Excellency Senator Bola Tinubu. ‘Istda Coop’ currently has fifty-two registered members comprising individuals and town unions (2006)
7. Secured more than one dozen luxurious buses from the Imo State government, to convey ISTDAL members and Imo people in Lagos, to and from Imo state during the 2007 Christmas and new year celebrations
8. Produced a six-page spiral-bound all colour calendar (2007)
9. Organised three cultural carnivals/Imo day (2005, 2006 and 2007); the last of which was used to organize a befitting grand civic reception for the Governor of Imo State, His Excellency Chief Ikedi Ohakim (Ochinanwata)
10. Organized a press conference in Owerri, on ‘Progress Report and State of Affairs’ in Imo State (2007)
11. Improved the Association’s relationship with the governments of Imo state, and supported the government’s participation in major activities in Lagos including the international trade fairs
12. Sponsored some members of the Executive Committee to a leadership training/capacity building programme in Otta (2006)
13. Set up a committee to review our constitution which report has been received and is handed over to the new administration for subsequent discussions before adoption by the general meeting
14. Provided a crisis-free environment for the conduct of the Association’s meetings and other activities all years-round
15. Organized joint meetings with our Grand Patrons, Patrons and leaders of member-town Unions
16. Produced annual reports of the Association’s activities (2005 and 2006) for the first time in its history. The 2007 annual report is already being concluded
17. Produced annual financial statements of the Association’s (2005 and 2006) for the first time in its history. The 2007 financial statement is already being prepared
18. Participated in the activities of other Igbo groups in Lagos
19. Set up an audit committee whose report is still being expected
20. Conducted what is arguably the most peaceful election in the history of ISTDAL, where all the candidates emerged by consensus without a single voting done
21. Published ISTDAL’s magazine, the Searchlight

Your Excellency, today also marks the end of the transition period which commenced with the election of a new Executive Committee in September 2007.

YOU MADE IT POSSIBLE

As I step out and march forward/ahead, I must not fail to acknowledge and thank some of the persons and institutions who have contributed in the form of support, encouragement, criticisms and or even outright opposition, which have all made it possible for us to accomplish the above under my leadership. Indeed, when harnessed well, the opposition is one of the greatest assets a leader may have. It is in the opposition that great leaders find growth, while their comfort lies in their supporters.

‘Gidi gidi bu ugwu Eze’, so says the Igbo adage. Grant me your indulgence to convey my appreciations and that of my family and friends and well-wishers, to some of the persons and institutions – in no particular order - who contributed to the successes recorded in the course of my tenure.

I am grateful to my Governor, His Excellency Chief Sir Ikedi Ohakim (Ochinanwata) and Her Excellency Chief Mrs. Ohakim, for all the kindness they showed and good things they did for this Association, and the greater things they continue to do in Imo State; to His Excellency Chief Achike Udenwa (Onwa), who most kindly inaugurated me as leader of this Association on 23 January 2005. I am immensely encouraged by the support received from my ‘Big brother’ and Governor’s Special Adviser and Liaison Officer, High Chief Bonny Ebili (Odokara omee) – the one who made things to happen – for being a pillar of support and our strongest bridge to Government House and our governor’s heart. I appreciate his predecessors – Sir George Egu, Mr. Alfred Uzoaru and Mr. Charles Osigwelem, and other members of the Lagos liaison office. I appreciate the immense supporting team that High Chief Ebili recruited for me in the governor’s office and Abuja. In particular, may I request you sir, to convey my appreciation to Chief Elvis Agukwe, Governor’s Special Adviser/liaison officer Abuja, Chief Ethelbert Okere, Executive Assistant to the Governor on Public Affairs, Louisa Aguiyi-Ironsi, Special Adviser on Communications and Barrister A.C. Otuokere, Director of protocols, for their help and considerations. I thank my predecessors in office – Chief Barrister L.C. Anucha (Akuruo Ulo 1 of Uvuru) and Chief Barrister George Nnamdi Umunnakwe for their contributions to the growth of this Association and in particular for their contributions to the successes recorded during my tenure.

Thank you very much, members of the ISTDAL Executive Committee who always held forth, officers of our women wing, representatives of member-Town Unions, our Life Patrons, Grand Patrons and Patrons; and Chairmen and Secretaries of the member-Town Unions, including their women wings. Permit me to single out for appreciation, the tremendous support received from Grand Patrons Eze Hyacinth Ohazurike, OON, Eze Mkpume, Eze Ndigbo of Lagos State; Chief (Dr.) M.I. Okoro (Ohia Ndigbo), Chief A.E. Anozie (Oduenyi of Imenyi) and Chief Dr. Sam Opara.

‘Oku ahunyere nwata n’aka a naghi eregbu ya’. I am very thankful to the leadership of my local government Orsu and community Amaruru for standing solidly by me during my tenure: the former Chairman of Orsu LGA Chief Charles Okeke (Odiukonamba) who sent a representative during my inauguration, my traditional ruler His Royal Highness Eze W.O. Igwe, Ozuo omee I of Amaruru, President General of Amaruru Development Union Chief Okpara D. Okpara (Omereoha) and members of the Amaruru Council of Chiefs and Ndi Ichie, for the chieftaincy title conferred on me, for traversing the length of the East and West of this country to witness my inauguration, and for blessing me, in 2005.

But could this have been possible without a Lagos base? Not at all! Which is why I am grateful to the Chairman of Amaruru Development Union (ADU) Lagos Branch - Mr. Vincent Dimanozie and his executive members; former Chairmen of the branch including Chief Ezeifeadigo F.E. Ezeh who sent me to ISTDAL, late Nze Jason Okpara and Mr. Okechukwu Ogbuehi, and indeed all Amaruru sons and daughters and friends, for taking pride in my responsibilities and accomplishments. I am indebted to my friend and brother, Honourable Chief Dr. Geff Chizee Ojinika (Emezioha) - former member of the Federal House of Representatives and his amiable wife Chief Mrs. Comfort Ojinika for their incredible support during this period.

Oh! I am forever thankful to God for his grace during this period and always, for my wife and best friend Chief Mrs. Edith UzoAdirieje (Eziadaukwu) and our children, and for all the resources, strength and spirit which enabled them to cope with the lonesomeness that the exigencies of my service period brought upon them. My darling wife and jewel of inestimable value, I thank and love you.

Your Excellencies, ladies and gentlemen, ndibe anyi si na onye amaghi ebe mmiri bidoro maa ya, a naghi ama ebe okwusiri a. One great man ‘brought’ me to Lagos in 1990, and encouraged me to enroll and participate in my town union, from whence I was sent to ISTDAL. His name is Chief Eddor E.C. Dimanozie (Onyechimere eze). Unfortunately, he did not live to see me become the leader of this Association. I want to continue to thank and appreciate him. In his honour, my wife and I have instituted an annual award in ISTDAL - the Chief Eddor E.C. Dimanozie prize for the Best Overall Performing Town Union in ISTDAL, at a value of N20, 000.00 (Twenty Thousand naira only) yearly. This award shall be presented during every Imo Carnival and it is my wish that the ceremony brochures will reflect it accordingly. Mr. President General Sir, here is a first cheque for N60, 000.00 (sixty thousand naira only) to cover this award during your first tenure/three years in office. You are at liberty to set out any modalities for choosing the winner(s).

FOR THOSE WHO HAVE GONE

Across the length and breath of this country, we lost some of our representatives, patrons, town union leaders, relations, friends and statesmen during this period. In their honour, may I request you to observe a minute silence…. May their souls rest in perfect peace! Amen.

Long live ISTDAL
Long live Imo State
Long live Federal Republic of Nigeria

Thank you and God bless you all. Good bye!

Uzo’ Adirieje
President General, 23 Jan. 2005 – 27 Jan 2008
1st Vice President, 27 Jan. 2002 – 23 Jan. 2005
Secretary General, Jan. 1999 – 27 Jan. 2002
Mob: 0803 472 5905
Email: ahaejiejemba_amaruru@yahoo.com
Blog: http://uzodinma-adirieje.blogspot.com/
Mails: P.O. Box 8880, Wuse Abuja (from 1 February 2008)

Re: 13th ICASA: We want more access to care but what care? (13)

2007-06-02T08:15:00.000-07:00

-Uzodinma Adirieje, Nigeria
***********************************
The twin issues of access to care for HIV/AIDS and what manner of care,
deserve the very serious attention we all paying to it on this forum. When
we demand more access to care, much advocacy is focused on ARVs. For more
than two decades now, the HIV/AIDS pandemic has consistently been
devastating and decimating various populations the world over, with
effects that can best be described in only superlative terms, on
Sub-Saharan Africa.
It is no longer news that out of a total of 40 million people with
HIV/AIDS worldwide, about 70% live in Sub-Saharan Africa. Whereas the
international community remains preoccupied with the public/business
relations of ARVs as the most trumpeted measure to manage/prevent
HIV/AIDS, about 90 percent of people living with the disease do not have
access to anti-retroviral therapies. The need for more holistic approach
to care for people with HIV/AIDS therefore can never be emphasised, in
order to have a more effective impact on the anti-AIDS war.
In order to ensure more access care, the fundamental elements of any
effective response to HIV care should be embedded in a ‘code of conduct
for HIV/AIDS care’, which must be humane in its approach, universal in its
application, adaptable in every circumstance and affordable to the patient
community.
To accomplish this, countries and states must live up to their UNGASS
undertakings to ensure that “by 2003 (that is before the end of this
year), national strategies would have been developed in close
collaboration with the international community, civil society and the
business sector to increase substantially the availability of
antiretroviral drugs and of essential drugs (and services), for the
treatment (and care) of HIV infection and opportunistic infections, by
addressing factors affecting the provision of these drugs, including
technical and system capacity, pricing,including differential pricing and
by examining alternatives for increasing access and affordability of
HIV/AIDS related drugs (and services)”.
Do we need to collectively redefine the concept of ‘care’ to include such
things as essential needs (such as food, water), primary care, prevention
and management of other opportunistic infections, nutrition, emotional
support, and care delivery strategies?
Whether collectively and/or individually, this must be done and can indeed
be accomplished with the context of the UNGASS undertakings mentioned
above. This writer is particularly advocating that the provisions in the
above undertakings relating to ensuring ‘technical and system capacity,
differential pricing and alternatives’ provide the functional fulcrum for
a most sincere and effective approach to AIDS care and cure.
This will also ensure that the UNGASS 2005 target of making significant
progress in implementing comprehensive HIN/AIDS care strategies will be
accomplished, by strengthening community based health care and health care
systems and infrastructure to provide and monitor treatment and care to
people living with HIV/AIDS, support individuals, households, families and
communities affected by HIV/AIDS, and improve the capacity of health care
personnel, supply systems, financing plans and referral mechanisms
required to provide access to affordable medicines and quality medical,
palliative and psycho-social care for PLWAs.
The unfortunate relationship between HIV/AIDS and malnutrition is already
known and acknowledged. Malnutrition increases the progression of HIV
infection while HIV/AIDS aggravates malnutrition by weakening the immune
system through its various negative impacts on the patients’ food intake,
digestion, absorption and utilisation.
Provision and adequate consumption of the right kinds and quantities of
foods certainly improve fitness and quality of life of PLWAs and those
already infected with the HIV virus. Availability of sufficient and proper
foods and a balance of different foods would help to maintain body weight
and muscles and maintain and improve the performance of the immune system,
thus reducing the impacts of many of the symptoms of HIV/AIDS.
To fully utilize and benefits from the nutritional management angle to
HIV/AIDS care, we must improve our understanding and knowledge of the
interrelationship between nutrition and the disease, including the
possibilities and limitations of nutritional care and support for people
with HIV, the skills and techniques to apply innovative and programmatic
approaches in designing programmes that would implement and communicate
information on nutritional care and support to people with HIV, their care
givers, health workers and others, as well as provide the motivation to
strengthen existing services and initiate new approaches to improve
nutritional care and support for people with HIV, with full involvement of
the target groups.
In broad terms therefore, it could be said that nutritional care for
HIV/AIDS should necessarily include considerations for such factors like
HIV disease progression and implications for immunity and nutritional
status, HIV related complications like diarrhoea, weight loss, loss of
appetite, etc., the role of anti-oxidants and other micronutrients in HIV,
support for children with HIV, food security, food safety and hygiene It
would also include nutrition education, communication and counselling for
PLWAs, implementation and integration of well-thought-out nutritional care
and support in programmes/ policies, which must take into consideration
all necessary practical work on translation and dissemination of
guidelines into culturally specific recommendations, preparation of
recipes and nutrition education.
Do we really only want access to ARVs?
NO, is the shortest answer to this question. We want better care that goes
far beyond just access to ARVs. At the risk of any repetitions, PLWAs need
access to ARVs, proper medical, psychological and social care, nutrition,
qualitative home and community care including administration of other
essential drugs, certain roles to be played by themselves especially a
better understanding of PWA therapeutic routes, capacity development and
or improvement of HIV/AIDS and othe related community based organizations
and improved positive perception of home and community based palliative
care by health workers and HIV/AIDS carers.
The ‘code of conduct for HIV/AIDS care’ proposed here is intended to be an
adaptable model of care with details and operating procedures set out and
approved; including the need to care for the caregivers, considering that
most of the caregivers in many countries are elder persons due to the lost
generation in between them and their grandchild, especially in Africa.
Although access to medications for treatment of HIV/AIDS-related
conditions is increasing, and indeed targets have been set for national
strategies to ensure that therapeutic, psychosocial and palliative care is
available in some countries in Africa, the dearth of infrastructure for
implementing such strategies is another problem. Efforts are needed to
ensure adherence to the drugs prescriptions, support people through
emotionally trying times, promote disclosure, and provide informed
home-and-community based care especially in resource-poor settings. It is
important in such settings to try and have health worker/personnel who
have experience with treating HIV-positive patients, could prescribe
HAART/ARVs in clinically justified ways, provided voluntary counselling
and testing counselling (VCT) perform HIV-testing or tests for CD4-counts
and/or viral load.
How do we advocate for complicated therapies and essential needs
simultaneously?
The idea is to ensure effective care programme mobilization, service
delivery planning/implementation, commitment and preparedness, and the
availability of support, maintenance, expansion and service.
According to UNGASS declaration, countries should have developed national
policies on creating a supportive environment for children affected by
HIV/AIDS by 2003. The ‘code of conduct for HIV/AIDS care’ proposed here
would include means and measures to identify/establish and utilize carers
and potential carers who can provide the complicated therapies and/or
essential needs, if given help; those that have limited HIV/AIDS
management experience such as ARVs and PMTCT, and whose services can be
expanded to include complicated therapies and essential needs
simultaneously such as follow-up for people on ARVs who have begun
treatment elsewhere; those who have already made arrangements to provide
complicated therapies and essential needs simultaneously and who only need
to be provided with the resources to start their implementation, including
those who have already started this wider pattern of treatment within the
past 12 months; and those who have enough experience in providing
simultaneous complicated therapies and essential needs for HIV/AIDS, and
are sufficiently organized to be able to help others mentioned above, to
move in the same direction as prescribed by the proposed ‘code of conduct
for HIV/AIDS care’.
The issue about schooling for HIV positive children and the role of
teachers and education/teaching authorities are particularly important
here, so that what happened to little Miss Rachel Obetan (aged 2 years),
who was expelled by the authorities of Fabio Nursery and Primary School,
Agboju in Amuwo Odofin Local Government Area, Lagos on July 23, 2002, on
account of her (Baby Obetan’s) mother’s self-declared HIV positive status
would be avoided.
The norm must be integration of services for the benefit of PLWAs. For not
withstanding that non-integrative/vertically managed unilateral HIV/AIDS
services that are less effective and hard to sustain, integration among
services for HIV/AIDS related social, psychological and health problems
will lead to more holistic, efficient and successful provision of
simultaneous complicated care.
In this regard, the need for training, re-training, and more training,
back-up support and supervision especially as regards management of
HIV/AIDS complications and side effects, referrals, availability of
effective drugs and VCT at the community level, compliance to treatment
guidelines according to the recommended by the proposed ‘code of conduct
for HIV/AIDS care’ as approved by the relevant health authority(ies),
including motivation, reward/punishment and compensation for 'volunteers'
and caregivers, cannot be overemphasized.
Given the short supply of resources how can care be provided?
The health, psychological, physical and social complexities of HIV/AIDS,
coupled with attendant emotional and economic consequences of the disease,
create an imperative for very careful and systematic coordination between
primary, secondary, tertiary care and all other levels of care for the
disease.
Efforts at recruiting and training volunteers and family members to
provide home and community based care (HCBC), must be provided for in the
proposed ‘code of conduct for HIV/AIDS care’, adapted to the local
environment,and intensively prosecuted. This writer is not advocating for
a so-called ‘unified national/international care policy/programme
implementation for HIV/AIDS, but for the evolution of an adaptable and
minimally affordable care pattern, which ensures coordination of major
sectors/players at the various levels, with a gender perspective and
respect for human rights, particularly to ensure equal rights and
opportunities for people living with HIV/AIDS (PLWA).
It is agreeable that individuals will seek to learn their HIV status where
care and treatment are available. Therefore, the fight against HIV/AIDS
includes providing care and treatment, both for humanitarian reasons and
because providing care enhances prevention efforts through increasing use
of voluntary counseling and testing. Care and treatment interventions help
to stabilize or improve the physical or mental health of individuals
infected or affected by HIV/AIDS and reduce the burden on their families,
and provide hope to those who have or fear they may have HIV/AIDS, remove
the stigmatization associated with the disease, and prevent secondary
epidemics of TB and other complications.
This does not necessarily need to transit into new buildings and other
large equipments and infrastructure. However, the provision of private
space for counselling is essential inpatient care and laboratory services,
and for VCT to be acceptable, although this has not always been provided
in healthcare.Also, the potential for patients to help one another and/or
become involved in the development and running of services tailored
towards them, for example by giving suggestions on how services can be
improved, must be explored. These may include the provision and/or
modifications of equipments that may be needed for home care of patients
such as wheelchair, incontinence supplies, syringe driver and modification
Hand rails, Widening doors, Raised toilet seat, Bath aids, Bed elevator,
Stair lift, etc. Caring for these patients should also include thoughts
and care for those who are about to die, whose illnesses are at their
terminal points. This is more so because, although most patients wish to
die at home, barely a quarter manages to do so.
Who is providing the care in your community/country…?
Because of the complicated nature of HIV/AIDS, the need for more holistic
approach to its care and the paucity of formal care for PLWAs, it can be
safely said that all sorts of persons and groups provide care in Nigeria.
Depending on patients' stage of the disease and his/her particular needs,
the delivery of care to HIV/AIDS care in Nigeria is shared with the
various members of the primary care team and members of the community.
Care are being provided on a daily basis by medical services, families and
communities throughout the country including community level
organisations, civil society, NGOs, the private sector, trade unions, the
media, religious organisations, schools, youth organisations, women
organisations, people living with HIV/AIDS organizations and individuals
who care for, support and sensitise our population to the threat of
HIV/AIDS and associated opportunistic infections and also to protect those
not yet infected, particularly the women, children and youth.
Also, despite the mistrust, misconceptions and power struggles that
dominate the relationship between traditional healers and other relevant
stakeholdersin this country, thousands of Nigerians consult traditional
healers and other non-formal care providers including seers and voodooers,
on a daily basis, for HIV/AIDS care and related complications.
Uzo'
***************
Dr. Uzodinma A. Adirieje
Afrihealth Information Projects
Email: afrepton@hotmail.com
= = = = = = = = = = = = = = = =
AF-AIDS is supporting the 13th ICASA in Nairobi, Kenya (Sept 21-26 2003)
http://www.icasanairobi2003.org/
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ON PROGRESS MADE BY 'CCMs' OVER THE PAST TWO YEARS

2007-06-02T08:13:00.000-07:00

Country Coordinating Mechanisms (CCMs) are national 'partnerships' agencies within each country for the effective implementation of the Global Fund's (GF) commitment to local ownership and participatory decision-making. They are responsible for developing and submission of grant proposals to the Global Fund based on priority needs at the national level, on HIV/AIDS, TB and malaria, as well as oversee progress during implementation.

However, CCMs exist and function like unnecessary octopus. Where do the responsibilities of the CCMs start and those of the government’s bureaucracy stop? How do you separate programmes run through the GF and those run through the routine annual budgetary estimates and allocations of a country? How good is it to have an officer from the civil service as the chair of such a body when it is known that one of the reasons for the emergence of the GF in the form in which it operates, is because current government policies as implemented by the civil service have not given the desired impetus to the campaigns against these diseases, and the overbearing influence of a supervising minister/ministry can not be ruled out? Is it a GF rule that CCMs must have multi-nationals as members? How much have these organizations contributed to the GF for the countries in which they operate and in which they would serve as principal recipients and LFAs (Local Fund Agents), and what visible programmes are they running to tame HIV/AIDS, malaria and TB in those countries?

Nigeria is a country of about 130 million persons, 250 ethnic/linguistic groups, 36 States (and Abuja) and 6 geopolitical regions. Information on the Nigerian CCM, its members that represent “the various constituencies involved in fighting these diseases” and its activities; is hardly readily available outside the CCM board and the individual organizations/interests/groups that are represented on the board; despite all efforts to present the contrary. The prevalence and risks of HIV/AIDS, malaria and TB in the various segments of the Nigerian society are not the same. We demand that the definite constitution, identities and contacts of the representatives of the Academic/Educational Sector, Government, NGOs/Community-Based Organisations, People living with HIV/AIDS, TB and/or Malaria, Private Sector, Religious/Faith-Based Organisations and Multilateral and Bilateral Development Partners on Nigeria’s CCM, be made readily available; to enable us know who to contact with specific problems requiring attention within the various segments of the Nigerian society.

How regularly (if at all) have these representatives briefed their constituencies on their assignments, in both formal and informal settings? The truth is that most of the constituencies do not even know who represents them on the CCM. Producing in-house reports and forwarding them to the GF board is not enough. The activities of the every CCM must regularly be brought to the fore for all stakeholders to know how various segments of the population that are living with these targeted diseases or are at risk for them, are benefiting or can benefit from the objectives of the GF. The Board of the GF would help this initiative by dispatching survey questionnaires on the activities of each country’s CCM, to various email forums outside the CCMs themselves, to ascertain which things that are actually happening in the fields.

If the Global Fund is to remain the broad partnership it was/is meant to be, it must truly employ new and innovative structures to bring the impacts of its activities in fighting these diseases, to bear on the poor village girls and market women in Nigeria who are readily liable to financial inducements for unprotected sex from money-wielding city-men, the indigent septuagenarian in India who is daily exposed to the risk of malaria because of the poor environment in which he lives, and the poor road-side food seller in Kenya whose TB would be worsened by cooking with impure firewood and smoky kerosene stoves along a very dusty road in a windy dry season.

One must not fail to observe that, whether it is to increase the awareness of HIV/AIDS and behavioural changes towards safer sexual practices; reduce the present level of discrimination and stigmatization of People Living With HIV/AIDS (PLWHAs) and increase their access to home based care and support; strengthen the capacity of non-governmental and governmental organizations and their staff to implement HIV/AIDS interventions; increase the use of Insecticide Treated Nets (ITNs); increase the proportion of under-fives correctly treated for malaria; or increase the proportion of pregnant women that use Intermittent Preventive Treatment (IPT) according to the new national guidelines; more than 80% of the very ambitious objectives of Nigeria’s CCM are projected for realization by year 2007, without any immediate and/or short-term components objectives. And despite the fact that these diseases are indeed health and development emergencies, and visible measurable impacts of interventions are expected now, not later; we must wait for 5 long years before we can assess the performance of Nigeria's CCM, according to its objectives. So long, then.

Dr. Uzodinma A. Adirieje
Secretary General/CEO
Afrihealth Optonet Association
Postal Address: P.O. Box 4127, Oshodi, Lagos 100010, Nigeria
Courier/office Address: 32c Adetola Street, Aguda-Surulere, Lagos 101014, Nigeria
Phone: 234-1-4815220, Mobile: 234-803-472-5905, Fax: 234-1-4520333
Email: afrepton@hotmail.com
Web: http://uk.geocities.com/afrihealthoptonetassociation/AfrihealthOptonet.html

TOBACCO AND THE REST OF US

2007-06-02T08:12:00.001-07:00

- Dr. Uzodinma A. Adirieje, Nigeria

Originally, tobacco is a solanaceous, mainly American plant of the specie Nicotiana tabacum whose leaves have stupefying narcotic effects, and when dried, could be prepared and adapted for smoking, chewing and or snuff. Solanaceous plants are so called because; they belong to a family of plants scientifically referred to as Solanum, many of which contain poisons and other medicinal substances. As Nicotiana specie, tobacco contains nicotine- a poisonous drug/narcotic that has the capacity to induce stupor and or sleep in its consumers. Nicotine is a colourless liquid that turns yellow in the air or light, with a characteristic sharp burning and mostly bitter taste. Tobacco’s nicotine is miscible with water, very soluble in alcohol, and can also be synthesized/manufactured industrially. Within the Nicotiana family, nicotine has no medicinal value, while its other major use is as an insecticide, for killing cockroaches, mosquitoes and their likes. It is also intoxicating and addictive, with the capacity to make its consumers become drunk and excessively elated with excitement to the extent of high enthusiasm or madness, and possible death.

In certain communities and countries, families rely on the cultivation and sale of tobacco for economic sustenance and social well-being. Such families are either selling tobacco to final consumers and petty retailers in small quantities, and or supplying to big time tobacco companies as feeder producers. Worldwide, more than one thousand and three hundred million persons currently consume tobacco, with about seventy per cent of them in the world’s poorest countries. In many of such countries, the use of tobacco varies continuously among people of various race, age and income, as tobacco manufacturers design and package their products in such ways that create and maintain dependence, using materials and compounds that are toxic and can cause cancer. In Nigeria and other low-income/less developed countries, it is the poorest persons and peoples with less education who tend to consume tobacco the most, and who bear most of the tobacco-related disease burden.

In numerous ways, tobacco consumption for whatever reasons has its impacts on the health, economy and development of its producers and consumers, their families, communities and countries at large. While the producers smile to their banks as more of their products are consumed, the consumers thrive in pains and ill health, their families weep to the cemeteries, while their communities and countries agonise in depleted available manpower and avoidable tobacco-related economic losses. The 'vicious circle' slogan holds true for the inextricable link between tobacco consumption/dependence and the social economy of its consumers. In majority of the situations, the use of tobacco has an inverse relationship with the economic status of its consumers. This is especially true for the poorest persons who consume it most. Their consumption of the plant increases as their economic, health and living standards decrease under the weight of the harmful consequences of tobacco.

Tobacco is probably the only commodity in existence whose manufacturers clearly warn that those who consume it are likely to die (young). This is because tobacco kills one of such consumers every 6.5 seconds and nine of them in one minute. Five hundred and forty (540) tobacco users are killed every hour, 12, 960 every day, and 90, 720 every week. If you are a tobacco consumer, chances are that you could be among the three hundred and sixty-three thousand persons it would kill this month and or the nearly more than 4.7 million corpses that would result from its consumption this year alone. If you lose the chance of dying this year due to tobacco consumption, there is no way you could escape being one of the several other millions who fall ill, suffer diseases and disability, and or would be visited with negative health impacts due to tobacco use. Tobacco is also a national economic disaster, when one considers losses in foreign exchange spent on imported tobacco and tobacco-related goods and services, and the losses that the country surfers regularly as a result of loss of tax revenues due to smuggling which is very characteristic of the tobacco trade, and damages to the environment caused by tobacco cultivation.

In addition to being a health and economic issue, tobacco consumption carries a huge developmental concern especially for the poor. According to the World Health Organisation, "tobacco is not only a health issue, it is also a development issue. It particularly disadvantages the poor, and can even contribute(s) to malnutrition when money is spent on tobacco rather than food. The links between poverty and tobacco need to be addressed as part of the broader health development agenda.” In many societies, situations and circumstances, several poorer persons and families (including the poorest of the poor) spend a disproportionately high percentage of their earnings on tobacco products, to the detriment of other basic needs in the homes such as food, healthcare, clothing and education. Currently, the developed countries spend 6-15 per cent of their total health-care costs to treat tobacco-related health problems; while developing countries like Nigeria where there are unrestricted production and consumption of tobacco, tobacco consumers are left at the mercy of the contemporary economic exigencies of privatization, liberalization, right-sizing, down sizing, retrenchment, withdrawal of subsidies, etc.

Unknown to many tobacco retailers and consumers, and shielded by those who produce it, tobacco consumption could damage almost all aspects of sexual functions, reproductive life and child health. It has become an expanding epidemic especially in developing countries where more than eight in every ten smokers currently live. Tobacco-related death figures are expected to double in the next years, rising to as high as 1.7 billion by 2025. Over the years therefore, tobacco has firmly established itself as an entirely unnecessary threat to health, human welfare and community socioeconomic advancement. It is the only product, which has the assurance of killing half of its consumers between their prime and old age. More than one billion (1, 000, 000, 000) consumers are addicted to tobacco in today’s world, again majority of them in developing countries, including Nigeria. In several of those who smoke and or chew tobacco, it causes excess plaque, yellowing teeth and tooth decay, with a completely avoidable five-fold increase in risk, for oral cancer.

In men, tobacco has been attributed with causing reduced sperm counts, significantly high malformed sperms and problems with erection of the penis, all of which are major causes of impotence and infertility. In women, tobacco consumption doubles the risk of infertility and increases the risks of developing malignant cancer of the cervix, of having miscarriages and giving birth to babies whose birth-weights are clinically classified as “low”. Low-birth-weight infants are often weak and sickly when they are born, and might continue to have health problems through childhood and unto old age. Even passive or second-hand tobacco consumers (those whose proximity compel to inhale tobacco consumed by other people) are known to also suffer from the adverse effects of tobacco on reproductive and sexual health.

One of the top health secrets withheld by tobacco companies, and unfortunately underemphasized by our unnecessarily over-commercialised national health systems, is that inhaled tobacco smoke contains carbon monoxide – a known toxin which reacts with the oxygen in the blood of smokers, saturating it with carbon dioxide, thereby hampering the flow and contents of blood within their circulatory systems. This potentially hampers the flow of blood to and from various body organs including the penis, thereby causing impotence. In women who smoke, tobacco causes problems for the fallopian tube or uterus- the hollow, thick-walled, muscular organ in which a woman’s fertilized egg develops into a new baby, thus precipitating infertility. Tobacco consumption doubles a woman’ chance of infertility and can reduce her chances of conception or becoming pregnant, by as much as forty percent. Even in these days of artificial insemination/impregnation or in vitro fertilization when couples are prompted by tobacco-related and sundry infertility to attempt assisted reproductive procedures, such a process is less likely to succeed in tobacco-consumers than in non-tobacco consumers.

Part of tobacco’s massive toll on children’s health and upbringing, as well as those of adolescents and girls of child-bearing age, is that passive smoking or second-hand smoking, which they are most likely to be exposed, has been linked to the perplexing situation whereby infants, often in their first year of life, are suddenly found dead in their cots/beds, often with their faces down, especially during cold seasons- the so-called cot death. Passive or second-hand smoking has also resulted in respiratory infections in children, and in the development of childhood asthma. Thousands of children under five years of age are hospitalised annually because of respiratory illness caused by second-hand smoke.

From the foregoing, it has become imperative, that conscious, sincere and well thought out national policies must be enthroned and religiously implemented in order to reduce tobacco-related deaths, disease and infirmities; which are currently on the increase in our nations and around the world. In line with the World Health Organisation’s (WHO’s) Tobacco Free Initiative and the international Framework Convention on Tobacco Control (FCTC) adopted unanimously by all WHO Member States in May 2003, Nigeria and other tobacco-consumption endemic countries must establish provisions and minimum standards to curtail the production and use of tobacco products, and break the vicious circle of the poor consuming more tobacco, and more tobacco consumption increasing poverty. Additionally, the goal of stemming the continuing rise in tobacco-related deaths and diseases must be seen and approached as a goal to which everyone can, and should contribute.

Sincere, purposeful and well-coordinated local and international implementation of such policies require addressing such tobacco-related issues like taxation, consumption prevention, addiction treatment, illicit trade, advertising/promotion, labelling, sponsorship, indoor-smoking ban in workplaces (including private commercial concerns/offices) and bars/restaurants and clearly defined public places, second-hand smoke and product regulation; culminating into genuine introduction of tobacco control programmes, rules, regulations and legislations in the public health agenda at country levels, supported by equally genuine political will and processes. At such country levels, governments must take actions by supporting, signing, ratifying and implementing the WHO FCTC and by ensuring its formal incorporation into existing law books, using relevant acts of the competent authorities/national assemblies.

At local levels, governments must institute policies for the cessation of smoking and treatment of tobacco dependence, as well as evidence-based guidelines and materials for overall implementation in relation to each country’s national health objectives and local circumstances, in order to ensure measurable public health gains for all. This would make such places safe (tobacco-wise) for all and sundry especially pregnant women and children. It is the opinion of this writer, that a comprehensive tobacco control strategy must include a complete ban on the sale of cigarettes to children and all persons younger than eighteen years of age, a complete ban on tobacco advertising in the media (print, radio and television), and the removal of tobacco adverting from existing billboards.

Countries should consider and adopt tobacco-cessation services/strategies for all ages of their population as necessary and proponent beneficial public health strategies for tobacco control, including efforts to prevent people especially young persons, from starting to smoke. One of such strategies is to increase taxes on tobacco and tobacco-related or tobacco-supported products and services by as many folds as would match the costs to government, of efforts/programmes for the mitigation of the overall economic and health consequences of tobacco. Such mitigation efforts/programmes include the provision of treatment, training of health-care providers for tobacco-associated diseases, advocacy/intervention for the successful quitting of tobacco consumption and necessary rehabilitation assistance/programmes for previous consumers. These would however depend on well-informed local perception of such efforts, and experience with efficacy, cost-effectiveness and acceptability.

The disastrous impacts of tobacco on our societies challenges the responsibility and commitment of all leaders, parents, policy-makers, professionals, researchers and healthcare providers to become involved in its control by promoting a new code of conduct, supporting and strengthening tobacco surveillance and cessation activities, ensuring access to tobacco-free facilities, implementing tobacco education and community counselling/advocacy, helping people change their behaviour by emphasizing the dangers of smoking and benefits of quitting, and serving as role-models through exemplary attitudes by personally quitting tobacco consumption, production and or distribution. Fortunately, there available, application and affordable clinical and household options for individuals wanting to quit, such as nicotine replacement therapy using nasal sprays, gum, patches, lozenges, etc. For children and young persons, after-school activities and mentorship/monitoring programs targeted at smoking prevention/cessation have been successful in preventing further loss of lives and futures due to tobacco-related diseases.

At all levels and times, in all places and for all peoples, holistic efforts to prevent and/or minimize tobacco-related activities must be intensified. Our communities must no longer tolerate easily preventable human, social and economic losses due to tobacco. We must strive to prevent these losses by continuously deploying all our enthusiasm, persistence and political commitment, to accomplish a total control of what has become a tobacco epidemic, ensure healthy societies and improve the standards of living of our peoples. After all, only a person who is mad and or on a suicide mission would consume a product whose maker has said that those who consume it are liable to die young. My late grand father told me that a stitch in time saves nine. Did yours tell you?

Dr. Uzodinma A. Adirieje
Executive Coordinator (Research & Development)
Afrihealth Information Projects/Afrihealth Optonet Association
Postal address: P.O. Box 4127, Oshodi, Lagos 100010, Nigeria
Courier/office address: 32C Adetola Street, Aguda-Surulere, Lagos 101014, Nigeria
Phone/Fax: 234-1-4520333, Mobile: 234-803-472-5905
Email: afrepton@hotmail.com
http://uk.geocities.com/afrihealthoptonetassociation/AfrihealthOptonet.html

THE GLOBAL FUND AND HIV/AIDS CONTROL IN NIGERIA

2007-06-02T08:11:00.000-07:00

Dr. Uzodinma A. Adirieje, Nigeria
************************

(Mod: This comment was submitted to PartnersGF and published in the
Nigerian Daily Sun - http://www.sunnewsonline.com - on 1 June 2004)

The Global Fund was created by the United Nations as a unique global
public-private partnership between governments, civil society, the
private sector and affected communities, for attracting and disbursing
additional resources to prevent and treat HIV/AIDS, tuberculosis and malaria.
Probably because the UN is headquartered in Switzerland, the Fund was
established as an independent private foundation under Swiss law with an
international governing board. It seeks to work closely and in
collaboration with other bilateral and multilateral organizations to support
existing efforts dealing with these target diseases. This Fund therefore
provides a very critical opportunity for countries, organizations,
communities and corporations to turn the tide of the scourge of HIV/AIDS,
tuberculosis and malaria. Although it attaches no conditions to its
grants, it requires that programmes to be supported by it, must be of high
standard and technical quality, have local ownership and planning, and
desire to direct resources to the frontline for the control of these
diseases; with clear-cut objectives and effort to reach those most
affected and most in need. It strives to ensure that funds are used
efficiently to create visible, measurable and verifiable changes in the lives
and circumstances of disease-affected people and communities.

The policy commitment of the Fund’s readiness to provide significant
financial support to organizations preventing and treating HIV/AIDS, TB
and malaria, needs not be unduly emphasized. One of such policies is the
creation and existence of Country Coordinating Mechanisms (CCMs), as
integral parts of the funding process. These CCMs are to work effectively
to secure results in the control of these diseases in cooperation with
NGOs, the private sector and people living with the diseases and/or
affected by them. The obvious implication of this is that CCMs are
national 'partnerships' agencies within each country for the effective
implementation of the Global Fund's commitment to local ownership and
participatory decision-making. They are responsible for the development and
submission of grant proposals to the Global Fund based on priority needs
at the national level, on HIV/AIDS, TB and malaria, as well as oversee
progress during implementation.

In certain countries however, CCMs exist and function like unnecessary
octopus. Where do the responsibilities of the CCMs start and those of
the government's bureaucracy stop? How do we separate programmes run
through the GF and those run through the routine annual budgetary
estimates and allocations of a country? How good is it to have an officer from
the civil service as the chair of such a body when it is known that one
of the reasons for the emergence of the GF in the form in which it
operates, is because current government policies as implemented by the
civil service have not given the desired impetus to the campaigns against
these diseases, and the overbearing influence of a supervising
minister/ministry can not be ruled out? Is it a GF rule that CCMs must have
multi-nationals as members? How much have these organizations contributed
to the GF for the countries in which they operate and in which they
would serve as principal recipients (PRs) and Local Funds Agents (LFAs),
and what visible programmes are they running to tame HIV/AIDS, malaria
and TB in those countries?

In a country like Nigeria, with a population of about 130 million
persons, 250 ethnic/linguistic groups, 36 States (and Abuja) and 6
geopolitical regions, information on the Nigerian CCM, its activities, and its
members that ‘represent’ the various constituencies involved in fighting
these diseases; is hardly readily available outside the CCM board and
the individual organizations and interests groups that are represented
on the board; despite all efforts to present the contrary. The
prevalence and risks of HIV/AIDS, malaria and TB in the various segments of the
Nigerian society are not the same. In order to fully appreciate the
spirit of openness, accountability and due process, it is imperative that
the definite constitution, identities, activities/contributions and
contacts of the ‘representatives’ of the Academic and Educational Sector,
Government, NGOs/Community-Based Organisations, People living with
HIV/AIDS, TB and/or Malaria, Private Sector, Religious/Faith-Based
Organisations, Multilateral and Bilateral Development Partners on Nigeria's
CCM, be made readily available; to enable us know who to contact with
specific problems requiring attention within the various segments of the
Nigerian society.

How regularly (if at all) have these representatives briefed their
constituencies on their assignments, in both formal and informal settings?
The truth is that most of the constituencies do not even know who
represents them on the CCM. Producing in-house reports and forwarding them
to the GF board is not enough. The activities of every CCM must
regularly be brought to the fore for all stakeholders to know how various
segments of the population that are living with these targeted diseases or
are at risk for them, are benefiting or can benefit from the objectives
of the GF; and how various stakeholders can contribute, especially the
vast majority that are most likely not aware of, or participating in
the CCM’s activities. The Board of the GF would help this initiative by
dispatching survey questionnaires on the activities of each country's
CCM, to various email forums outside the CCMs themselves, to ascertain
which things that are actually happening in the fields. The local CCM
would also find this suggestion very useful for their internal assessment.

To continue to hold out hope to the millions infected and affected by
the three diseases, and remain the broad partnership it was/is meant to
be, the Global Fund and the country coordinating mechanism must truly
employ sincere, transparent, proactive, people-oriented, new and
innovative structures to bring the impacts of their activities in fighting
these diseases, to bear on our poor village girls and market women who are
readily liable to financial inducements for unprotected sex from
money-wielding city-men, our indigent septuagenarians in our various villages
who are daily exposed to the risk of malaria because of the poor
environment in which they live, and our poor road-side food sellers whose TB
would be worsened by cooking with impure firewood and smoky kerosene
stoves along very dusty roads in windy dry seasons.

A curious observation though, that whether it is to increase the
awareness of HIV/AIDS and behavioural changes towards safer sexual practices;
reduce the present level of discrimination and stigmatization of People
Living With HIV/AIDS (PLWHAs) and increase their access to home based
care and support; strengthen the capacity of non-governmental and
governmental organizations and their staff to implement HIV/AIDS
interventions; increase the use of
Insecticide Treated Nets (ITNs); increase the proportion of under-fives
correctly treated for malaria; or increase the proportion of pregnant
women that use Intermittent Preventive Treatment (IPT) according to the
new national guidelines; more than 80% of the very ambitious objectives
of Nigeria's CCM are projected for realization by year 2007, without
any immediate and/or short-term components objectives. And despite the
fact that these diseases are indeed health and development emergencies,
and visible measurable impacts of interventions are expected now, not
later; we must wait for 5 long years before we can assess the performance
of Nigeria's CCM, according to its objectives. For those who might soon
die from these diseases, this sounds like eternity.

Dr. Uzodinma A. Adirieje
Executive Coordinator (Research & Development)
Afrihealth Information Projects/Afrihealth Optonet Association
Postal address: P.O. Box 4127, Oshodi, Lagos 100010, Nigeria
Courier/office address: 32C Adetola Street, Aguda-Surulere, Lagos 101014, Nigeria
Phone/Fax: 234-1-4520333, Mobile: 234-803-472-5905
Email: afrepton@hotmail.com
http://uk.geocities.com/afrihealthoptonetassociation/AfrihealthOptonet.html

HIV AND AIDS: ENCOURAGING DISCLOSURE AND OPENNESS

2007-06-02T08:10:00.000-07:00

- Dr. Uzodinma A. Adirieje, Nigeria

Imagine that an annual contest for the most-beautiful-girl-in-the-universe has just been concluded. The world’s most beautiful girl for the year has been announced and crowned. She is to assume duties immediately, as well as engage in several other celebrity and public functions throughout the international community during her reign.

In her acceptance speech, our most-beautiful-girl-in-the-universe pays glowing tributes to the pageant’s organizers, her sponsors, supporters and admirers. Prior to her speech, the out-going queen, eminent VIPs and who-is-who at the occasion have variously embraced, hugged, kissed, pecked and/or received her hand shake with her, with some dropping their cards and contacts, you know. Applause. Then, the new queen ponders a little, and declares, “I thought I would not be able to make it to this final, especially when I was tested and confirmed to be HIV positive two months before this historic event. I am living with the virus that causes AIDS. I am an HIV carrier. I thank the Governor of XYZ State and the Executive Chairman of JKL Company PLC that confidentially adopted and nurtured me for this contest after I was confirmed positive for HIV. When I enrolled for this contest, nobody else knew of my HIV status. I have contested with ninety-nine other girls. I am most probably the only one who is HIV positive. I have also become the best among equally beautiful girls. I promise not to let your Excellencies, our country and indeed the world, down.”

As we ponder what new dimensions of movements, speeches and sounds that would follow her opening up on her HIV/AIDS status inside such a capacity gathering and media event; it would be equally important that we analyse the circumstances leading to the emergence of this HIV positive beauty, as the most beautiful girl in the contest. There was an opening-up, definitely. A disclosure. Sure. But this opening-up, this disclosure was not turned against the person who made it; she was not taken to the media to announce her HIV-positive status. Those, to whom her status was disclosed, gave her concern, care and cure - what this writer has earlier called the 3Cs for empowerment of persons infected and affected by HIV/AIDS. She made her disclosure to people who were out to help her and other persons who currently suffer from 20th century’s most infamous scourge. She must have been informed that this disease is really deadly. But if they had taken her to the media, to announce that “here is a very hard working, honest and ambitious beauty living with HIV/AIDS who we are sponsoring for the forthcoming pageant to show how much we care, and to encourage other HIV positive persons to turn up for similar assistance” –name-calling, stigmatization, labeling, our girl might probably not have gone beyond the competition’s preliminaries, and no “other HIV positive persons” would have turned up for whatever “assistance”, because of fear of stigmatization.

However, they went beyond pronouncing Armageddon for her. She said that they (the Governor of XYZ State and the Executive Chairman of JKL Company PLC) to which her status was disclosed, “confidentially adopted and nurtured” her. Assuming she were in Nigeria, this means that she received appropriate counseling; her anti-retroviral drugs (ARVs) and other life-saving medicines never went out of stock and she didn’t have to travel from Sokoto to Lagos, Calabar to Maiduguri, or queue up in front of one agency’s office endlessly in search of such ARVs and other needed life-saving drugs that were already expired, or just won’t come. They were there when she needed them – the drugs and the carers, in the right forms and correct proportions. It also meant those to whom her status was disclosed were interested in seeing her become the best she wanted to be, so they nurtured her ambition of coming tops at the contest. They were confident in her potentials. I guess they must have also shared with her, all that could be shared without being infected: dined with her, held hands, talked about life, ambitions and vanities, stayed in the same house, sat together on the same settee, and probably shared some dresses. She must never have been isolated, nor isolated herself, nor tried to take undue advantage of her situation by refusing to challenge herself using their support. She must have been part of the team that was managing her situation.

This definitely is what empowerment and fair treatment are all about. “AIDS no dey show for face” is a local saying relating to this disease. It means that HIV infection is not noticeable by mere observation of a person. And now that there is an ever-growing understanding of the disease and some modicum of pharmaceutical and nutritional remedies in the forms of ARVs, life saving drugs, supplements and other effective alternative medicines, infected persons must not necessary tie the bells to their necks just to announce to the rats that the cat is coming. There are absolutely no sustainable reasons for different levels of competence measurement or yardstick for persons living with HIV, in such ways that clearly or subtly indicate that such person(s) are (is) being hounded together or marked out for differential standards because of known HIV status. Any person, group or institution advocating the use of standards for persons with HIV, that are radically different from those for non-HIV carriers in the same activity; is guilty of discriminatory practices, regardless of the outcome of such exercises.

It must be emphasized that every one is at liberty to choose where to subject oneself for testing and who to disclose the result of the test to, whether positive or otherwise. It is not the duty of the person or organization running the test, to announce the result to any other person, except with a confirmed informed consent of the tested fellow, no matter the direction of the result. To do otherwise would amount to a breach of the individual’s privacy, and constitutes a major source of worry and fear for persons about to be tested or already tested. Also, it amounts to a mere wishful thinking to suggest that people who discriminate against persons known or perceived to be suffering from HIV/AIDS should be seen to have committed an offence, arrested, charged to court, bla bla bla. No. The constitutions still guarantee every individual’s freedom of association.

Governments by their own inactions, inadvertently fuel people’s reluctance to disclose their status. In Nigeria for instance, how many of those who are already publicly known as persons living with HIV/AIDS (PLWAs) do we have appointed by the government into responsible executive positions. Even in NACA (the National Action Committee on AIDS) and similar bodies, what proportion of their memberships are known persons living with HIV/AIDS who are there on their merits, and not as representatives of PLWAs or other bodies of PLWAs? How many of such persons do we see as participants and/or invited guests at government’s activities that are not just related to HIV/AIDS? How many of them are in our President’s entourage when he travels abroad or hosts our international friends and foreign guests for issues outside this disease? Just tell me.

In this era of globalisation and openness, every effort must be made to encourage everyone infected and affected with HIV/AIDS, to be open about their status. This is because disclosure is that gulf that stands between survival and morbidity/mortality from the disease, between productive life and unproductive existence/eventual extinction from the disease. Only those who disclose their status are able to approach health and development facilities for care, concerns and cure.
The importance of disclosure -whether self or assisted- can never be overemphasized. It is a healing/soothing balm as problems shared are problems solved. It facilitates access to care, as only those whose problems are known are very likely to receive attention and assistance – ARVs, VCT, treatment and prophylaxis for opportunistic infections, etc. It heals the soul as the burden of any guilt and secrecy is gradually dispensed with. It encourages healthy attitudes as partners and friends come to understand and appreciate the sexual preferences –abstinence, keeping to a partner only and condom use- of their spouses. It prolongs the life of the infected and affected as all the above work in synergy to prolong their lives and promote their relevance and productive participation in daily activities, in their families and the society.

For a disease that has killed more people in the last decade than all the wars and disasters in the past 50 years could do, which has already killed 25 million persons and currently resides in more than 40 million others, which pandemic has reached massive proportions with little signs of abating, and which so far has got neither a cure nor a vaccine, it is not unexpected that the infamous nature of HIV/AIDS could bring labels, fears, stigma and discrimination; especially in a world where more money is deliberately provided to fight wars and kill those who are healthy, than to provide education, knowledge and cure for those who are ignorant, poor, sick and dying.

There are ways that stigma is unnecessarily tied to disclosure –or lack of it- and they question our focus on why disclosure and stigma are such topical issues about HIV/AIDS. Ebola fever (virus) and severe acute respiratory syndrome (SARS) were very deadly diseases that invaded the world in the last decade, but were contained. Today, they do not attract any stigma, even though the veracity with which they killed and maimed their victims were stronger than that of HIV/AIDS. Gonorrheal diseases were sexually transmitted infections that ravaged mainly young persons in some parts of the world in the not too distant past, and even attracted stigma in certain communities because of their association with behaviours that may be illegal or forbidden by religious or traditional teachings, pre- and extra-marital sex and prostitution. Today, persons infected with gonorrheal diseases no longer hide their status because the next chemist shop has a medicine that would arrest the disease within 24 hours and bring definite cure.

Major fears and stigma/discrimination in HIV/AIDS exist because the disease is infectious, not well understood, and very likely to kill its victims due to the absence of available, affordable and effective remedies. The disease is infectious because that is its nature. It is not well understood because both local and international communities and governments have failed to take the giant and bold steps –provision of enough financial and material resources and opportunities- needed to engender appropriate knowledge and adequate understanding of HIV/AIDS. It is very likely to eventually kill its victims because the United States-led developed/donor countries, big pharmaceutical manufacturers and their developing countries’ collaborators, continue to prefer the commercial benefits of the scourge to its humanitarian counterpart; as exemplified by the objections to the use of more affordable generic fixed-dose combinations (FDCs) of antiretroviral drugs (ARVs) by the United states, during the major conference on anti-AIDS drugs held in Botswana recently, despite the fact that they (FDCs) have been certified by the World Health Organization (WHO).

Additionally, HIV/AIDS is very likely to kill its next victim because of the very low government budgets for health, and poor private sector involvements in HIV/AIDS-related activities/services, in countries like Nigeria. This means that HIV/AIDS education, affordable voluntary counseling and testing (VCT) services and ARVs, which would enhance early detection and disclosure of the disease/status, are not readily available to the generality of the citizens in the various communities. It also means that those who know their status or the status of their relatives, are not encouraged to disclose it because, in the absence of HIV/AIDS education, VCTs and ARVs, doing so would bring them causes and castigations, instead of cure and care. Until HIV/AIDS education, VCTs and ARVs become readily available and affordable to the citizenry; disclosure will continue to be a scarce commodity, and commercial undertakers will continue to smile to the banks.

Dr. Uzodinma A. Adirieje
Executive Coordinator (Research & Development)
Afrihealth Information Projects/Afrihealth Optonet Association
Postal address: P.O. Box 4127, Oshodi, Lagos 100010, Nigeria
Courier/office address: 32C Adetola Street, Aguda-Surulere, Lagos 101014, Nigeria
Phone/Fax: 234-1-4520333, Mobile: 234-803-472-5905
Email: afrepton@hotmail.com
http://uk.geocities.com/afrihealthoptonetassociation/AfrihealthOptonet.html

HIV AND AIDS: ENSURING ACCESS TO ALL

2007-06-02T08:09:00.002-07:00

- Dr. Uzodinma A. Adirieje, Nigeria

Among other meanings and synonyms, the Chambers Dictionary defines access as approach, admittance or a way of opportunity, addition or entrance, to locate, to retrieve or to get possession of. Since the early eighties of the twentieth century, the Acquired Immune Deficiency Syndrome (AIDS) and its progenitor, the Human Immunodeficiency Virus (HIV), have had virtually unfettered access in the lexicon of international health and development community. The world on the other hand, has strived, albeit in various ways, in various places and at various times, to impede this pandemic’s inglorious access to her environment and its six billion inhabitants. This it has strived to achieve by making statements, giving commitments, and displaying practical efforts to enhance humanity’s access to factors that have the potentials or have demonstrated capacities to impede and or control the disease.

Indeed, there is the need today, more than ever before in human history, for all groups and everyone- scientists, community workers and leaders, from all levels in all the fields, the public and private sectors, to have unlimited access and give unlimited sincere commitments, to all resources and opportunities for fighting the HIV/AIDS scourge head-on. These include access to relevant education and information through conferences and trainings, relevant journals and research results; access to infected and affected persons/groups, policy makers and implementers, supporters and caregivers; access to good and improved working environments, funding, relevant medicines, food security and adequate nutritious foods. It includes access to capacity building and voluntary counseling and testing (VCT) services. This piece is a contribution to the ongoing efforts to provide ‘access to all’- a necessity epitomized by the 15th International AIDS Conference (IAC), which commences in Bangkok this month under the same theme.

EDUCATION AND INFORMATION
The need to provide and or improve access to relevant education and information through relevant journals and research results brings to the fore, the imperative of broadening consultations among all HIV/AIDS, health and development stakeholders, especially those living and working in developing countries, at local government levels, in villages and rural communities, and in poor urban neighbourhoods. Such consultations must be a continuing process to ensure that all stakeholders contribute their experience, ideas and recommendations on an ongoing basis, not just in preparation for major events like the IAC and International Conference on AIDS and STIs in Africa (ICASA). Over the years, experience has shown that dialogue tends to work well when there is a combination of face-to-face encounters and online discussions. Several of such dialogues are currently going on, including the ‘icasa2005forum’ (International Conference on HIV/AIDS in Africa 2005 Forum)- an online discussion forum for the exchange of HIV/AIDS views and news/information between stakeholders, in order to ensure that the objectives of the year 2005 ICASA scheduled for Abuja, Nigeria are completely realized, and that a greater achievement on the control of the disease is recorded.

Attendance and participation at such conferences are sure ways of providing ‘access to all’. Unfortunately, lack of individual and or community access to funds has become an impediment to the realization of this ‘access component’. People from these constituencies tend to rely on scholarships to be able to attend such meetings. This creates an urgent need to establish institutions at the community, local and national levels that would respond relevantly and practically to such needs. Areas to consider in this regard include affordable conference registration fees, subsidized and or free hostel (not hotel) accommodation for such participants, and scholarships. In the particular case of the year 2004 IAC, ninety percent or 90% of all those who applied for scholarships to attend the conference, were turned down; conference registration fee is about one thousand United States dollars or US$1000 per participant irrespective of status and circumstance; and no significant free accommodation or relevant subsidies are available.

Even at the risk of repetition, this same conference singled out Nigerians (only) among citizens of one hundred and eighty-four or 184 countries, as those who must travel to Europe- London precisely, for Thailand visas. Following protests by concerned persons and groups including this writer, this discriminatory condition was whittled down to exclude those Nigerians who have registered for the conference before June 10th. Much as this is appreciated, it still means that a policy that all Nigerians (only) who would register for the conference within one month of its commencement, must travel to London at additional costs and inconveniences, to obtain their Thai visas, has been foisted, and is being implemented. This is still discriminatory and stigmatizing, and does not provide equal ‘access to all’. Truth is that access to this Conference would foster community empowerment and must therefore be encouraged and expanded, not impeded. Such deliberate barriers won’t help. For when such conferences’ activities are over, their impacts would be measured by their successes and or failures in assisting communities of persons living with HIV/AIDS (PLHWAs), persons affected by AIDS (PABAs), women, youths, the elderly, their carers and advocates, to take care of themselves and their circumstances.

In the efforts to provide ‘access to all’ in the control of the HIV/AIDS scourge, the need to improve the working conditions of PLWHAs, PABAs, carers and health care personnel; and to enhance the effectiveness of the supply systems, financing plans and referral mechanisms required to provide access to affordable medicine, diagnostic and related technologies, as well as qualitative medical, palliative and psycho-social care, can never be over-emphasised. We must ensure that affordable, applicable and adaptable community; local, national and international strategies are developed to provide psychosocial care for individuals, their families and all affected communities, including effective monitoring mechanisms. Where a world of difference exists between persons living with HIV/AIDS, one cannot fail to be astonished by what is responsible for the relative good health enjoyed by one infected person, at the same time that another's condition continues to deteriorate rapidly. When very necessary working conditions that facilitate access to care - medical, spiritual, psycho-social, conselling services, support groups/services/activities, and even making accurate and necessary information available to people who are living with HIV/AIDS- are adopted, they can go a long way to determine the well being of people living with HIV/AIDS and those affected by it.

MEDICINES AND LIFE-EXTENDING TREATMENTS
Access to needed medicines and life-extending treatments (the so called LET strategies) is one other way of ensuring ‘access to all’ in the efforts to control HIV/AIDS. For a disease which has mesmerized the world for more than twenty years, and for which all our past collective and individual efforts have so far failed to provide an acceptable cure, access to available medicines and palliatives must be made generally affordable. The United States of America and big world reputed pharmaceutical companies are among countries and institutions that have been variously accused of standing in the way of affordable access to these medicines. Even then, their accusers, namely majority of the countries of the developing world, have so far failed to bring to the discussion tables, convincing evidence that they (the developing countries) have genuinely made significant efforts towards supporting and funding the search for a cure.

Adrenaline ran very high among HIV/AIDS activists during the year 2003 International Conference on AIDS and STIs (Sexually Transmitted Infections) in Africa (ICASA) at the Kenyatta International Conference Centre in Nairobi, Kenya. They held a demonstration to drive home this point. Messages such as “You talk, we die”, “AIDS treatment now”, “Keep your promises”, were literally pelted at heads of governments, VIPs, funding agencies and the big pharmaceutical companies, and climaxed with the activists’ dramatic staging of a lie-in on the conference grounds, to buttress home the frustrations faced by all those infected and or affected by the disease especially in Africa and other countries of the developing world.

How justifiable or otherwise their actions were, is a matter of everyone’s conjecture. However, it must be explained that although more than three million, five hundred thousand (3500000) persons are infected with HIV/AIDS in Nigeria, only about fifteen thousand (15000), or 0.43 percent of them are currently receiving treatment in very epileptic circumstances (apologies to NEPA). In South Africa, of the five hundred thousand (500000) people currently in need of treatment, only one thousand five hundred (1500) people or 0.3 percent, are currently receiving treatment; while an additional three hundred and eighty-eight thousand (388,000) persons would develop the disease and or become infected by the time year 2004 runs its full course. In Zimbabwe, about one in every four persons or 25.0 percent of the country’s population is HIV-positive, access to treatment is still very limited and drugs are unaffordable. Even the World Health Organisation’s (WHO’s) 3X5 strategy, that aims to provide antiretroviral drugs for three million persons by the year 2005 has been declared unrealistic and impossible, and can be clinically classified as dead on arrival (DOA); going by feelers reported from within WHO.

While death and disabilities from HIV/AIDS continue on their astronomical increase; corruption, lack of political will, foot dragging/refusal of donors, resistance from large and not-so-large pharmaceutical companies backed by some of their home countries, World Bank and International Monetary Fund-prescribed structural adjustment programmes, and debt-serving commitments continue to constitute barriers/hindrances against the ability of HIV/AIDS-endemic countries, mostly in sub-Saharan Africa, to provide the necessary social and health services/facilities required to fully and effectively ensure access to the treatment of AIDS and other opportunistic infections (OIs). Only very recently, the 2003 Doha agreement on generic drugs not-withstanding, and despite the enormous progress already made by the World Health Organisation (WHO) in verifying the quality of generic AIDS drugs- the only hope for millions of low-income people infected and or affected with HIV/AIDS, the United States of America still opposed the use of these safe, inexpensive and WHO-certified generic medicines; presumably to protect US brand-name pharmaceutical interests. Failure would be the most appropriate verdict if these laws fail to empower developing, poor and or HIV/AIDS endemic countries from accessing the full range of medicines required from multiple suppliers, including generic producers, when making purchasing decisions.

Perhaps, such countries should be encouraged to be guided by the provisions of WHO’s new edition of the International Pharmacopoeia (IntPh) which provides specifications for the content, purity and quality of active ingredients and pharmaceutical products according to internationally approved standards, in order to improve the quality and efficacy of medicines, facilitate control of counterfeit and substandard drugs and address problems of drug resistance; including generics for HIV/AIDS, Tuberculosis and malaria. Considering the death and disability implications of poor quality medicines, some of which lack single medicinal values, countries where national and local agencies for food and drugs administration and control or other regulatory authorities/bodies charged with assuring the quality and safety of medicines, lack enough funds or staff to function optimally; must be encouraged to battle counterfeit and poor quality medicines, mainly for reasons of their negative serious health, economic and development implications for the society.

One must add however, that deliberate efforts are desirable, to ensure that any regulations put in place for the control of the quality and efficacy of medicines must be such that would not in any way slow down attempts to get low-cost drugs to countries in urgent needs for them, especially in sub-Saharan Africa, which is home to home to more than 50 percent of the world's population of HIV-infected persons. Unfortunately, some of them are countries where doctors were reported to be discontinuing ARV treatments for some patients on the excuse that the drugs needed to circulate to more PLWAs, countries where there are no available and affordable alternative aspects of care, and where several millions of US dollars have been spent on ARVs.

NUTRITION AND FOOD SECURITY
Expectedly, ‘access to all’ must include adequate nutrition and food security, the lack of which significantly complicates the management of HIV/AIDS, especially in the poor and developing countries. World wide, 95% of persons infected and or affected with HIV, are malnourished. Food security determines adequate or inadequate nutrition or nutritional status. Whereas food security is determined mainly by the availability or abundance of an adequate and varied foods in the food chain or food supply system, nutritional status is determined by the food manipulations, applications and practices or what is done with the available foods. As a result, the former does not automatically guarantee the latter, as malnutrition could still occur even when there is food security or enough food. HIV-infected persons in the United States suffered from malnutrition during the initial stages of the diseases between 1981 and 1994, due to poor and or inappropriate utilization of available foods, despite the abundance of food.

Significantly, HIV/AIDS worsens malnutrition and food security in every society where its endemicity is not under control, even as the resulting malnutrition also worsens the disease by inducing deficient immune responses. This leads to the emergence of the so-called opportunistic infections, worsens existing health problems and systemic infections, decreases appetite and food intake, decreases intestinal nutrient absorption, and results to poor tolerance to pharmaceutical interventions and other HIV/AIDS-related therapies. The bottom line is that the nutritional status of every person infected or affected by this disease is regularly at risk because of pre-existing and or consequent poverty, hunger, illness, ignorance, stigma, poor access to food, etc. Clinical wasting, surgical complications, morbidity and mortality would then become common sights. This situation is worse in the rural areas where the HIV/AIDS-related diseases are significantly prevalent, while agricultural outcomes and annual harvests which determine the incomes, food security and nutritional status of these rural inhabitants, remain mercurially unpredictable; especially in this era of poor health financing and economic and agricultural reforms “without human face”.

STIGMA AND DISCRIMINATION
HIV/AIDS-related stigma and discrimination are vital issues that must be tackled head-on if the intention and effort to ensure ‘access to all’ must be realised for all stakeholders and those affected/infected by the disease. In as many circumstances as they exist, stigma and discrimination are manifested as avoidance, denial, fear, isolation and or rejection of those known or suspected to be HIV positive. In very ridiculous situations, even members of their families and close relations could also be so stigmatized. This has become rampant because among other things, the disease has been presented essentially –albeit wrongly- as a ‘sex’ and promiscuity disease; related and or arising from ‘illegal’ sexual activities and intimacy of those infected, which end must be death-very-soon for the victims. As a result, people have been made to stay with the wrong impression that everyone who comes in contact with persons infected with HIV/AIDS would get infected and finally die. And although these stereotypes are giving way to a better understanding of the disease prognosis/progression, the disease still attracts stigma and discrimination even in the most affected countries.

Reduction and expected-elimination of HIV/AIDS-related stigma and discrimination must be given an accelerated priority as critical components of ‘access to all’ in the control of this pandemic. This could be achieved through HIV/AIDS awareness-raising to provide universal knowledge about modes of its transmission, individual and or group risk propensity and assessment, enhanced family acceptance and community tolerance, support, solidarity and care. The duo (stigma and discrimination) breeds a lack of appropriate information due to fear of stigma, prevents people from seeking early care for tuberculosis and other opportunistic infections, and from adhering to available treatments. Victims also get scared of seeking counselling and testing services, and accessing and receiving good quality care. In several communities and institutions, stigma and discrimination have turned out to be the most significant barriers to providing effective responses to HIV/AIDS.

As paralyzing, dehumanizing and mortalitic as stigma and the discrimination against people living with and or affected by HIV/AIDS are, overcoming them is one of the surest ways of responding adequately to the pandemic, by encouraging people to participate in control programmes and to openly discuss issues related to it and related diseases. It is extremely horrendous to allow things to continue to happen otherwise. The time has come to treat and regard HIV/AIDS as any other disease and establish strong relationships between it and human rights, something that has been done for other communicable disease. It is stigma when people are prevented from maintaining employment because of their perceived or real HIV/AIDS status; it is stigma when an hotel in Thailand implements a separate accommodation policy against customers and visitors on accounts of their perceived or real HIV/AIDS status, whether such an hotel is officially designated for the international AIDS conference (IAC) or not; and it is a clear-cut discrimination when a child is denied access to a classroom or school facility because of his or her parent’s perceived disease status. These are all violations of the human rights of the individuals involved (that should be an issue for another day). There are persons who have been actively living with the HIV disease for upwards of twenty years, and who constitute mirrors through which the society should continue to see the hopes and opportunities that must not be missed in the management and control of this pandemic.

FUNDING
In today’s world, not much might be accomplished if the problem of paucity of funding for research and intervention activities continues to bedevil HIV/AIDS. The so-called ‘10/90 gap’, whereby less than 10 percent of health research funding is allocated to more than 90 percent of the global disease burden must be urgently addressed with greater sagacity and responsibility from all stakeholders. Providing ‘access to all’ in the control of HIV/AIDS would require appropriate political leadership and manifest funding commitments from national governments, international organisations, the private sector, especially the pharmaceutical industry, and wealthy countries, particularly the United States and the European Union. For Africa and the rest of the developing world, adequate funding for HIV/AIDS control activities and implementation of sound social security policies that target the poor, women, the sick, the hungry, children and the elderly, present an immense challenge to health-care systems, to sustainable economic, social and human development, and to the achieved of national and or international targets of millennium development goals (MDG).

Unfortunately, one must continue to brave the shame that most national governments -especially in developing and sub-Saharan African countries where this disease impacts most- continue to pay lip service to its control; rich and donor countries continue to foot-drag on their promises and commitments to mobilize/provide necessary resources for HIV/AIDS control; big pharmaceutical companies continue to restrict access to essential medicines and diagnostics by lobbying and standing in the way of cheap and affordable generics and fixed-combination drugs (FCDs) and by charging exorbitant prices; while World Bank and International Monetary Fund (IMF) induced structural adjustment programmes in whatever names they have appeared, continue to hamper the funding of vital social services and destroy public health-care systems through various debt management instruments and restrictions of governments’ expenditures on social services.

CAPACITY BUILDING/TRAINING
In addition to funding, it is quite imperative to improve the capacity of HIV/AIDS carers and concerned communities through regular trainings and education tailored towards the development of policy and advocacy skills and strategies/plans, enhanced understanding of HIV control and treatment/access issues, presentations and action-oriented discussions on developing national treatment plans, advocacy, World Trade Organisation (WTO) and patent issues, research-based and generic priorities. When this is done, it would enable carers, their organisations and other stakeholders to be forthcoming in providing effective ‘access to all’, especially within their localities. Also, web-based discussion forums like the ‘icasa2005forum’ should be continuously encouraged to provide carers and stakeholders with the opportunity to review the progress made and the obstacles against enhancing access, hear each other's voices and state some of their hopes for the achievement of individual and collective HIV/AIDS control objectives, while reviewing issues related to national treatment plans and advocacy formulation and lobby issues.

Research results and relevant journals are essential components of educational opportunities for carers and stakeholders, and should continuously be made available to them as hard copy materials in the most HIV/AIDS endemic countries, especially those who live and work in rural areas and poor urban neighbourhoods that lack or have very limited Internet access and computers, and where poverty and bad economy occasioned by factors earlier mentioned in these series, have ingloriously ensured that subscriptions to such journals are largely unaffordable and epileptic. In other places where Internet access and computers exist, free online access to the results of the latest clinical and field research should be encouraged as much as possible, while local authorities must diversify local energy sources to include solar energy, to ensure that these gains are not lost at the altar of epileptic electricity generation and distribution, especially in sub-Saharan Africa. Capacity building materials like affordable and or free personal computers diskettes and CD-ROMs should also be provided.

Dr. Uzodinma A. Adirieje
Executive Coordinator (Research & Development)
Afrihealth Information Projects/Afrihealth Optonet Association
Postal address: P.O. Box 4127, Oshodi 100010, Lagos, Nigeria
Courier/office address: 32C Adetola Street, Aguda-Surulere 101014, Lagos, Nigeria
Phone/Fax: 234-1-4520333, Mobile: 234-803-472-5905
Email: afrepton@hotmail.com
Web: http://uk.geocities.com/afrihealthoptonetassociation/AfrihealthOptonet.html

AFRICAN WOMAN’S ROUGH ROAD

2007-06-02T08:09:00.001-07:00

- Dr. Uzodinma A. Adirieje, Nigeria

The roads of life within the African continent and some African communities in the diaspora are dotted with traditions, beliefs, practices and laws that have continued to subject millions of women to conditions that continuously militate against personal dignity, genuine sense of personal achievements, self-actualisation and integrated holistic development of the society.

Over the past several years, in almost all African countries and communities, efforts to improve the status and involvement of the women in major decisions within the households/community, enhance their relative freedom from domination and violence as perpetrated through age-old gender-related societal systems, strengthen comprehensive reproductive health and family planning programmes principally for their direct benefit, reduce economic poverty among them, increase their real household incomes, mobility and visibility, economic security and ability to make small and large purchases, holistically empower them socially, politically and psychologically, and improve their health and well-being; have continuously suffered several avoidable set-backs.

A majority of the African woman’s rough roads starts from the day her mother gets married or the day she becomes pregnant. Her mother could be married out at any age, to any person, without her consent, and for any reasons. The earnest desires of the families is that her mother should become pregnant immediately and bear them many children, among who MUST be males and PROBABLY females. When her mother’s first pregnancy appears, the expectation in majority of the African woman’s rough roads is that the baby should come out as male, regardless of the sexual orientation of the sperm cells that her husband has given to her. In most cases, even the woman also harbours this expectation.

When the baby is eventually born a girl, there is celebration all right, but obviously not as much as would have been if she were born a he. If the subsequent siblings are also girls, fear, sadness and desperations could easily descend on her family, while her mother must get her self ready for endless trips to the labour rooms and tutorials/clinical visits that are targeted at having a male child. If she were a he, and the subsequent siblings are all males too, many a today’s African father would ask the mother to stop becoming pregnant after only two to four male issues. The same mother would be expected to go through a possible nineth or tenth pregnancy if only one of her eight or nine children is a male. Along the African woman’s rough road, the preference for male children is as loud as the thunder. In fact, some men are known to have abandoned their wives and new babies in the hospital simply because the babies in questions were girls.

As the African woman passes through her childhood, the society systematically inflicts pains and deprivation on her. Even when she could barely recognize her environment, she is subjected to female genital cutting or female genital mutilation (FGM) or circumcision. And although this practice is gradually giving way, the implications of the past activities necessitate that the African society must be prepared to sanction duly and publicly, all concurrent culprits, and at the level of the African Union, symbolically apologise to our daughters, wives, mothers and sisters who have been subjected to this wicked regime. It is an established fact that all the reasons hitherto advanced for this exercise had been all numb, dumb and bunkum. At middle age and or menopause, her husband could abandon her for a younger woman, without care and concern.

Undone yet, the next bumps on African woman’s rough road include the outright shameless open-eyed discrimination she is subjected to within the family. She is made to see, feel, know and bear, that her younger or even twin male sibling, whose only contributions to the household are to play and eat, is more important to her parent’s union than herself. She does all the kitchen and household cleaning jobs and eats the least portable of what is available if this is not enough to take care of her brother’s appetite. She is made to work while her male counterpart plays around, made to stay back to do some house shores– thus earning a place among the 65 million out-of-school girls in the world’s educational statistics, while he goes to school. If she were lucky to escape sexual assault, sexual exploitation and or rape from ‘family friends’ or other close relations, she might not be so lucky when it comes to early marriage, unbridled predatory aggressive masculinity as exemplified in endless wife-battering, the mother-in-law ‘syndrome’, and the fact that she could be one of the over 585 000 women worldwide who die yearly of pregnancy-related complications.

The African woman could be judiciously killed on her rough road if it is proven that she slept with another man at the same time that her husband was sleeping with another woman somewhere, while the man is rewarded with the right and support to not only continue to sleep with other women, but to bring any of them home as an additional wife if he sore desires, regardless of all the promises and vows made during their marriage contract. A system that sentenced an Amina Lawal to death for having a child out of wedlock would gladly roll out its drums for Aminu Lawal at the naming ceremonies of a child he has gotten out of wedlock. The African woman’s traditional/automatic inheritance line is very vague. For, while her brothers or other male relations - if her father has no male child - would inherit her father’s properties, the African woman’s husband’s properties –which she must have sacrificed so much to jointly acquire- would be traditionally inherited by her male children or other male relations - if her husband has no male child.

In some societies, the African woman’s rough roads continue in married life with inglorious wife battering, neglect, deprivation and institutionalized social injustice. She is made to offer apologies, sacrifice or gifts to her husband -must not be pronounced guilty in his wife’s presence- after quarrels or misunderstandings even when it is obvious and agreed that the husband had indeed done wrong. Her husband’s relations can come into her maternal home to insult, intimidate and or fight her, while she is expected to hold her rage and ignore this unwarranted infringement on her privacy and right because she is the ‘wife of every member of the family’. When there is war, the African woman’s rough road becomes littered with bread winning, bread baking, bread sharing and bread protection – roles she must combine with looking after herself, her children and necessary new pregnancies that are expected to serve as replacement mechanisms for those men who would die in the war front. At the same time, she is faced with poor health and economic facilities, hunger and diseases.

If she is so unfortunate to lose her husband to the cold hands of death when her children are not well-established and old enough to stand by her through thick and thin, the African woman’s rough road to widowed would be littered with several traditionally justified thorns, stones and bumps; majority of which would be set and rolled on by fellow African women. Apart from having to compulsorily shave hair to the skin, she is made to sit two-four by the husband’s corpse until he is buried, while the husband’s relations busy themselves ransacking her home, taking stock of her families’ properties and stealing those they can immediately do with. Hours after the burial ceremonies, her civil war with her husbands relations over the custody of her family’s/husband’s properties -a war that might cost her sanity and or life, would start.

Depending on whether she has children for her late husband, and whether these children include male or not, the African widow’s civil war with her late husband’s family could be summarily executed or systematically fought. In some communities, if she has a male child, chances are that those who have come to deprive her of her family’s belongings would be fewer, cautious, challenged by concerned persons and probably lose out, because an heir is available. If she has no male child, and regardless of the number of daughters she has, it would be a Herculean task for her to be allowed the custody of her family’s belongings as the late husband’s male relations could unfortunately surface to lay claims of inheritance in the absence of any son from their late brother. If the worst happens, and this particular widow has no child yet for the late husband, then not only has the man’s death annulled their marriage, the absence of a child also means she could be sent back to her maiden home by the husband’s relations, without any properties, provisions for her welfare or necessary compensations.

Absurdity takes the stage when her late husband’s family would decide and impose one of their sons on the widow as the new ‘husband or care-taker’ whether she so wishes, likes or wants him, or not. Seen largely as one of their late brother’s properties that is available for inheritance, the African widow has no role or voice in deciding who ‘inherits’ her among her late husband’s relations. Usually, such an inheritor would present himself or be presented by her late husband’s senior family members as having been mandated by the family to ‘look after’ the widow and her children. In the real sense, he has come to sap, prey and parasite on them. He would come with no resources to sustain himself and or the family, and no provisions whatsoever made for the widow and her children. He would want the widow to treat and regard him exactly the way she had done for her late husband, and it is expected that she must largely comply, or continue with the costly civil war with her husband’s family members.

One of the first casualties of the family’s new ‘caretaker’ is the children’s welfare. Out of sheer jealousy and or greed, he could suddenly discover that too much of his late brother’s money was being spent on training the children in private schools, when their late father had succeeded with education obtained from market-corner public/community schools. He could also discover as the man-of-the-moment, that the nutritious meals (eggs, milk, fruits, fish, meat, etc.) that the children were used to, constitute a waste of resources. They could make do with local staples (garri, fufu, amala, etc.). This is no longer the time for the family to maintain a car for the children’s use. The ‘inheritor’ uncle could readily show them other children who are making it to their schools on foot, while their mother could continuously be reminded that it was because of her laziness that her late husband provided her with a car for her movements. After all, does it mean that she has two heads or is more beautiful or stronger than all the other women who accomplish their movements on foot and or with public transportation?

No longer should the children look forward to their usual occasional outings to public entertainment joints and recreational centers with dad and mum, nor should they expect to freely express themselves within the household. The new ‘husband’ might perceive these as uncomfortable exuberances of ‘spoilt children’ and further waste of money. In worse situations, some of the children could have their education truncated so that money could be used for ‘more important things’ as decided by the family. These children, some of who would have confided in their late father their desires to become professionals of all sorts, could suddenly discover that instead of going to higher schools, colleges and universities, the males among them would be sent to learn some trades as apprentices while the females are sent out are housemaids or be given out to forced second-generation early marriages; where the earnest desire of the husbands’ families would be that they should become pregnant immediately and bear them many children, among who MUST be males and PROBABLY females. This would also be the time to employ them as wares in the Africa’s alarmingly booming child-trafficking businesses; once more exposing them to second-generation sexual assault, sexual exploitation and or rape, unbridled predatory aggressive masculinity as exemplified in endless wife-battering, the mother-in-law ‘syndrome’, and the fact that they could be part of the next generation of women worldwide who die yearly of pregnancy-related complications. Full circle one would say.

Smoothening these rough roads has become an urgent, extreme humanitarian and developmental imperative for today’s society and the future. Efforts must be intensified to engender appropriate political will in the continent and among all Africans in Diaspora, to genuinely and practically implement the Millennium Development Goals and other relevant internationally agreed goals; especially as they concern the African woman. These include policies and programmes that seek to advance and achieve improvement in her health, educational, social, economic and political status. We must strengthen our commitment to improved access to and quality of health care for the African woman by eliminating early marriages and the untoward pregnancy/childbirth, which, are the leading causes of death among African women aged 15 to 19. This way, we would remove them from the about 70,000 teenagers who die annually because of complications from pregnancy and childbirth; and whose babies are 50% more likely to die than those born to older women. We must also provide effective, available and affordable birth planning services for all African women of childbearing age (15-49), through community-based antenatal care, child delivery by skilled birth attendants and the provision of essential emergency obstetric care on demand. All interventions that are identified as life saving/protecting should be encouraged, embraced and domesticated in our communities.

Deliberate efforts must also be made to improve the African woman’s access to education, by identifying and deploying appropriate information delivery strategies. This is very critical to achieving the Millennium Development Goals of reducing child deaths by two-thirds and maternal deaths by three-fourths by 2015. The African woman must be educated about her human rights, and be assisted to work to advance, claim, utilize, adapt, protect and propagate those rights. This way, we would provide a level playing field for the manifestation and promotion of their economic capabilities, elimination and or reduction of the feminisation of poverty, and enthronement of economic empowerment of the African woman, through such instruments as genuine micro-credit loans for our local women. We must also acknowledge and enhance the vital roles women could play in politics, governance and the family, by ratifying and implementing/enforcing national and international laws that seek to improve the status of women as essential development partners everywhere.

This writer urges all multilateral and intergovernmental agencies, donors, health professional associations, NGOs, academic/research institutions and development partners to foster partnerships through communication, coordination and cooperation, to studiously implement programmes aimed at mobilizing increased resources at all levels, and documenting and disseminating lessons learned from them; in order to enhance advocacy/information-sharing, technical advancement, and country-level support, and permanently smoothen the African woman’s rough road for the sake of all. The time has indeed come for us to move Africa into the real stage of development in human and social capital. We cannot get there without the African woman. Can we?

Dr. Uzodinma A. Adirieje
Executive Coordinator (Research & Development)
Afrihealth Information Projects/Afrihealth Optonet Association
Postal address: P.O. Box 4127, Oshodi, Lagos 100010, Nigeria
Courier/office address: 32C Adetola Street, Aguda-Surulere, Lagos 101014, Nigeria
Phone/Fax: 234-1-4520333, Mobile: 234-803-472-5905
Email: afrepton@hotmail.com
http://uk.geocities.com/afrihealthoptonetassociation/AfrihealthOptonet.html

HIV/AIDS: CARING AS AN OBLIGATION

2007-06-02T08:08:00.001-07:00

– Dr. Uzodinma Adirieje; Afrihealth InformationProjects/Afrihealth Optonet Association

The twin issues of access to care and what manner of care for HIV/AIDS, deserve serious attention even as the world battles to provide antiretroviral therapies/drugs (ARVs) for its treatment. For upwards of twenty years, HIV/AIDS pandemic has devastated and decimated various populations the world over, with effects that had been described in superlative terms, on Sub-Saharan Africa. It is no longer news that 70 percent of the more than 40 million people with HIV/AIDS worldwide, live in Sub-Saharan Africa, and that about 90 percent of those living with the disease do not have access to antiretroviral therapies. This implies a more urgent need to provide holistic approaches to care for people with HIV/AIDS and their caregivers, in order to have a more effective impact on the battle against the pandemic, especially in poorer countries like Nigeria, where medicines that controls HIV/AIDS are simply unaffordable to the majority of those who need them.

In formulating, providing and institutionalizing such holistic approaches to caring for persons living with HIV/AIDS (PLWHAs), it is imperative that their fundamental elements should be embedded in a typical ‘code of conduct for HIV/AIDS care’, which must be humane in its approach, universal in its application, adaptable in every circumstance and affordable to the patient community. To accomplish this, countries and states must live up to their undertakings to ensure at the last United Nations General Assembly (UNGASS) on the disease, that “by 2003 (that is before the end of last year), national strategies would have been developed in close collaboration with the international community, civil society and the business sector to increase substantially the availability of antiretroviral drugs and of essential drugs (and services), for the treatment (and care) of HIV infection and opportunistic infections, by addressing the provision of these drugs, including technical and system capacity, pricing, including differential pricing and by examining alternatives for increasing access and affordability of HIV/AIDS related drugs (and services)”.

Whether collectively and/or individually, it is imperative that the society should provide care for those living with HIV/AIDS and those directly affected by the disease, including orphans and caregivers, in the context of the UNGASS undertakings mentioned above. It is the belief of this writer that the provisions in the above undertakings relating to ensuring ‘technical and system capacity, differential pricing and alternatives’ provide the functional fulcrum for a most sincere and effective approach to AIDS care and cure. This becomes clearer when viewed alongside the UNGASS target of making significant progress in implementing comprehensive HIV/AIDS care strategies and strengthening community based health care and health care systems and infrastructure to provide and monitor treatment and care to people living with HIV/AIDS, support individuals, households, families and communities affected by HIV/AIDS, and improve the capacity of health care personnel, supply systems, financing plans and referral mechanisms required to provide access to affordable medicines and quality medical, palliative and psycho-social care for PLWHAs; by 2005 (next year).

The unfortunate relationship between HIV/AIDS and malnutrition is already known and acknowledged. Malnutrition increases the progression of HIV infection while HIV/AIDS aggravates malnutrition by weakening the immune system through its various negative impacts on the patients’ food intake, digestion, absorption and utilisation. Provision and adequate consumption of the right kinds and quantities of foods certainly improve fitness and quality of life of PLWHAs and those already infected with the HIV virus. Availability of sufficient and proper foods and a balance of different foods would help to maintain body weight and muscles, maintain and improve the performance of the immune system, and reduce the impacts of many of the symptoms of HIV/AIDS and its opportunistic infections.

To fully utilize and benefits from the nutritional management angle to HIV/AIDS care, we must improve our understanding and knowledge of the interrelationship between nutrition and the disease, including the possibilities and limitations of nutritional care and support for PLWHAs, the skills and techniques to apply innovative and programmatic approaches in our efforts to implement and communicate information on nutritional care and support to PLWHAs, their caregivers, health workers and others. We must provide the motivation to strengthen existing services and initiate new approaches to improve nutritional care and support for people with HIV, with their full involvement and those of all target groups.

In broad terms therefore, it could be said that nutritional care for HIV/AIDS must include considerations for such factors like HIV disease progression and implications for immunity and nutritional status, HIV related complications like diarrhoea, weight loss, loss of appetite, etc., the role of anti-oxidants and other micronutrients in HIV, support for children with HIV, food security, food safety and hygiene. It should also include nutrition education, communication and counselling for PLWHAs, implementation and integration of well-thought-out nutritional care and support in programmes/ policies, which must take into consideration all necessary practical work on translation and dissemination of guidelines into culturally specific recommendations, preparation of recipes and nutrition education.

The most important message should be caring for or controlling HIV/AIDS goes far beyond just access to ARVs. Probably more than ARVs, PLWHAs in resource-poor settings –and indeed everywhere- need proper medical, psychological and social care, nutrition, qualitative home and community care including administration of other essential drugs, opportunities to play certain roles in their communities and beyond, capacity development, improvement of HIV/AIDS and other related community based organizations, and improved positive perception of home and community based palliative care by health workers and all caregivers. The ‘code of conduct for HIV/AIDS care’ proposed by this writer is intended to be an adaptable model of care with details and operating procedures set out and approved; including the need to care for the caregivers, since most of them are older persons who have lost (to HIV/AIDS) the human generation between them and their grandchild, especially in Africa.

In recognizing that medications for treatment of HIV/AIDS and opportunistic infections are increasingly being provided, and indeed targets have been set for many national strategies to ensure that therapeutic, psychosocial and palliative care is available in some countries in Africa, the dearth of infrastructure for implementing such strategies is another problem. Efforts are needed to ensure adherence to the drugs prescriptions, support people through emotionally trying times, promote disclosure, and provide informed home-and-community based care especially in resource-poor settings. It is important in such settings to try and have health worker/personnel who have experience with treating HIV-positive patients, could prescribe antiretrovirals in clinically justified ways, provide voluntary counseling and testing counselling (VCT), and perform HIV-testing or tests for CD4-counts and/or viral load. The idea is to ensure effective care, service delivery, commitment, preparedness, and availability of support for maintenance and expansion of services.

According to the declaration of the United Nations General Assembly special session on HIV/AIDS, countries should have developed national policies on creating a supportive environment for children affected by HIV/AIDS by 2003 (last year). Have we? Have they? The ‘code of conduct for HIV/AIDS care’ proposed here would include means and measures to identify/establish and utilize caregivers and potential caregivers who can provide the complicated therapies and/or essential needs, if given help; those that have limited HIV/AIDS management experience such as antiretroviral therapies (ARVs) and prevention-of-mother-to-child-transmission (PMTCT) of HIV, and whose services can be expanded to include complicated therapies and essential needs simultaneously such as follow-up for people on ARVs who have begun treatment elsewhere; those who have already made arrangements to provide complicated therapies and essential needs simultaneously and who only need to be provided with the resources to start their implementation, including those who have already started this wider pattern of treatment within the past 12 months; and those who have enough experience in providing simultaneous complicated therapies and essential needs for HIV/AIDS, and are sufficiently organized to be able to help others mentioned above move in the same direction as prescribed by the proposed code.

School environment for HIV positive children and the role of teachers and education/teaching authorities are particularly important. These must be fashioned to remain receptive, caring and accommodating; so that what happened to little Miss Rachel Obetan (then aged 2 years), who was expelled by the authorities of Fabio Nursery and Primary School, Agboju in Amuwo Odofin Local Government Area, Lagos on July 23, 2002, on account of her (Baby Obetan’s) mother’s self-declared HIV positive status would not repeat itself or be repeated any where else. Integration of services for the benefit of PLWAs and their caregivers must be the norm. Integration among services for HIV/AIDS related social, psychological and health problems will lead to more holistic, efficient and successful provision of simultaneous complicated care, as against vertically managed unilateral and or non-integrative services that are less effective and more difficult to sustain. To accomplish this, the need for training, re-training, and more training, back-up support and supervision especially as regards management of HIV/AIDS complications and side effects, referrals, availability of effective drugs and VCT at the community level, compliance to treatment guidelines according to the recommended by the proposed ‘code of conduct for HIV/AIDS care’ as approved by the relevant health authority(ies), including motivation, reward/punishment and compensation for 'volunteers' and caregivers, cannot be overemphasized.

The health, psychological, physical and social complexities of HIV/AIDS, coupled with attendant emotional and economic consequences of the disease, create an imperative for very careful and systematic coordination between primary, secondary, tertiary care and all other levels of care for the disease. Efforts at recruiting and training volunteers and family members to provide home and community based care (HCBC), must be enumerated/programmed in the proposed ‘code of conduct for HIV/AIDS care’, adapted to the local environment, and intensively prosecuted. This writer is advocating for the evolution of an adaptable and minimally affordable care pattern, which ensures coordination of major sectors/players at the various levels, with a gender perspective and respect for human rights, ant with emphases on equal rights and opportunities for people living with HIV/AIDS (PLWHAs), in place of all forms of the so-called ‘unified national/international care policy/programme implementation, for HIV/AIDS.

With the proven scenario that individuals will seek to learn their HIV status where care and treatment are available, the effort to contain and prevent HIV/AIDS must include providing care and treatment, both for humanitarian reasons and because providing care enhances prevention by increasing the use of voluntary counseling and testing. Care and treatment interventions help to stabilize or improve the physical or mental health of individuals infected or affected by HIV/AIDS, reduce the burden on their families, provide hope to those who have or fear they may have HIV/AIDS, remove the stigmatization associated with the disease, and prevent opportunistic infections and secondary epidemics of TB and other complications.

Caregiving as an obligation must not necessarily imply the provision of new buildings and other large equipments and infrastructure. However, the provision of private space for counseling, and inpatient care and laboratory services are essential for VCT to be acceptable, although this has not always been provided in our healthcare settings. Also, the potential for PLWHAs to help one another and/or become involved in the development and running of services tailored towards them-- as exemplified through suggestions on how services can be improved-- must be explored. These might include the provision and/or modifications of equipments that would be needed for home care of patients. Such equipments and or modifications wheelchair, incontinence supplies, syringe driver and Hand rails, Widening doors, Raised toilet seat, Bath aids, Bed elevator, Stair lift, etc. Caring for these patients should also include thoughts and care for those who could be about to die, whose illnesses were at their terminal points. This is more so because, although most patients wish to die at home, barely a quarter manages to do so.

Because of the complicated nature of HIV/AIDS, the need for more holistic approach to its care and the paucity of formal care for PLWAs, it can be safely said that all sorts of persons and groups serve as caregivers for their welfare in every society today, including Nigeria. And, depending on patients' stage of the disease and his/her particular needs, the delivery of care to HIV/AIDS care in could be shared with the various members of the primary care team and members of the community. Care giving is being provided on a daily basis by medical services, families and communities development unions, other community level organisations, civil society, NGOs, the private sector, trade unions, the media, religious organisations, schools, youth organisations, women organisations, people living with HIV/AIDS organizations and individuals. These and others too numerous to be listed here now, are persons who care for, support and sensitise our population to the threat of HIV/AIDS and associated opportunistic infections and also to protect those not yet infected, particularly the women, children and youth.

Ironically, despite the mistrust, misconceptions and power struggles that dominate the relationship between traditional healers/alternative medical practitioners and other relevant stakeholders in HIV/AIDS /health care in the developing world and poorest countries, millions of their citizens patronise the former and other non-formal care providers including seers, self-proclaimed healers, and voodooists, on a daily basis, for HIV/AIDS care giving and related complications. To everyone that is so patronized in the traditional/alternative and formal health care settings, truth is that, whichever care is given, must be conceived, nurtured, presented and dispensed in a most sincere manner, and as an obligation.

Health, Empowerment & Development,

Uzo’
*****
Dr. Uzodinma A. Adirieje
Afrihealth Information Projects/Afrihealth Optonet AssociationPlot 1907, Sokode Crescent; P.O. Box 8880, Wuse Abuja, Nigeria
Phone: 2349.4818145, Mobile: 234803.4725905, 234805.6580180Email: afrepton@yahoo.com Web: http://afrihealthoptonet.kabissa.org http://uk.geocities.com/afrihealthoptonetassociation/AfrihealthOptonet.html

DIABETES ON THE PROWL

2007-06-02T08:06:00.000-07:00

– Dr. Uzodinma Adirieje; Afrihealth InformationProjects/Afrihealth Optonet Association
Long before HIV/AIDS surfaced on the world’s health profile as an incurable disease, diabetes has been. Its (diabetes’) insipidus variant is characterized by frequent and heavy urination, excessive thirst and an overall feeling of weakness, but with normal blood glucose/sugar levels. The mellitus variant on the other hand, is characterized by an unusual thirst and higher frequency of urination, but with the blood glucose/sugar level much increased beyond normal. It therefore follows that the urine fluid tastes more sugary in diabetes mellitus than in the insipidus variant.
It is diabetes mellitus that is of a great concern to the health and development community. It too, is of three forms. One form, typically called Type 1, mostly affects children and makes it appearance early in life. It is precipitated when the body’s pancreas does not produce insulin – the vital component that takes away glucose/sugar from the blood stream and converts it to usable energy for the human body. This situation consequently prevents the glucose/sugar from entering the tissue cells to be used as energy, thereby accumulating in the blood stream. Another form of diabetes mellitus, called Type 2, is the far more common type, affects adults mainly, but has recently been diagnosed in children. It occurs when the human body does not produce enough insulin, and/or the body is unable to use insulin correctly, the insulin already produced; once more leading to an accumulation of unused glucose/sugar in the blood stream of the individual. The third form is called gestational diabetes, and develops in certain women during pregnancy. When too much glucose ends up in the bloodstream, it could cause trouble for the circulatory system, the nervous systems and major organs in the body including the eyes and the limbs.
Type 1 Diabetes tends to develop suddenly, and requires that patients periodically inject themselves with insulin. Any affect child needs to prick his/her finger to test his blood sugar as frequently as 2 to 4 times daily; and if sugar level was found to be elevated, must give himself/herself a shot of insulin. Occasionally, such a child’s glucose level might fall too low, leading to loss of consciousness and constituting an emergency. At such periods, hospitalization and/or an emergency shot of the hormone glucagon to stabilize his sugar and possibly save his life might be needed. Recent postulations conjure that children born to Type 1 female patients of childbearing age might be predisposed to developing Type 2 diabetes as adults, due to exposure to a diabetic environment in the womb.
On the other hand, Type 2 diabetes occurs mostly in adults of ages thirty-five years and above. With its most common warning signs as increased thirst and frequent urination, it has the symptoms of frequent tiredness/fatigue, constant hunger and increasingly blurred vision. In women, it could precipitate irregular menstrual activities and chronic yeast infections - symptoms which tend to come on slowly and could easily be mistaken for other conditions. Its major risk factors include giving birth to a baby weighing more than four kilogrammes; being overweight, obese or physically inactive; having a parent or sibling with the disease; having high blood pressure or high cholesterol; and being of African-American, Hispanic, Asian or American Indian descent; and being over age 45. Lately though, younger people, including children, have also suffered from the disease.
Because of its characteristic slow onset, type 2 diabetes manifests in its victims long after it has been ravaging their body systems unnoticed. Typically, the patient ignores the symptoms of the disease, frequently attributes them to other factor like “you know the weather is somehow hot and one naturally feels thirsty and tired, and must drink water”, and therefore fails to piece them together. It must also be noted that diabetes risk profile has been known to be higher in women than in men, probable due to genetic and hormonal factors. But one sure factor is the tendency for a greater number of women than men, to suffer from obesity or excessive weight and general inactivity (the housewife syndrome), especially in the cities. Family history of the disease is also a crucial factor in its spread and containment. It has also been thought that people who develop Type 2 diabetes could have been prediabetic for some previous years, during which their blood-sugar levels were elevated but not high enough to qualify them as diabetics. As it ravages its victim, diabetes leads to frequent pains in the feet or gangrene, with shooting pains and intensified numbness of feet during the nights.
Gestational diabetes occurs in pregnant women, and has pregnancy as its major risk factor. It could also occur without any symptoms or history of the disease. However, women who develop gestational diabetes are 20 to 50 percent more at risk of developing Type 2 diabetes over the next 5 to 10 years, than those who do not. This writer thinks that there is be a possibility that the higher blood sugar of a diabetic mother could affect the development, nature and/or insulin-producing capacity of her yet-to-be-born baby’s pancreas, but this is just a thought. Suffice it to say that the effect of gestational diabetes on the future diabetic predisposition of the foetus is presently unclear.
For women and other obese people, fat releases varying levels of hormones that can affect insulin resistance. For type 1 Diabetes patients, intensive therapy would include multiple daily insulin injections or the use of an insulin pump with multiple blood glucose readings, in order to avoid many of the complications faced on a daily basis. For gestational diabetes, controlling the pregnant woman’s blood-sugar levels through diet, and continuing the controls after the baby was born, would help normalize blood sugar level permanently. Danger is, that untreated diabetes could eventually lead to blindness, kidney disease, heart disease and nervous system damage, especially in the hands and feet, which in turn can cause gangrene, necessitating amputation.
Over the years, procedures for diabetes diagnosis have become increasingly simplified. Type 2 diabetes, gestational diabetes and prediabetes could be diagnosed through blood tests, which measure the level of sugar/glucose in the blood. The fasting plasma glucose test or fasting blood sugar measurement is a typical method. With it, a small volume of blood is usually taken from the patient’s after he/she has fasted or not taken any food for at least eight hours. Oral glucose tolerance test - a method, in which blood samples are taken after the patient has been made to drink a special glucose solution, is another diagnostic test for diabetes. At the same time, diabetes education would help to protect, better and improve the lives of millions of our citizens who are suffering from the disease, or are at risk for it. It is important that all diabetics and those at risk must appreciate that following a healthy diet, keeping body weight down, exercising (as simple as up to 30 minutes walk daily), cutting back on fats and carbohydrates, reducing body cholesterol, and having a basic-knowledge nurse in each children’s school, can have major benefits for the society in controlling diabetes and preventing its manifestation in future generations.
Most importantly, one of our ‘current concerns’ is that Nigeria should institute a National Diabetes Control Policy/Programme (NDCP). After all and to a larger extent, the pains and pressures of diabetes could be delayed, controlled or prevented through diet and exercise. So cheap!

Health, Empowerment & Development,
Uzo’
*****
Dr. Uzodinma A. Adirieje
Afrihealth Information Projects/Afrihealth Optonet AssociationPlot 1907, Sokode Crescent; P.O. Box 8880, Wuse Abuja, Nigeria
Phone: 2349.4818145, Mobile: 234803.4725905, 234805.6580180Email: afrepton@yahoo.com Web: http://afrihealthoptonet.kabissa.org http://uk.geocities.com/afrihealthoptonetassociation/AfrihealthOptonet.html

BLINDNESS MORBIDITY AND NATIONAL ECONOMIC PRODUCTIVITY

2007-06-02T08:02:00.000-07:00

– Dr. Uzodinma Adirieje; Afrihealth InformationProjects/Afrihealth Optonet Association

Blindness is the absence or loss of the ability to see or the power of seeing or the faculty of vision. In practical and clinical terms, it is classified, as visual impairment characterized by a person’s best-corrected visual performance being the ability to counter another person’s fingers from a distance of three meters, where a person with normal vision would count the same fingers from a distance of sixty meters. At the extreme of blindness is the inability to perceive light.

Worldwide, there are 45 million blind people, and this number could double in twenty years. For every minute that you spend reading this piece, twelve previously sighted persons, including a child, would become blind in the world. Unfortunately, 90 percent of all the blind persons live in developing countries with about nine million in India, six million in China, and seven million in Africa. Fortunately, 80 percent of all blindness is avoidable by direct treatment and or prevention while eye care remains one of the most cost-effective health care interventions ever known to man. Among the causes of blindness are industrial/occupational accidents, cataract, trachoma, onchocerciasis, childhood blindness, refractive errors and low vision. Others include such systemic diseases as HIV/AIDS, diabetes and hypertension.

Industrial/occupational accidents often occur in various human activities, endangering eye safety- a very critical to the overall safety programmes in companies/industries, sports and families. One is at risk for blindness if his/her activities in these setups involve such dangerous eye hazards like gases, vapors, liquids, radiation/radiant energy, large flying particles and fragments, dust, fumes, mists, small particles, splashing metal, intense heat and/or lasers. These hazards should motivate concerted corporate, family and individual actions. Any person who works, plays or stays in an environment that is characterized by any of these hazards, is at an increased risk of becoming one of the twelve persons who would go blind in the next minute, and must be provided with adequate information, care and protection. Blindness prevention and concerns must be major parts of the complete safety program in companies/industries, sports and families, and a complete analysis of these environments is necessary to identify the existence of any of the potential eye hazards mentioned above.

Cataract – the clouding and loss of transparency of the crystalline lens in the eye- is one of the major causes of blindness among adults, the other two being trachoma and onchocerciasis. It is the leading cause of blindness in older persons around the world. In younger persons and even children, it could result from injuries and diabetes. That many people are blind today as a result of cataract clearly indicates the need for more community-based approaches to identify and manage cases, since many people blind from cataract do not know that their blindness is curable. One recognized preventable cause in high-risk occupational groups is exposure to UV-B radiation in sunlight; an exposure that transcends all races and genders, and could be reduced by the use of eye protection measures such as hats, plastic glasses, and sunglasses. Cigarette smoking increases the risk for cataracts in older persons, but it is unclear how completely this risk is reversed in people who stop smoking. Proper nutrition -including antioxidants vitamins- and lifestyle adjustments could slow down and possibly reverse cataracts development especially in the very early stages and in the absence of other causes.

Trachoma- a chronic infectious disease of the conjunctiva and cornea, characterized by follicular formation, papillary hypertrophy, vascularisation, corneal infiltration and opacity/scaring, is another major cause of blindness, especially among persons who dwell in dry/dusty environments, and or prone to dirty lifestyles. It is caused by the bacteria Chlamydia trachomatis, and could be responsible for up to 35 percent of blindness in endemic places. It is spread by flies and through infected hands and cloths, and characterized by strong ‘sandy feelings in the eyes’, intense redness and thickening of the usually pink-coloured conjunctivae. It is known that regular washing of the face, marinating a clean environment, application of antibiotics and surgery when eventually the in-turned eyelashes start rubbing painfully on the cornea/eye ball, are effective approaches to trachoma control.

Glaucoma-an increase in the pressure inside the eyeball to an extent that the concerned eye could no longer tolerate- is another leading cause of blindness, accounting for up to 15 percent of all blindness in certain situations. Blindness in glaucoma is usually due to the damage it causes the optic nerve and retina. Such visual loss affects mainly side vision. Glaucoma has no cure and loss of vision from it is irreversible, but early detection and control are quite possible, and can help preserve sight.

HIV/AIDS also causes blindness. Cytomegalovirus (CMV) retinitis is the most common ocular opportunistic infection and cause of visual loss in people with AIDS. Depending on the immune recovery status of a person living with HIV/AIDS, visual loss from CMV retinitis often occurs in HIV-infected individuals even when treated with highly active antiretroviral therapy (HAART). This is a more common complication of healed CMV retinitis producing ocular sequelae and consequent visual loss following recovery following HAART, with or without immune recovery uveitis (IRU). It has been reported that ocular sequelae occured least in patients with immune recovery but without IRU, and that moderate visual loss- significantly associated with retinal detachment- could develop in eyes with immune recovery and subsequent IRU. This could be due mainly to a high incidence of intraocular inflammation secondary to HAART induced immune recovery uveitis in healed CMV retinitis. According to a finding, “prior to the advent of HAART, 20% to 30% of patients with a CD4+ cell count <100 cells/microliter (mcL) could be expected to develop CMV retinitis over a 1-year period. The widespread use of HAART and the development of new systemic and intraocular drug therapies have had an enormous impact on the incidence, clinical features, and long-term outcomes of CMV retinitis. …. 30 percent of patients with AIDS will develop CMV retinitis during their lifetime, (but) effective treatment with HAART has led to a decline in vision impairment from the disease.”

Diabetes is one other cause of certain preventable blindness in today’s world. It causes diabetic retinopathy (DR)- a most common microvascular complication, affecting approximately 49% of all those with the disease. DR remains the leading cause of new blindness among working-age individuals in developed countries, and is gradually gaining the grounds in developing countries as well. Blindness from DR is due to retinal ischemia from progressive loss of retinal capillaries, causing abnormal proliferation of new vessels in the retina- the so-called micro-aneurysms, leading to bleeding, scarring, macular edema, fibrosis and traction on the retina, retinal detachment, and severe visual loss. Malnutrition is another cause of blindness, and the major cause in children. Its impact includes vitamin A deficiency diseases (VADD) among pre-school and school aged children, leading to keratomalacia, xerophthalmia and corneal opacity (which causes the blindness). It is important that the nature, identification, causes, and management/prevention of VADD, using vitamin A supplementation and locally available and affordable food source like vegetables and fruits, be regularly emphasized.

Blindness -especially in developing poor countries is compounded by the lack of resouces, political will and adequate baseline data on its prevalence and causes, which are needed to produce reliable national databases and programmes. This is because for every one person that goes blind, three others become visually impaired. Imperatively therefore, we must get informed, concerned and involved, because the next blind person could be you. Or me!

In May 2003, the World Health Assembly passed a resolution urging all member-states including Nigeria, to develop National Prevention of Blindness Plans by the year 2005, implement them by
2007, and have evaluated results by 2010. Aptly called Vision 2020, this Plan aims to eliminate unnecessary blindness in every nook and cranny of the world by the pear 2020, in order to give all people in the world, particularly the millions of needlessly blind, “The Right to Sight”. It is a global initiative of the International Agency for the Prevention of Blindness (IAPB) and the World Health Organization (WHO), with a coalition of international Non-Governmental Organisations

On a larger scale, Vision 2020 is aimed at increasing the awareness of blindness as a major public health issue; controlling the major causes of blindness – cataract, trachoma, onchocerciasis, childhood blindness, refractive errors and low vision, making low vision services, including low vision devices and spectacles, available at affordable prices to people suffering from impaired vision and refractive error; training sufficient eye care workers to treat even the most remote and poor communities of the world; and creating local infrastructure to ensure that high quality and affordable eye care services are available to all.

Unnecessary blindness is described as a blindness that should not have been, that could have been prevented and or controlled. Today worldwide, in addition to the 135 million persons with low vision, 45 million are blind - a total of 180 million people with significantly poor vision. The 45 million blindness figures could reach 76 million by 2020 if urgent efforts are not made to contain the tide. Conversely, appropriate effort would reduce the blindness figures to 24 million in 2020, save the world 429 million blind person-years and provide a conservative $102 billion estimate in terms of economic gains. It therefore follows that blindness is not just a health issue. It is an issue of huge national and global economic importance. It is also an issue of poverty.

From this writer’s experience in providing industrial/occupational vision services, uncorrected visual problems cause accidents and death in the workplace, during sports and social activities, and even at home. Regular eye examinations are important to detect and manage any vision disorder, while all adults and active persons are advised to have their eyes checked by a qualified eye doctor every six months. Eye safety/protection appliances must be worn whenever exposed to potential hazards, and such eyewear must be properly fitted in order to provide the needed protection. Even when eye problems and industrial injuries/accidents occur, appropriate first-aid must be provided immediately, to provide temporary relief, and prevent any additional damage. Work safety programs with strong focus on eye safety will significantly reduce the incidence and impacts of eye injuries in industrial settings; and when using electric/manual saws, lawnmowers, automobile engines and other high-speed machines and equipments in and around the workplaces, offices, fields and homes.

Blindness and low vision from whatever cause(s) are visual impairments that constitute considerable socioeconomic strains on both the individual and nation. Often, persons with blindness and low vision face extremely narrow job market, limited participation in social activities, increased suffering and premature death when compared to their age mates; while their families, communities and nations suffer from lost worker productivity and incur additional costs in providing social and rehabilitation services, where available. The causes of blindness and low vision wherever are generally associated with lack of access to quality eye care services, poverty, illiteracy and deprivation, and most commonly found in rural, often remote and undeveloped areas of Nigeria and other developing countries, especially in the global south. Grossly inadequate budgeting for blindness prevention and health care, and the absence of adequate and reliable baseline data on the prevalence and causes of blindness further compound this problem.

Therefore, the need to understand the magnitude, geographical distribution and causes of blindness within communities, countries and regions, is essential for the design of effective intervention programmes. Relying on hospital and clinic based data would not give the real picture prevailing in such circumstances. The only means of developing reliable data on the prevalence, causes and economic costs of blindness in these situations is by conducting community-based, nationwide and regional prevalence surveys as appropriate. This way too, it would be possible to provide reliable data on say the level of economic development that followed regression of trachoma through controls, the level of increased utilization of farmlands and agricultural productivity that followed onchocerchiasis control in endemic areas, and so on.

The time has come for visual impairment detection, prevention and management to be moved onto our community and national health agendas beyond rhetoric, through the ESTABLISHMENT OF A NATIONAL EYE CARE PLAN FOR NIGERIA - expected to come out of genuine national consultation of all partners and stakeholders, in order to ensure eye health promotion, effective eye care services delivery and research into the causes and prognosis/sequence of blindness and low vision in the country. The proposed National Eye care Plan would provide an overview and exploration of eye care and vision issues in the country, and a platform for advocacy and partnerships for eye health. Expectedly, it would document or seek to document the economic costs and burden of visual impairment on Nigeria and her people, the prevalence and risk factors of visual impairment, the benchmarks and recommendations for preventing/controlling them, and the country’s Vision 2020 plan of action.

Suffice it to submit that a national eye care plan for Nigeria must address issues of public information and awareness, professional education and development, clinical and support services, policy, legislation and standards, and research, monitoring and evaluation activities. It is important to increase awareness among health workers, community leaders and people in government on the detection and management of the various eye problems that could lead to blindness and low vision, and their management approaches. It is important to improve facilities at health institutions for the detection and management of this disease, and at the various institutions that train eye health professionals. It is important for the government to enforce and or review existing policies and legislations to eliminate quackery; mediocrity and poor standards in the provision of eye care services in the country. And it is important that companies, industries and business/social concerns be compelled by law, to provide visual impact assessments of their activities, especially those that are prone to generating visual and environmental hazards in their line of operations, breeding dusts, smokes, flies/pests, etc.

As the world marks this year’s WORLD SIGHT DAY on October 14, let us ensure that governments, community leaders, international nongovernmental development organizations, local NGOs, vision/health care providers, Vision 2020 partners, and all those who would wish to prevent 17, 280 persons from becoming blind today alone, to come together for the prevention of avoidable blindness, without which the much-talked-about millennium development goals (MDG) and increased national economic productivity would not be achieved. Have a blindness-free week!

Health, Empowerment & Development,

Uzo’
*****
Dr. Uzodinma A. Adirieje
Afrihealth Information Projects/Afrihealth Optonet AssociationPlot 1907, Sokode Crescent; P.O. Box 8880, Wuse Abuja, Nigeria
Phone: 09.4818145, Mobile: 0803.4725905, 0805.6580180Email: afrepton@yahoo.com Web: http://afrihealthoptonet.kabissa.org http://uk.geocities.com/afrihealthoptonetassociation/AfrihealthOptonet.html

PUBLIC-PRIVATE PARTNERSHIP AND NIGERIA’S DEVELOPMENT

2007-06-02T07:37:00.000-07:00

Public-Private partnerships or PPP relate to perceptions and practices affecting public private sector relationships in ensuring national/global health, development and well-being of the society, and the conceptual aspects of such relationships, including the role of the key players in collaborating to make these partnerships successful or otherwise.In Nigeria and other developing countries, sustainable access to healthcare and other socio-economic services and products can be accomplished through public-private partnerships, where the government delivers the minimum standard of services, products and or care, the private sector brings skills and core competencies, while donors and business bring funding and other resources. Such collaborations will be especially productive in promoting poverty alleviation through micro-finance, enhancing health through partnerships as has been the case with polio eradication and other child immunization efforts.In the efforts to achieve sustainable PPP, the objectives would be to highlight perspectives on development from leaders in civil society, government, business and the media, share information on development alternatives, provide forums for informed debate on related issues, seek to accomplish better understanding of the nature of relationships between governmental and nongovernmental organizations, and introduce conceptual frameworks for understanding such relationships. PPP objectives would also include bridging the information gap between the public and private sector organizations, analysing their capacities and opportunities, and suggesting mechanisms for improving the relationships between the government and the governed/citizenry.Intrinsic in the aforementioned objectives of typical public-private partnerships is the mission to contribute to the economic integration of a country or region, accelerate its economic growth and sustainable development, engender and sustain private sector participation (PSP) in traditionally public sector projects, and expand local access to international markets, thereby ensuring the country’s deeper integration into the global economy. For Nigeria in particular, this could be done within the official NEPAD structure, ECOWAS, other regional economic communities in Africa, governments, private sector, civil society and other stakeholders. The overall objective would also include the mobilization of private investment for infrastructural development, socio-economic growth and poverty elimination. It would also include increasing the effectiveness of public-private collaboration, such as helping those seeking to develop and provide healthcare products and services, and improving access the several local products that are targeted towards achieving disease eradication, controlling other health problems and accomplishing adequate standard of living within the country.
In order to achieve a sustainable PPP for ensuring the most effective, productive, compassionate, result-oriented and efficient use of resources, it is imperative that the members or subscribers to the partnership must adopt a single framework of action that provides the basis for co-coordinating the work of all partners; put in place and maximally utilize a single national or community coordinating body with a mandate from various sectors or stakeholders, and agree on a single national monitoring and evaluation (M & E) mechanism to ascertain and maintain accepted standards. Such an arrangement will enhance the coming together of several stakeholder such as federal, state and local governments; profit-oriented businesses and not-for-profit organisations, community development associations, UN and other transnational agencies, civil society groups and faith-based organizations; to work towards sustainable development and poverty reduction within the communities and the country as a whole. It is obvious that the synergy of a PPP of this composition could – and indeed should – produce recommendations from series of meetings, researches, seminars and or workshops on public private partnerships in their areas of concern; using one or more common perspective, and working within fairly common environmental conditions. It would also provide a basis for offering and sharing existing information on PPP, and for follow-ups. This way, the partnership could support member-organizations that build capacities within citizen organizations through management training and advice, conducting researches, collecting data on health development issues, applying policy analysis through dialogue, and promoting enabling environments. A potential outcome of this engagement is a private sector-led initiative, which could serve as catalyst for investment in community and national development projects, leading to more collaboration among the wide array of stakeholders in tackling the social, political, financial, technical and other obstacles that stand in the way of the projects being implemented. It will also empower the partnership with a brokering role between prospective investors and other stakeholders including government and local communities. This will ultimately eliminate or reduce to the barest minimum, the social, economic, political, financial and capacity constraints that impede the development of infrastructure within the community or country.Several commentators, including this writer, hold a strong view that public and private sectors are complementary, and that effective public-private partnership is only possible through mutually designed, analysed and accepted instruments of cooperation and collaboration. This writer in particular, believes that such instruments are effective in all sectors of human endeavour including health, profit and not-for-profit, education, housing, micro-finance, community-based development projects, etc. For Nigeria in particular, achieving the PPP paradigm would mean deliberate and sincere effort to understand the nature of prevailing efforts in this regard within the country, identify their key challenges and opportunities, and seek to know how they can contribute to stronger national and family-level health, economic and social systems.For rural and poor urban communities in particular, PPP projects of interest would include interest transportation by rail, road and waterways, electricity and energy, telecommunications, agriculture and food preservation/processing, housing and water. In accepting such projects for the PPP arrangement, it must be noted that most of them would be expected to have predictable cash flows and provide investors in the partnership with an acceptable return on their investments. Therefore, care must be taken to ensure that projects so selected, have undergone rigorous due diligence processes by the relevant organs of the stakeholders, and have been chosen as the best projects with well-conceived business plans, realistic financing plans and anticipated investment returns that is favourably disposed to the purchasing powers of the poorest of the poor. Costly services and products will ultimately become unaffordable to the majority of the people, and ensure that projected patronage and income remain mere dreams.
In undertaking any PPP project, it must be understood that partnerships rarely occur without external impetus. PPPs must, therefore, be facilitated through processes aimed at translating the desires of stakeholders into the form of partnerships so desired. Even after formation, the continued existence of any PPP needs to be deliberately institutionalized, using various mediating processes or programmes deemed necessary for the implementation of partnership agreements. Such processes or programmes need to be rooted in local circumstances and comprehensively understood by representatives of all stakeholders. Anticipated outcomes and problemsIt must be noted, however, that greater output shall be realized if PPP agreements or contracts are structured in ways that do not place the poor majority in any social, economic and or political disadvantage. Also, combining the partnership with credible and group-accepted innovative approaches to funding and mobilization has the potentiality of increasing the overall access to essential services based on PPP structures already in place. For trail blazers and champions of community participation and human development evangelism, a deficiency of clearly stated mechanisms of action and or the absence of credible avenues for monitoring and informing interested parties on the progress and status of approved PPP projects, should be seen as an avoidable anathema.In conclusion, in order for government to deliver the minimum standard of services, products and or care required for a PPP to thrive, it must put in place, laws, regulations and institutions or enhance existing ones, as well as improve the enabling environment for private sector participation (PSP) in the provision and development of infrastructure to occur. Stakeholders’ commitment to the PPP would be accomplished by focusing on micro, small and medium-sized operations, involve community leaderships like community development associations, town unions, non-governmental organizations, local, state and/or regional governmental authorities including private company operators.Included among these potential partners are municipalities, government agencies and ministries, public and private companies, and trade associations as potential partners. It is incumbent on all stakeholders to orient PPP activities around orientation, match-making, implementation and institutionalization for effective and sustainable outcomes.

Dr. Uzodinma A. Adirieje
Programs Director/CEO
Afrihealth Information Projects/Afrihealth Optonet Association
7/9 Enoma Street, Okota-Isolo, P.O. Box 4127, Oshodi 100010, Lagos, Nigeria
Phone/Fax: 234.1.452.0333, Mobile: 234803.4725905, 234805.6580180Email: afrihealthoptonet_ng@yahoo.com
Web: http://afrihealthoptonet.kabissa.org, http://uk.geocities.com/afrihealthoptonetassociation/AfrihealthOptonet.html

PUBLIC-PRIVATE PARTNERSHIPS FOR SUSTAINABLE COMMUNITY-BASED HIV/AIDS ADVOCACY

2007-06-02T07:29:00.000-07:00

BACKGROUND

Public-private partnership - also called PPP or P3 - is a system in which a government service or private business venture is funded and operated through a partnership of government and one or more private sector organisations or companies, including NGOs. Advocacy on other hand is the process for altering the ways in which power; resources and ideas are created, consumed and distributed at any level, so that people and organisations have a more realistic chance of controlling their own development.

When deployed in a community, advocacy sets in motion the dynamic process of developing consensus and a mandate for action, and produces/brings together like-minded allies with shared goal(s) in order to change their ways of doing things and the ways other people and institutions perceive and or treat them. A process, condition or action is sustainable when it can be maintained indefinitely without progressive diminution of valued qualities inside or outside the system in which the process, condition or action operates and or prevails.

Within and for a community, HIV/AIDS advocacy should entail persuading and convincing people, increasing their knowledge, understanding, access, demand for and utilisation of voluntary counseling and testing (VCT) services and available antiretroviral therapies (ARVs), and even participation in vaccine trials. It would mean deploying efforts and emphases towards the elimination of stigma and eradication of extreme poverty. It would mean activities geared towards increasing household disposable income through the creation of new employment opportunities, democratization of access to credit and establishment of income generation activities for women.

Effective HIV/AIDS advocacy in any community must also mean fostering actions that decrease the workload on persons living with AIDS (PLWAs) and persons affected by AIDS (PABA) including widows and orphans. That is, the promotion of more local control of the resources for advocacy within the community by persons living within the community, especially decreasing the skewed distribution of income and wealth that is typically very unfavourable to women; using emphasis on equity, socioeconomic justice and fairness. It should endeavour to address discriminations based on social, gender and ethnic/tribal or caste statuses; promote as many elements and means of sustainable development as possible; and influence community development-related actions by ensuring active participation of the people in informed decision-making.

It must focus more on what is possible and doable within a community’s identified capacity, and particularly on how it can be done. Advocacy should ultimately raise the community’s - and its people’s - consciousness about how so important they are in using the resources and ideas available to them in creating, distributing and consuming HIV-related goods and services within their community, thus providing them with a more realistic chance of controlling their own health and development processes.

In order to facilitate and improve community-based HIV/AIDS advocacy, a PPP would be needed to generate basic knowledge/research, participate in products discovery and development (ARVs, vaccines, condoms, etc.), improve access to available health products, support HIV/AIDS and health services strengthening and health promotion/public education, and coordinate efforts towards the regulation, quality assurance and standards of existing and upcoming products and services.

The PPP in place should adopt strategic advocacy in deploying the aforementioned information to change policies that adversely affect the lives of PLWAs, PABAs, widows, children orphaned by AIDS and other disadvantaged people within the community. This should often involve lobbying local and international development partners, governments at as many levels as possible, and local NGOs involved in HIV/AIDS, health and development. Traditional, political, business and religious institutions should also be lobbied.

In addition to enhancing the advocacy skills of members of the PPP to challenge local, national and international policies, such strategic deployment of information and resources by the PPP will strengthen the structures through which the very poor, PLWAs, PABAs, widows, children orphaned by AIDS and other disadvantaged people within the community can participate in the formulation of the policies that control their lives, including the development of strong local networks and representation on local and national civic institutions and in related activities. This writer is stating the obvious that projects which involve the people affected by policy change in developing, implementing and monitoring advocacy usually work better to achieve concrete desired change on the ground – the essence of advocacy!.

THE PROBLEMS….

Typically, a PPP is dissatisfied with the impact and or processes of existing HIV/AIDS programs, products and or services available in the community, and has united to initiate actions and provide needed support for themselves (including their families and employees) and others that were impacted by the spectrum comprising HIV and its related diseases; and wants to effect and or influence changes that would visibly improve the health status of PLWAs, PABAs and the community at large.

In this onerous effort, the PPP confronts a multitude of challenges including uneven and inadequate distribution of services, complexities in health services being offered, poor or lack of cohesive policy and planning, cumbersome fragmentation of services and unpredictable demands on the existing health systems with limited resources as we witnessed with Ebola, SARS and bird flu to mention but a few.

It must also confront inefficiencies in data management within the health system especially as they relate to processes, outcomes and costs; confront deficits in the community’s knowledge of prevention, care and cure especially among poor and mostly illiterate inhabitants; understand the strategies and principles of the consumers, providers and public in relating with the health system that manages HIV/AIDS within the community; evaluate access to, quality and effectiveness of prevention and care service; and determine the imperative for change through the identification and dissemination of information, definition, identification and implementation of ‘best practices’; and improve efficiency through well-coordinated decentralisation approaches Community-based PPPs should advocate for HIV/AIDS control programmes and activities that reach organizations within their communities, and for the provision of HIV/AIDS-related services to clients and educational institutions, businesses, churches, etc (including non-members of the partnership). These groups could benefit from advocacy tailored at providing and accessing foods and nutrition to AIDS orphans, the elderly and persons on home-based care and or treatment. They could also benefit from advocacy meant to establish thriving ‘ten-to-teens’ peer education groups, producing monthly/periodic newsletters, organizing small focus groups to discuss HIV/AIDS in the community, providing help with housing and emergency financial and healthcare needs, transportation, VCT, nutrition counseling, referrals, etc.
For Nigeria and other ‘undeveloped, non-developing or developing (?)’ countries, the infectious disease burden due to HIV/AIDS, TB and malaria is enormous. Although the three diseases are being given a global onslaught through the Global Fund and several other similar initiatives, each of them is basically different in terms of the impact of its burden and local coping capacity within different communities. In some communities, products and services needed to control one or more of the diseases are available and accessible/affordable. In others, available products and or services are bedevilled by poor access and or lack of affordability, while some others are beset with problems of acquired drug resistance mainly due to improper usage.
The PPP might wish to address these issues through collaboration with any research and or development effort that is underway within the community (e.g. by a pharmaceutical or marketing firm), or initiate one and invite its members to buy into it. It is essential that the partnership realises that this would require some level of scientific knowledge which is most likely available within the PPP, or can be identified and brought into it. One of the poorly-emphasised advantages of the PPP is its freedom and capacity to enlarge and co-opt required ‘power bases’ into its fold and activities, at any time. The leadership of the PPP has the duty to discover such ‘power bases’ and decide when to bring them in.
WHY THE PPP’S HIV/AIDS ADVOCACY AT COMMUNITY LEVELS

Although other approaches might be available – and indeed might have been used – to pursue HIV/AIDS advocacy nationally and internationally, there still remains an acute dearth of visible concerted effort at the community levels. PPP-championed community level advocacy for HIV and Aids prevention, care and treatment recommends itself for the following possible reasons:
a) It would prevent or mitigate an AIDS epidemic among targeted and participating communities
b) It could be one of the key elements in achieving high coverage and sustainability as it is an activity from and for within
c) HIV/AIDS advocacy has a greater tendency of becoming part of the community’s culture as the PPP is passed on from generation to generation, thus assuring its own sustainability
d) It links experienced and emerging leaders within and across HIV/AIDS-affected communities, sectors and issues
e) It emphasizes the importance of the health needs and rights of all members – indigenes and migrants alike - and supports them to access available HIV and Aids products and services
f) It is capable of utilizing available knowledge and instruments of HIV and Aids prevention, care and treatment to bring the epidemic under control
g) Its participatory nature encourages ‘patient self-advocacy’ i.e. involvement of PLWAs, PABAs, widows, orphans and vulnerable children in decisions and actions on HIV/AIDS within the community, either directly or through equally affected representatives
h) It helps the community to organize and ensure that the voices of people living with HIV/AIDS and their loved ones are directly heard by elected officials and administrators of government programs - who are also part of the PPP; thus short-cutting over-bearing bureaucracies and attracting government’s ‘quick action’
i) Its all-embracing nature puts the PPP in a best position to define mortality/morbidity, trends and costs, access to treatment, care and support, availability and suitability of non-drug interventions, limitations of existing products and services, alternative potential interventions, possible scientific challenges, extent of current industry engagement, etc within the context of the community
j) By its nature too, the PPP has the capacity to employ private-sector approaches to support HIV/AIDS research and confront drugs and vaccines development challenges
k) Because the PPP’s primary motive is public health rather than commerce, it is capable of monitoring the implementation of approved and existing government’s policy for the control of the pandemic, as well as providing more sincere evaluation of the same

DECIDING ON PPP’S OBJECTIVES FOR THE HIV/AIDS ADVOCACY

Depending on the peculiarities of each community, the system objectives of a typical PPP for sustainable community-based HIV/AIDS advocacy may include any of – but is not restricted to – the following:

i. To increase the participation of people living with HIV, their families, communities and organizations in non-partisan HIV and Aids control activities
ii. To link local HIV/AIDS activists to State, national and global campaigns for effective HIV prevention, care and universal access to quality treatment
iii. To build HIV and Aids outreach and service into community activism
iv. To help workers and all persons affected by HIV and Aids to find a voice in the larger systems
v. To encourage the utilization of the ‘Doha Agreement’, for local production and effective roll-out of inexpensive generic medicines for HIV diseases and associated opportunistic infections
vi. To improve the capacity of its members to monitor stakeholders’ delivery on various commitments and advocate effectively for improvement in HIV and Aids control through necessary sectoral reforms
SELECTING THE PPP’s PROJECTS AND ACTIVITIES
The sustainability of each community-based PPP’s advocacy projects and activities for HIV/AIDS depends largely on the partnership’s existing facts-backed knowledge-base of the current status of the pandemic and the efforts towards its control within the community. Typically, projects and the activities tailored towards their implementation will benefit immensely from baseline studies and or a detailed literature reviews of ‘what has/have been done’ previously, including the existence of any ongoing projects. In selecting the PPP’s projects and activities, it is necessary to increase the numerical strength of the PPP’s membership and ‘power bases’, in order to avoid unnecessary duplication, minimize wastages and ensure that any project subsequently initiated, is owned by a vast segment of stakeholders within the community.
Depending on the findings from the baseline survey and or detailed review of existing projects and activities, the PPP may choose to:
i. Provide technical assistance and mentoring to member-organizations of persons living with HIV/AIDS, youth groups and young leaders seeking greater engagement in HIV/AIDS advocacy
ii. Provide training and capacity-enhancement to build sustainable advocacy skills for partners and other local groups
iii. Implement strategic media engagements for locally relevant, winnable and community-based prevention policy campaign
iv. Organize town meetings and other stakeholder consultations to create the opportunity for government, businesses and development partners to engage in face-to-face interactions with PABAs, PLWAs, orphans, widows and the very poor within the community; with focus on initiating State policies and programmes for effective control of the Aids and other HIV diseases
v. Improve the organizing ability of community leaders for HIV and Aids activities, especially in the area of power relations, identification and enlistment of potential partners, choice of appropriate issues for advocacy; strategies development, coalition building and media ‘tangos’
vi. Develop tools for increasing the power and ability of local leaders to collaborating with governments, development partners and other service organizations
vii. Increase the knowledge-base of stakeholders within the wider context of social and political struggles related to HIV and Aids, and current challenges of solidarity and health/human rights activism within the community, local government/municipality/county, State, country and beyond
viii. Deepen collaboration between its members, other AIDS activists and similar PPPs in identifying areas of common concern in HIV prevention and Aids treatment, care and support within a holistic health system; in order to bridge existing gaps and prevent the re-emergence of previous problems
A CHECKLIST FOR SUSTAINABILITY
Although by no means complusive, the following comprise a quick success-checklist for a PPP engaging in community-based HIV/AIDS advocacy and aiming at sustainability:
a) Factors that will help maximize chances of success include:
i. Existence of a clearly defined mission with a well articulated goal
ii. Availability of adequate financing for the initial phases of project activities and projection of total financing required to meet the end goal
iii. Access of the partnership’s top management team to the best information and science available for the project and activities, and a track-record in delivering on assigned responsibilities despite current/ongoing tight professional and social engagements
iv. Availability of a work plan providing for the steps to be taken, by whom and when, in order to achieve the mission
v. Existing assurances of real collaboration from members and other stakeholders with the required expertise and proven record of keeping their promises
vi. Active presence of and experienced and independent board to take charge of regular oversight functions on the management’s daily activities
b) Factors that indicate measures/degrees/extent of success achieved by the PPP in its advocacy drive:
i. Success with direct fund-raising
ii. Success with timely roll-out of activities in the work plan
iii. Emergence of hitherto neglected or unidentified areas of critical concerns
iv. ‘Discovery’ and enlistment of new members into the partnership while the project is ongoing
v. Increase in the number of interests expressed in the projects, and or enquiries received on it, such as enrolment of ‘more-than-anticipated’ anticipated number of candidates in VCT or vaccine trials
vi. PPP members and personnel display a new desire, willingness and or ability to apply private-sector models to the challenges of HIV prevention and Aids treatment, care and support within and beyond the community
SOME RECOMMENDATIONS FOR CONSIDERATION BY THE ‘PPP’
As stated in the first part of this piece, the PPP is ‘system’ for funding and operating government services and or private ventures for the maximum social benefit of PABAs, PLWAs, widows, OVCs i.e. orphans and vulnerable children, etc. Its motive is essentially non-profit, and participation of members might be in a nominal sense to enable them pay due attention to their main activities and businesses.
In order to derive maximum benefit from minimum inputs therefore, this writer recommends that:
i. PPPs should emphasise cooperation with each other and avoid competitions that bring duplication of products and services or monopoly of same
ii. They should create and emphasis a sense of their common purpose and direction is needed for appropriate cross-linkages and synergies
iii. Activities must be in line with identified community/environmental HIV control and Aids treatment, care and support needs
iv. Appropriate internal mechanisms should be developed for research and development, continued provision and utilization of products and services, and provision/optimum utilization of evidence for policy
v. All areas of conflict and potential conflict must be identified and turned into collaborative zones
vi. Strong local ‘on-the-ground’ stake-holding should be developed through the integration of capacity building and utilization in all projects and in as many activities as possible
Finally, as Dr. Paula J. Dobriansky, former United States Undersecretary of State for Global Affairs – and now the Undersecretary of State for Public Diplomacy and Public Affairs - said at the Council on Foreign Relations/The Brookings Institution on Thursday, May 23, 2002, “Our vision… is twofold. First, we believe sustainable development for every nation begins at home with the support of effective domestic policies. This is an unmistakable lesson of past development efforts. Second, we believe that the best way to capitalize upon these effective domestic policies is through building and nurturing local, national, and international public-private partnerships” Through this approach, sustainable community-based HIV/AIDS advocacy development can be achieved in a way that benefits everyone.

REFERENCES

1. Adirieje, UA. Public Private Partnership for Nigeria’s Development, http://phishare.org/documents/afrihealthoptonet/4267/, assessed on 17 August 2006
2. Burrows D. Advocacy and coverage of needle exchange programs: results of a comparative study of harm reduction programs in Brazil, Bangladesh, Belarus, Ukraine, Russian Federation, and China Cad Saude Publica. 2006 Apr;22(4):871-9. Epub 2006 Apr 5
3. Brashers DE, Haas SM, Neidig JL. The patient self-advocacy scale: measuring patient involvement in health care decision-making interactions. Health Commun. 1999;11(2):97-121
4. Pramming S. A partnership for a healthy future; Oxford Vision 2020, Cambridge, April 2004
5. Samuels, G. Public Private Partnership Issues in Communicable Diseases;
6. Schuftan, C. The Community Development Dilemma: when are Service Delivery, Capacity Building, Advocacy and Social Mobilisation really Empowering? Comm. Dev. J., Vol.31, No.3, July 1996.
7. Holdren JP, Daily GC, Ehrlich PR. The Meaning of Sustainability:
Biogeophysical Aspects, http://dieoff.org/page113.htm, assessed on 17 August 2006

Better Health for All,

Uzo’
****
Dr. Uzodinma Adirieje
Resource Centre Manager/Project Coordinator, Nigeria ART Study
Health Reform Foundation of Nigeria [HERFON]
10 Sakono Street, Off Adetokunbo Ademola Crescent, Opposite AP Plaza, Wuse II, Abuja, Nigeria
Phone: 09.4618496, DL: 09.4818145, Mobile: 0803.4725905, 0805.6580180 Fax: 09.5240433
Email: uadirieje@herfon.org, uaadirieje@yahoo.com
Website: www.herfon.org, www.nhc2006.org

Re: Gambia Premier Claims AIDS Cure

2007-06-02T07:27:00.000-07:00

I have read this and previous articles on this subject matter. I have also read the (probably) originating story in The Independent, UK of 3 February 2007 captioned "The President who claims he can cure Aids on Mondays".

I insist that this is painful news of managing HIV/Aids with VOODOO by His Excellency President Yahya Jammeh of The Gambia, until it is proven otherwise.

According to the original article in The Independent, UK:

1. The President Yahya Jammeh believes he has mystic powers, and was giving “treatment” to PLWHAs by laying his hands on the heads of patients at the Royal Victoria Hospital in Banjul.
2. Mr. Jammeh told diplomats that he has long had MYSTIC POWERS (emphasis mine) but that he only recently received a "mandate" to treat large numbers of people, adding "The cure is a day's treatment. Within three days the person will be negative."
3. According to rumours in Banjul, Mr. Jammeh's treatment is based on seven UNNAMED herbs that are mentioned in the Koran.
4. The President has not revealed the names of the herbs, nor divulged who has bestowed the "mandate" on him, which includes specific days of the week for each disease treatment. "I am not doing it for money or popularity," he said. "For asthma I have to choose between Saturday and Friday. I am also not authorised to treat more than 100 people. The one on HIV/Aids cannot be mass-produced because I am restricted to 10 patients only on every Thursday and Monday."

I have read from this posting that “present during the treatment [by HE President Yammeh] is the Secretary of State for Health and Social Welfare Dr. Tamsir Mbowe, Dr. Malick Njie the Chief Medical Director all were on attendance when the president was administering the treatment”. Doesn’t The Gambia have a health/medical practice regulating body?

In fact, Dr Tamsir Mbowe had been quoted as saying the results of this voodoo are "really very impressive...excellent news and means that the treatment is going very fine and there is marked improvement in the patients' condition". He had then curiously added that "this clearly shows that the treatment is very effective and we are really having gains now, which can be declared to the whole world... (bla bla bla) ... I am very much comfortable and happy with the treatment"

I remain worried that this approach is still shrouded in secrecy, restrictive, neither evidence-based nor adaptable, not transferable, relies on very questionable procedures, and is still promoted as “impressive”, “excellent” “treatment” for HIV and Aids by the Government and health managers in The Gambia. Does any one have information on the position of the World health Organisation (WHO), UNAIDS or the West African Health Community (WAHC) on this claim from The Gambia?

Better health,

Uzo’
****
Dr. Uzodinma A. Adirieje
Afrihealth Information Projects/Afrihealth Optonet AssociationEmail: afrihealthoptonet_ng@yahoo.com
Web: http://phishare.org/partners/afrihealthoptonet, http://afrihealthoptonet.kabissa.org

Re: Perspective: When Africa will be self dependent?

2007-06-02T07:26:00.002-07:00

Truth is that in today’s world, it seems utopia to envisage a “self-independent” Africa, America, Europe or anywhere else. The global village (it is global living room now) is here to stay with its attendance increase in knowledge and mobility of all the factors of production, including labour (professionals and unskilled workers) and capital (funding).

At the risk of sounding semantically, it is somehow confusing at how “Africa has become the favourite HUNTING GROUND for the development professionals from all over the globe who visit Africa TO DISCHARGE THEIR KNOWLEDGE AND EXPERTISE (emphases mine)” I dare say that although Africa is a hunting ground for development INSTITUTIONS from abroad, it is our people (those caught during the hunting) that go to the rest of the world to discharge their knowledge and expertise. And we must accept that these knowledge and expertise are essentially western, and were never original to our continent.

It is obvious that the anonymous writer of the article being responded to by this piece is either not an African, or is seeing the continent from abroad and captured in the phrase “things will never change over there (paragraph 4)”. Africa needs all the foreign funding it can receive, especially when these are meant for projects and activities identified by the local communities, institutions and or governments as their priorities. Undoubtedly, there is always a greater local funding for every cent received in the continent from abroad. It is not possible yet, for foreign funding to replace local resources. ‘Complement’ has always been the word. The rest of the world also needs all the manpower it can receive from Africa as informed by their local priorities.

In the opinion of this writer, the real solutions to the myriad of social and economic problems facing Africa will come from the following:

A leadership that is caring, sees itself as part of the community, and strives to provide for the welfare of the majority of the citizenry within the limits of a TRANSPARENT (emphasis) application of available resources. Such a leadership will neither be nepotic nor condone corruption, and will dispense justice no matter whose ox is gored through appropriate punishments and rewards;
A follower-ship that is not IMPOVERISHED through socioeconomic policies that lack human face; policies that seek to demolish citizen’s abodes without providing alternative homes, take away their jobs without providing for their basic needs and increase direct and indirect taxes without increasing incomes;
An international community that refuses to provide its financial, property and other money-guzzling institutions as the underground tanks for the unlawful freighting, storage and investment/utilization of moneys that are illegally removed from the African continent’s treasuries by the those (Africans) whose duty it is to ensure that this did not happen in the first place.

It is also high time that we (Africa) stop blaming the rest of the world for all our woes. As one Nigerian musician (Sunny Okosuns?) put it many years ago, “what some African leaders are doing to their people is worse than apartheid”. Unfortunately, the same is true today in most part of the African continent.

Let us strive for EQUITABLE INTER-DEPENDENCE of Africa and the rest of the world… not self-dependence that never comes.

Better Health for All,

Uzo’

******************
Dr. Uzodinma Adirieje
Resource Centre Manager
Health Reform Foundation of Nigeria [HERFON]
10 Sakono Street, Off Adetokunbo Ademola Crescent, Opposite AP Plaza, Wuse II, Abuja, Nigeria
Phone: 234(0)9.4618496 Ext 205, Cell: 234(0)803.4725905
Email: uadirieje@herfon.org, uaadirieje@yahoo.com
Website: www.herfon.org

Re: National treatment programme: Expectations for 2007

2007-06-02T07:26:00.001-07:00

I suggest a national treatment programme that factors in, the infamous presence and impact of multi-drug resistant (MDR) and extensively drug-resistant tuberculosis (XDR-TB), as 10% of all new TB infections are resistant to at least one anti-TB drug, especially in populations with high infection rates like in Nigeria.

I suggest a programme that acknowledges and genuinely seeks to increase PLHIVs’ and their carers’ awareness of the problems; that recognizes the social, economic, political, religious and gender-related difficulties they face in accessing and adhering to treatment, as well as the vulnerability of frontline health workers.

I suggest a treatment programme that places the total management of all opportunistic infections on the same pedestal as the disease once a patient presents with any (OI), irrespective of whether there has been a confirmed laboratory diagnosis of Aids or not.

I will feel pleasantly spoilt if these SUGGESTIONS become EXPECTATIONS. Honestly!

Better Health for All,

Uzo’

******************
Dr. Uzodinma Adirieje
Resource Centre Manager
Health Reform Foundation of Nigeria [HERFON]
10 Sakono Street, Off Adetokunbo Ademola Crescent, Opposite AP Plaza, Wuse II, Abuja, Nigeria
Phone: 234(0)9.4618496 Ext 205, Cell: 234(0)803.4725905
Email: uadirieje@herfon.org, uaadirieje@yahoo.com
Website: www.herfon.org

Re: [hif-net] Fw (admin@wadn.org) The Gambia: The President says he has a cure for HIV/AIDS...works only on Thursdays

2007-06-02T07:24:00.002-07:00

Curiosity made me to rush to the URL that was referenced in this story. It turned out to be a story in The Independent, UK of 3 February 2007 captioned "The President who claims he can cure Aids on Mondays".

To my consternation, this is painful news of managing HIV/Aids with VOODOO by His Excellency President Yahya Jammeh, which was not correctly presented in this submission from the "Africa Doctors and HealthCare Professionals Network”, having been pushed out without a balanced reporting of the issues involved.

I then read the original (online) newspaper report of this event, in which the following information stands out:

1. The President Yahya Jammeh believes he has mystic powers, and was giving “treatment” to PLWHAs by laying his hands on the heads of patients at the Royal Victoria Hospital in Banjul.
2. Mr. Jammeh told diplomats that he has long had MYSTIC POWERS (emphasis mine) but that he only recently received a "mandate" to treat large numbers of people, adding "The cure is a day's treatment. Within three days the person will be negative."
3. According to rumours in Banjul, Mr. Jammeh's treatment is based on seven UNNAMED herbs that are mentioned in the Koran.
4. The President has not revealed the names of the herbs, nor divulged who has bestowed the "mandate" on him, which includes specific days of the week for each disease treatment. "I am not doing it for money or popularity," he said. "For asthma I have to choose between Saturday and Friday. I am also not authorised to treat more than 100 people. The one on HIV/Aids cannot be mass-produced because I am restricted to 10 patients only on every Thursday and Monday."

I still find it difficult to see this story’s clear “relevance to the discussion on the 'Brazil anti-HIV algal gel' discussion”, as intoned by the colleague who submitted it.

But my greatest worry is the statement credited to Dr Tamsir Mbowe, (Gambia's) Secretary (Honourable Minister) of State for Health and Social Welfare that the results of this voodoo are "really very impressive...excellent news and means that the treatment is going very fine and there is marked improvement in the patients' condition". He then added this curious clincher "This clearly shows that the treatment is very effective and we are really having gains now, which can be declared to the whole world... (bla bla bla) ... I am very much comfortable and happy with the treatment"

I am really worried that this approach is shrouded in secrecy, restrictive, neither evidence-based nor adaptable, not transferable, relies on very questionable procedures, and is still promoted as “impressive”, “excellent” “treatment” for HIV and Aids by the Government and health managers in The Gambia. Does any one have information on the position of the World health Organisation (WHO), UNAIDS or the West African Health Community (WAHC) on this claim from The Gambia?
Uzo’
****************************Dr. Uzodinma A. Adirieje
Afrihealth Information Projects/Afrihealth Optonet Association7/9 Enoma Street, Okota-Isolo, P.O. Box 4127, Oshodi 100010, Lagos, Nigeria
Phone/Fax: 2341.4520333, Mobile: 234803.4725905, 234805.6580180Email: afrihealthoptonet_ng@yahoo.com Web: http://phishare.org/partners/afrihealthoptonet, http://afrihealthoptonet.kabissa.org

Re: Halted HIV microbicide trial in Nigeria

2007-06-02T07:24:00.001-07:00

This is indeed a trying period for Henry Gabelnick, Annette Larkin and other eggheads at CONRAD, and indeed everyone in the HIV and Aids community. It is a major – but temporary - set back for us all.

The FHI Data Safety and Monitoring Board must be commended for halting a second Phase III trial of the Cellulose Sulphate (CS) microbicide underway in Nigeria (at least temporarily).

As efforts go on stream to identify where, how and when things went wrong - believing that the vaccine candidate is the same in both situations - and considering that a review of the Nigerian data by the trial's DSMB found no evidence of increased risk of HIV infection; one would like to suggest that we look at the processes of transportation, storage and administration of this vaccine candidate, as possible points of entry for the identified risk.

We must not relent.

Better Health for All,

Uzo’

******************
Dr. Uzodinma Adirieje
Resource Centre Manager
Health Reform Foundation of Nigeria [HERFON]
10 Sakono Street, Off Adetokunbo Ademola Crescent, Opposite AP Plaza, Wuse II, Abuja, Nigeria
Phone: 234(0)9.4618496 Ext 205, Cell: 234(0)803.4725905
Email: uadirieje@herfon.org, uaadirieje@yahoo.com
Website: www.herfon.org

Re: [eforum] Africa 'will die out before our eyes'

2007-06-02T07:15:00.000-07:00

It is all about people-disoriented priorities, political showmanship and incredible double-speak.

For many an African leader who is reputed to routinely disobey/manipulate the courts of the land, disregard the provisions of the constitutions, interpret/change rules and regulations to sooth his/her whims and caprices, and continuously treat the welfare of the citizenry with unimaginable ignominy, the contents of the 2001 Abuja summit were mere words, NOT bonds. Despite hosting the summit and playing other loud roles around and about it, Nigeria’s allocation to health in its annual national budgets has consistently been less that 6 (six) percent since 2001-2007, and not any where near the 15 (fifteen) percent agreed at Abuja.

And by the way, the 15% is a recommended minimum, and countries/governments are actually expected to allocate more, in the interest of the people.

I am afraid that this is not just about making “enough people understand the little things they are doing in their own houses everyday that are undermining their health," because the ubiquitous mountains of plastic bags that block drainages and breed mosquitoes in Nigerian cities, urban centres and slums, are direct consequences of government’s policies, actions and inactions. For example, because government has not provided portable and readily available water for the inhabitants of these dwellings, a new business culture of “pure water” – a euphemism for hygienic and unhygienic plastic sachet water - has consistently led to the littering of our environments with these plastic sachets and bottles, at a time when environmental maintenance activities are at an all time low especially in the slums. Many inhabitants routinely clear their gutters of these blockages and watch the rains and winds sweep them back into the gutters after some days, because the government-owned or hired or contracted disposal vehicles fail to turn up and collect them.

We all know that this is an open invitation to malaria-carrying mosquitoes, and need not be so.

We need policies and governments with genuine commitment to common good, poverty eradication and welfare of people. So help us God!

Health, Empowerment & Development, Uzo’
***************************************Dr. Uzodinma A. Adirieje
Afrihealth Information Projects/Afrihealth Optonet Association7/9 Enoma Street, Okota-Isolo, P.O. Box 4127, Oshodi 100010, Lagos, Nigeria
Phone/Fax: 2341.4520333, Mobile: 234803.4725905, 234805.6580180Email: afrihealthoptonet_ng@yahoo.com Web: http://phishare.org/partners/afrihealthoptonet, http://afrihealthoptonet.kabissa.org

NIGERIA’S ECONOMIC REFORMS IN SOCIAL CONTEXT [By Dr. Uzodinma Adirieje. Daily Sun, Tuesday, November 16, 2004]

2006-10-09T01:03:00.000-07:00

The discovery and exploitation of the nation's oil resources, and the management – some would say mismanagement- of her oil windfalls, have dominated the progress and decline of Nigeria's economy over the past three decades, and significantly influenced the evolution and perception of poverty in the country. Currently, the economy is still characterized by a large rural, mostly agriculture-based traditional sector, which comprises about two-thirds of the poor, and by a smaller urban capital intensive sector, which has benefited most from the exploitation of the country's resources and from the provision of services that successive governments had provided.

Since the early 1980s, the country had embarked on series of economic reforms, whose social outcomes have mainly meant poverty, hunger, misery and tears for majority of the citizens. The elite and various governments have engaged in series of ‘jaw-jaw’ and intellectual exchanges on the merits and or impacts of these reforms. Reforms have meant withdrawal of subsidies on social services including health and education and local products, and restrictions on foreign goods that are mainly used by the poor and non-elite. Foreign car manufacturers can easily bring in cars produced in their home countries and sell same in prices of seven digits within the country, but Nigerians who travel out to bring in such important household items as used clothes or ‘okirika’ or ‘bend down’, refrigerators, etc., are daily hacked down by government agencies. Reforms have brought unrelenting efforts to reduce government’s expenditure on social services and citizens’ personal welfares.

To the credit – glorious or otherwise- of these reforms, they have largely succeeded, as economic poverty has gradually become the middle name of a majority of households in the country. Implementation of agricultural reforms for instance, involved the withdrawal of subsidies, incentives and protection hitherto given to local mainly rural poor farmers, leading to loss of jobs, reduced incomes and exodus of labour to the cities; while removing import restrictions and reducing taxes on imported brand vehicles has meant creating more employment in the countries where these cars are produced. The first impact of subsidy withdrawal is that production now costs the farmers and industries more than it used to, since they have to spend more to make up for the shortfalls from the support previously given by the governments, but which have now been withdrawn as part of reforms.

As a result, our farmers/industries are producing less at higher unit costs, leading to poor harvests, fewer products; unmet consumer demands and higher costs for hitherto affordable/cheaper local products. This has unfortunately resulted in a widening of the gap between our locales and their foreign competitors; as there is no ‘one-size-fits-all’ reform model that can magically empower them to compete favourably in the world markets. It is the opinion of this writer that such ad-hoc and mainly business-interest measures as distribution of fertilizer and importation of tractors to some farmers for instance, have not produced any desired social dividend for the majority of the citizens. If anything, they have become sources of community acrimony where distribution is done in such ways that convey political patronage, and even beneficiaries have to abandon their farming activities for days in order to queue up at various distribution centres to receive them.

Indeed, it could be argued that just like the poverty alleviation programme, most of the people who directly benefit from these distributions, are not real farmers, at least within the community on whose location or origin such materials are collected. Perhaps, it is time for the government to review its distribution policies for these items. One major problem is that in most communities, poor farmers and artisans cannot transport their products to areas where they could be sold for more profits; either because roads or waterways are too bad or non-existent; or the cost of transporting them has become too high and made economic nonsense of any such involvement, due to the persistent and unrelenting regime of removal of subsidies from petroleum. Our rural farmers still produce vegetables, fruits and other items that rot away because they are both very costly and unaffordable, or they are not immediately bought up.

Rural farmers, especially young ones, are subsequently compelled to abandon agriculture for the urban areas in search of better paying jobs, leaving older and tired rural farmers and declining productivity, at a time when more young hand s are really needed in the farms to produce for the increasing population. While we continue to busy ourselves with implementing policies that make local agriculture and manufacturing unattractive – even to the unemployed, farmers in the European and the USA are receiving subsidies from their home governments, and overproducing. These excess products are subsequently exported to -some people would say dumped on- Nigeria and other countries of Sub-Saharan Africa; where there are now little or no restrictions on their importation.

During the 2001-2002 agricultural season for instance, US subsidies on cotton stimulated overproduction and led to a slump on the world market, leaving cotton-exporting countries in sub-Saharan Africa to incur losses of US $301 million in export earning. At the same time, Mozambique's hitherto efficient sugar industry could not compete on the international market, as European processors received a guaranteed price three times that of the market rate and dumped their excess at depressed prices on overseas countries where the Mozambicans hitherto sold their sugars.

Additionally, the reduction/elimination of import taxes on foreign products makes such foreign goods cheaper and more affordable than their local counterparts. When this is juxtaposed with the customary epileptic electricity supply that compels companies to spend more on electricity generation, costs of fuel, diesel and or gas, such goods would only cost more. For instance, the only tooth brush that carries Nigeria’s label of production, the ‘Jordan’ toothbrush, is also the costliest and most scarce in the Nigerian market.

While this scenario cannot easily be explained on the basis of demand not meeting supply, it could be more from the fact that the company’s working environment increases the costs of production, which is subsequently passed on to the consumers. Neither can we say that the company that produces the local toothbrush has made any appreciable impact in the local or any foreign stock market due to its sales. At the same time, the local market is daily flooded with competing toothbrushes of good quality imported from abroad and sold at rates that are as low as 20 per cent of the cost of their only local counterpart. While rich countries spend vast sums of money in providing social services and benefits for their citizens, subsidizing their local products and protecting the interests of their producers, they also spend enormous resources in forcing Nigeria and other poor countries not to do so.

The ‘current concerns’ are that if these reforms remain as they are now, without adequate government subsidies, market protection, investments in health and education, and infrastructure development, many more domestic products would be displaced or sharply undermined, majority of our local companies will continue close down due to poor capacity utilization, able-bodied persons would continue to lose jobs and become ready tools of destruction in the hands various interest groups, our men and women will continue to trade sex for food/money, and social poverty will refuse to go. How long more can Nigeria’s social matrix sustain this scenario? I just wonder.