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Saturday, October 28, 2017

The Effects of Economic Challenges on the Health Sector in Nigeria

It has come to a period where the Federal Government of Nigeria is to declare a state of emergency in health sector of the country. The Nigerian economy has decelerated, especially after the declaration in July 2016 of the Nigerian economic recession by the Finance Minister for the Federal Government because of the increased inflation to 17.1% higher than the previous years (Alloh F. T, 2017). The lead to a decrease in the price of crude oil from $115 in 2014, to $35 per barrel (World's Economic Forum, 2016).

The crude oil accounts for 75% of the country’s economy, therefore, having a significant impact on all sectors of the country. In addition, Nigeria is battling with one of the most dangerous terrorist group in the world known as book haram. Also, the pipelines in the south-south region of Nigeria is being attacked by the Niger-Delta militants. This is an unrest against the Nigerian government for disrupting the crude oil production among the area.

The Nigerian government has considered the healthcare of the people as a low priority. According to the United Nation Children’s Fund (UNICEF) in July 2016, the withdrawal of healthcare workers in Borno state has resulted to an increase of health victims due to the threat imposed on the lives of the health workers. UNICEF has estimated that more than 2 million crisis victims need health care services, leaving more than 1.2 million people internally disabled (Burki T, 2016). This has increased the rate of malnutrition among children with an estimate of over 244,00 children. 49,000 are at risk of dying if healthcare services are not provided in the areas most affected by the insurgency. The level of acute malnutrition recorded between July and August (2016) was well above the 15% threshold and classified critical with some cases higher than 50% representing about half of children affected.

In the northern states of Nigeria, more than 72% of health care facilities in Yobe, and 60% in Borno state have been destroyed because of the insurgency. The challenges confronted by Nigeria has led to a high poor rate of health outcomes. According to the African Health Observatory report by WHO, Nigeria has the fourth highest maternal death among African countries; leading to over 820/100,00 deaths per live births, and 109/100,00 death among children under the age of five per live births resulting to 58,00 women and 750,000 children dying in 2015 (WHO, 2016).

The life expectancy in Nigeria among men and women is 53years(males), and 56(females) which Is among the lowest in the world. Less than half (49%) of the children in Nigeria received DPT/Penta dose of immunization, which was below the target percentage (90%) in the goal of Millennium Development to decrease the child mortality rate. In 2015, half of the children were unable to receive vaccinations against measles and rubella, thereby raising the health risks. WHO reported three cases of polio crisis in Borno state; after the country stated that there were no existing cases of polio within the state (WHO, 2014).  

After the 2001 benchmark declaration in Abuja where 15% of yearly budget was allocated to the health sector, Nigeria has failed to reach the target in every given year. During the recession in Nigeria, the impact of poor funding on the health sector has risen. The federal ministry of health reported that the budget allocated to the health sector is reduced as a gradual decrease from N264.64 billion ($839 million), equivalent to 6.0% of the national budget in 2014, to N257.38 billion ($816 million) equivalent to 4.23% of the annual budget in 2016 6. This was because of the economic recession, causing the GDP to drop by -2.06% in 2016 according to the National Bureau of Statistics (National Bureau of statistics, 2016).  
Due to the lack of funding in Nigeria, the health sector is unable to address the health issues confronted by the country. This increases the poor framework of the health sector, and coordination with variation of fragmented services, scarcity of medical supplies, and medical pills, old and decaying infrastructure, lack of healthcare services, poor quality of health care delivery, and increase in health inequality gap between the rich and the poor.

REFERENCES

1.      Alloh F. T, a. R. (2017). Effect of economic and security challenges on the Nigerian Health Sector. Retrieved from http://eprints.bournemouth.ac.uk/29580/1/Effect%20of%20economic%20and%20security%20challenges%20on%20the%20Nigerian%20Health%20Sector.pdf
2.       Burki T. (2016). Health crisis intensifying in Nigeria. Borno State, Nigeria.
3.       National Bureau of statistics. (2016). Nigerian gross Domestic product report.
4.       WHO. (2014, july). Government of Nigeria reports 2 wild polio cases,. Retrieved from http://www.who.int/mediacentre/news/releases/2016/nigeria-polio/en/
5.       WHO. (2016). Atlas of African Health Statistics 2016 - Health situation analysis of the African Region. Retrieved from http://www.aho.afro.who.int/en/atlas/atlas-african-health-statistics-2016-health-situation-analysis-of-the-african-region
6.       World's Economic Forum. (2016, March 2). Retrieved from What’s behind the drop in oil prices?: https://www.weforum.org/agenda/2016/03/what-s-behind-the-drop-in-oil-prices/


Tuesday, October 24, 2017

The Public Health Challenges in Nigeria: Lack of Government Revenue


According to the 2011 WHO statistics, the overall life expectancy at birth is 54 years, infant mortality rate is 86 per 1000 birth while maternal mortality ratio is 840 per 100,000 live births.  Nigeria is confronted with major public health problems such as infectious diseases, sewage disposal, health insurance, water supply, air pollution, noise pollution, environmental radiation, housing, solid waste disposal, disaster management, control of vector some diseases, doctor-population ratio, population-bed ratio, population per health facility, payment system/methods, utilization of care, access to care, improper co-ordination of donor funds, material mortality, infant mortality, health financing, poor sanitation and hygiene, incessant doctors strike, disease surveillance, smoking of tobacco, brain drain, rapid urbanization, non-communicable diseases, alcohol abuse, environment degradation, road traffic injuries.

The death rate in Nigeria will continuously increase if there are no interventions to address the public health problems in Nigeria. According to the WHO Global Status Report on non-communicable diseases, Nigeria, together with other developing countries have the highest death rate caused by non-communicable diseases, such as cardiovascular disease, cancer, diabetes, chronic respiratory diseases, sickle cell disease, asthma, coronary heart disease, obesity, stroke, hypertension, road traffic injuries and mental disorders.

The World Health Statistics have reported that the malaria mortality rate in Nigeria is 156 per 100,000 population. Nigeria has one of the highest Tuberculosis burden in the world (311 per 100,000) resulting in the largest burden in Africa. This is according to USAID. The proper design of programs to address the public health problems in Nigeria will no doubt go a long way in improving the health status of the people. Though there are programs designed to address some of the health issues, there is a need to solve many other health problems.

The Nigerian primary health care has not been helpful in solving the numerous health problems effectively. Equity, accessibility, affordability, quality, effectiveness and efficiency remains a problem in Nigeria. Cost effective interventions for priority public health issues such as non-communicable diseases, injuries, maternal and child health are hardly being used.

According to 2010 UNAIDS reports, the inter-sectoral cooperation and collaboration between the different health-related ministries remains a major issue. And, also, there are about 1000 new infections of HIV in each day in Nigeria. WHO statistic has shown that the number of reported cases of malaria increased from 2, 834, 174 in 2008, to 4,295,689 in 2009. The government has done nothing to improve the health status in Nigeria. The national health system is weak, its management is ineffective and inefficient. The human resources between urban and rural area remains undistributed. Over 70 percent of doctors are in urban areas where only 48 percent of the population live, leaving 52 percent of the population who live in the rural area at the mercy of inadequate health personnel.

There is inadequate supply of health workers. Also, there is limited opportunities for career advancement and continuing education for health workers. Governments at all levels are yet to review their allocation of resources to health sector in line with internationally recommended standards. Only 1 percent of the health budget is allocated to preventive services while over 70% is allocated to curative services. Additional avenues for financing the health system such as community financing and donor/partner funds have not been fully explored and utilized. The national health insurance scheme (NHIS) which is over six years old cover less than 10 percent of Nigerians. The construction and institutionalization of a National health account is still in the works. There is insufficient evidence on the number of girls who die from female genital mutilation in Nigeria.

REFERENCES:

Sunday, October 22, 2017

The Act of Ethical Injustice Against Biafra: The Nigerian Military Kills Unarmed Pro-Biafra Supporters

An investigation conducted by the Amnesty International confirmed that the Nigerian army gunned down civilian’s months ahead of the Pro-Biafra commemoration event which took place last month in Onitsha Anambra state.

Testimonials of eye witness, morgues and hospitals proved that in the month of May 2016, between 29-30, the Military of Nigeria opened fire on the member of the Indigenous people of Biafra (IPOB). According to M.K Ibrahim, Country Director of Amnesty International Nigeria, “a person was shot to death after the authorities burst in on them while they slept”.
The supporters of IPOB impose no threat or harm to anyone. The shooting towards them was the use of unnecessary power, and force that resulted to multiple deaths and injuries.

The number of deaths is yet to be identified, because the Nigerian army took away corpses and the Injured. However, the Amnesty International reported via various sources that the estimate number of those who were 40, and those who were injured in the cross fire were 50.

The leadership of IPOB declared that more than 50 of their members were killed. The Nigerian army stated that they acted based on self-defense, and they claimed that the actual number of IPOB members who died were 5. The amnesty international has no proof of evidence that the killings were done necessarily for the safety of the civilians because some of the dead and injured IPOB supporters were shot in the back as an indicator or evacuating the scene. Although the police authority also claimed that IPOB members killed two of their officers, the claim remains to be confirmed.
Such act of genocide would not be supported by the motion of the army’s argument which claims to be an act of self-defense.

A joint investigation was conducted by the Nigeria rmy, police and navybetween the night of 29th May, which was intended to prevent a rally march organized by the IPOB in Nkpor motor park. The military raided homes, and churches where the IPOB members sought for shelter, right before the rally.

The following are the testimonials of the civilians:


IPOB supporters told Amnesty International that hundreds of people who had come from neighbouring states, were asleep in the St Edmunds Catholic church when soldiers stormed the compound on 29 May.
I saw one boy trying to answer a question. He immediately raised his hands, but the soldiers opened fire…He lay down, lifeless. I saw this myself

A 32-year-old hair dresser who was in the church told Amnesty International: “At about midnight we heard someone banging the door. We refused to open the door but they forced the door open and started throwing teargas. They also started shooting inside the compound. People were running to escape. I saw one guy shot in the stomach. He fell down but the teargas could not allow people to help him. I did not know what happened to the guy as I escaped and ran away.”

Another witness told Amnesty International that on the morning of 30 Mayhe saw soldiers open fire on a group of around 20 men and boys aged between 15 and 45 at the Nkpor Motor Park on the morning of 30 May. He says that five of them were killed.“I stood about two poles [approximately 100 metres] away from where the men were being shot and killed. I couldn’t quite hear what they were asking the boys, but I saw one boy trying to answer a question. He immediately raised his hands, but the soldiers opened fire…He lay down, lifeless. I saw this myself.”

The witness described how military officers loaded men with gunshot wounds into one van, and what appeared to be corpses into another.

Later that morning, another witness described how police shot a child bystander as a group of young men protested the shootings, blocking a road and burning tyres along the Eke-Nkpor junction.

He told Amnesty International: “I heard a police siren and everybody started running helter-skelter. I ran away with other people, but before we left, the police fired tear gas at us and shot a boy in my presence. He was just hawking in the street. He wasn’t even there to protest,” he said.An investigation conducted by the Amnesty International confirmed that the Nigerian army gunned down civilian’s months ahead of the Pro-Biafra commemoration event which took place last month in Onitsha Anambra state.

Testimonials of eye witness, morgues and hospitals proved that in the month of May 2016, between 29-30, the Military of Nigeria opened fire on the member of the Indigenous people of Biafra (IPOB). According to M.K Ibrahim, Country Director of Amnesty International Nigeria, “a person was shot to death after the authorities burst in on them while they slept”.
The supporters of IPOB impose no threat or harm to anyone. The shooting towards them was the use of unnecessary power, and force that resulted to multiple deaths and injuries.

REFERENCES:


Friday, October 20, 2017

Neuro Blastoma Cancer among Infant Babies

Chris Jr Strong,  an infant  who was diagnosed with stage  4 neuroblastoma.



Neuroblastoma is cancer that begins in the early stage of nerve cells (also known as neuroblasts) of the sympathetic nervous system, therefore, they are found anywhere along this system.  1 out 3 neuroblastomas start in the adrenal glands. About 1 out of 4 begin in sympathetic nerve ganglia in the abdomen while the rest start in sympathetic ganglia near the spine in the chest or neck or in the pelvis (The American Cancer Society , 2014)


Neuroblastoma often begins in infancy and are diagnosed within the first month of life. It is found when the tumor begins to grow and cause signs of symptoms. Sometimes it forms before birth and is found during a fetal ultrasound.
By the time is diagnosed the cancer cells must have matured (spread). and this most often spreads usually to the lymph nodes, bones, bone marrow, and liver among infants. It also spreads to the skin (NATIONAL CANCER INSTITUTE, 2017). 


SIGNS AND SYMPTOMS:

Lump in the abdomen, neck, or chest.
Bulging eyes.
Dark circles around the eyes ("black eyes").
Bone pain.
Swollen stomach and trouble breathing (in infants).
Painless, bluish lumps under the skin (in infants).
Weakness or paralysis (loss of ability to move a body part).


PREVALENCE OF NEUROBLASTOMA:

This is a common extracranial solid tumor among children under the age of five years. It affects 1 in 7000 children. 40% of cases were diagnosed in children younger than 1 year of age. These infants have extremely favorable prognosis even in the presence of metastatic disease. The observation has contributed to screening infants with the aid of a specific catecholamine markers that are easily measured in the urine in order to identify the disease in preclinical stage, although it is unknown whether this approach can reduce mortality rate of neuroblastoma (William G. Woods, 2002). 


REFERENCES:


1.      NATIONAL CANCER INSTITUTE. (2017, OCTOBER 16). NATIONAL CANCER INSTITUTE.
2.       The American Cancer Society . (2014, March 14). What Is Neuroblastoma? Retrieved from The American Cancer Society : https://www.cancer.org/cancer/neuroblastoma/about/what-is-neuroblastoma.html#written_by
3.       William G. Woods, M. R.-N. (2002, April 04). Screening of Infants and Mortality Due to Neuroblastoma. NEW ENGLAND JOURNAL OF MEDICINE. Retrieved from http://www.nejm.org/doi/full/10.1056/NEJMoa012387#t=article

Thursday, October 19, 2017

Exposure to Generator Fumes in Nigeria

Indoor air pollution (IAP) is an increased public health concern over the past years. This is a result of high amount of time people spend indoors (Ismail Adefeso, Jacob Sonibare, Funso Akeredolu and AdemolaRabiu, 2012). According to World Health Organization Constitution, people are entitled to the humanrights of healthy indoor environment. They defined air quality as “thermal comfort, and visual healthand comfort” (R. Kosonen, and F. Tan, 2004). Due to insufficient funds, the Nigerian government hascancelled all power projects, there reducing the supply of electricity within the country. As a result, thedemand of generators increased.

Portable electric power generator (PPG) is a gasoline or diesel-powered device which provides
temporary supply of electric power upto a certain wattage in homes (Debbie J. Jarvis, Gary Adamkiewicz,Marie-Eve Heroux, Regula Rapp, and Frank J. Kelly). This is designed for only outdoor purposes.Generator owners often place their power generator near, or in their homes due to generator theft,noise to neighbors, and the design of the home (depending if the individual is an apartment tenant or ahouse tenant) (M. R. Ashmore, and C. Dimitroulopoulou, 2009). The exposure to generator fumes is associated with the combustion design of diesel/fuel engines.
The quality of air in homes, offices, schools and other institutions, is required to be clean because 80% of people spend, or perform their daily activities indoors. The National Health and Medical Research
Council (NHMRC) defines indoor air as air within a building occupied by people within a specific period of time (Godson Rowland Ana, Oyewale Mayowa Morakinyo and Gregory Adekunle Fakunle).

The US Consumer Product Saftety Commission reported five out of 104 deaths caused by generator
carbon monoxide (CO) poisoning is associated with generator placed outside the home towards open
windows or, doors or vents (N. E. Marcy and D. S. Ascon, 1990-2004). In 2008, over 60 people suffocated
to death in Nigeria as a result of exposure to high concentration of CO.

REFERENCES:

1. Debbie J. Jarvis, Gary Adamkiewicz, Marie-Eve Heroux, Regula Rapp, and Frank J. Kelly. (n.d.).
WHO Guidelines for Indoor Air Quality: Selected Pollutants. Retrieved from
https://www.ncbi.nlm.nih.gov/books/NBK138707/
2. Godson Rowland Ana, Oyewale Mayowa Morakinyo and Gregory Adekunle Fakunle. (n.d.).
Indoor Air Quality and Risk Factors Associated with Respiratory Conditions in Nigeria. World's
largest Science, Technology & Medicine. Retrieved from https://cdn.intechopen.com/pdfs-
wm/48283.pdf
3. Ismail Adefeso, Jacob Sonibare, Funso Akeredolu and Ademola Rabiu. (2012). Environmental
Impact of Portable Power Generator on Indoor Air Quality. International Conference on
Environment, Energy and Biotechnology. Retrieved from http://www.ipcbee.com/vol33/012-
ICEEB2012-B031.pdf
4. M. R. Ashmore, and C. Dimitroulopoulou. (2009). Personal exposure of children to air pollution.
Atmospheric. 43, 128-141.
5. N. E. Marcy and D. S. Ascon. (1990-2004). Memorandum: Incidents, deaths, and in-depth
investigations associated with carbon monoxide from engine-driven generators and other
engine-driven tools. United States Consumer Product Safety Commission.
6. R. Kosonen, and F. Tan. (2004). The effect of perceived indoor air quality on productivity loss.
36, 981–986.

Wednesday, October 18, 2017

Discrimination and Health Effects

THE SOCIO-ECONOMIC DETEREMINANTS OF ROMA HEALTH STATUS IN COMPARISON WITH NON-ROMA IN BULGARIA, HUNGARY AND ROMANIA:

The welfare of the Roma population has been an interest of case studies over the recent years. It has been estimated that 12-15million (Program, Open Society Institute Network Public Health, 2005)Roma minorities live in Europe. This has reflected decades of Roma Inclusion’ (2005-15), harmonizing with the entry of several Central and Eastern European (CEE) countries into the European Union.  The Roma minorities within the CEE countries are subjected to poor living conditions. They live in poor regions with lack or no access to education (Centre for Documentation and Research, 1994).

Historically, the Roma have been perceived and often discriminated as a source of contamination in Central and Eastern European countries (Martin McKee, 2004). This was a result of the health literacy of the Roma population which focused on infectious diseases, and genetic disorders as the main caused of Roma health differences (Steve Hajioff). Although many studies have failed to state the extent of the Roma inequalities and its association to health (Jeremiah A. Barondess, 1998), multiple data have indicated that the Roma population are limited to health literacy and access to medical care. Among most of the population in Central, and Eastern Europe, it is estimated that the Roma has 10 years of life expectancy (Braham M, 1993). It was concluded by a rare study which was conducted in 1989, that in Czechoslovakia, the Roma men and women have a life span of 12.1 and 14.4 years lower than the country’s entire population (Ferák V, 1987).

Recent studies have proven that there is an increased rate of chronic diseases and related risk factors compared to most population among the Roma minorities. High levels of insulin, hypertension and obesity were found among the Roma’s than the majority population in Slovakia. Due to the lifestyle and low level of education among the young Roma population, there is a higher prevalence rate of cardiovascular diseases risk factors and metabolic syndrome (Krajcovicova-Kudlackova M, 2004).

Studies have shown a decrease in Vitamin C, and other antioxidant vitamins and higher levels of inadequate nutrition, and smoking among the Roma minority groups in Czech (Jan Dejmek, 2013) and Slovakia republics (Philipa Mladovsky, 2007). The prevalence of underweight among the Roma population was high than that of the entire population in Croatia (Domagoj Šegregur, 2017). The sanitary conditions pose to be a policy objective and initiatives to improve sanitation of the Roma society. Policies on Roma health should be multi-sectoral, considering the economic, social and cultural crisis. The main determinants of inequalities in health status among the Roma population in Bulgari, Romania and Hungary were education and wealth. The study indicated that the Roma population experienced specific health inequalities after determining for education, expenditure and wealth.

The Romanian society has one of the worst cases of social stigma in Europe. This resulted from the reluctance and refusal of important public personalities of Romani origin to declare their membership or links to Romania’s Romani minority (Valeriu Nicolae and Hannah Slavik, 2003). Even though the Roma population has the biggest minority groups in Europe, they face extreme negligence and racism. Discrimination among the Roma population started from the 16th century of nationalism, which rendered them one of the most socially and financially excluded groups in Europe (Wilkin A, Derrington C, Foster B, 2009).

The significance of identifying the health inequalities among Roma and Non-Roma communities is reflected by a huge difference in their hygienic lifestyle (Hajioff S, 2000). According to WHO, sanitation is the provision of facilities and services for the safe removal of human faeces (WHO, 2010). Different backgrounds in cultures play a significant role in health inequalities. For example; since the Roma population are situated in poorer regions, with low access to medical care, the non-Roma are more likely to perform a chronic illness diagnosis just simply because they have access to medical care than the Roma. 

THE STRUCTURE OF ETHNIC INEQUALITIES IN HEALTH: ECONOMIC POSITION, RACIAL DISCRIMINATION, AND RACISM:

According to a US study, the nature of racial prejudice changes over time in such a way that experience of discrimination maybe hard to recognize. Davidio and Gaertner defined “aversive racism”, as people characterized by “endorse egalitarian values, who consider themselves as non-prejudiced, yet discriminate in a rationalized way. Thus, making it hard to measure the health effects (Dovidio JF, Gaertner S, 2000).

The Forth National Survey of Ethnic Minorities discovered an association between racial discrimination experience, perceptions of racial harassment, and different health risks across ethnic groups (Cooper RS, 1993). The study shows that racial discrimination experience against minority groups were independently linked to the likelihood of reporting fair or poor health, and the socioeconomic effects on occupational class which includes; economic disadvantage, the feeling of low self-esteem or devalued, minor status group, and personal insult and stress of being a victim of racism (Kaufman JS, 1998).

Although, data have shown that socioeconomic inequalities cannot explain the ethnic inequalities in health, it has proven that it contributes to health inequalities among different ethnic groups across different countries. Forth National Survey of Ethnic Minorities have illustrated that ethnic differences differed from each ethnic group. Example, the minority people had a smaller income compared to the whites (James Y. Nazroo and Saffron Karlsen, 1997).  Similar study in the US, according to Oliver and Shapiro, white people have more income than black peoples and, the black are most likely to remain in that situation among those below the poverty line (James SA, 1987). Black people are unlikely to own houses due to their low level of wealth (Melvin L, 1997).

Studies conducted in the US have indicated the relationship between self-reported experiences of racial discrimination and different health outcomes such as, hypertension, psychological distress, poorer self-rated health, and days spent ill in bed (Krieger N, 1990).
According to the National Survey of Ethnic Minorities in the UK, ethnic inequalities increase with age, with slight differences in younger age, and huge differences surfacing from mid-30s and above (Nazroo J, 2001). Increase in health inequalities among ethnic minorities at a certain age reflects on the range of health risks over the life span, and long-term outcomes of exposure to health hazards at an early age.


 

REFERENCES:


1.      Braham M. (1993). A Survey of the Roma People of Central and Eastern Europe: A Report to the Office of the United Nations High Commissioner for Refugees; Office of the United Nations High Commissioner for Refugees (UNHCR): Geneva, Switzerland. Retrieved from http://www.oalib.com/references/9318027
2.       Centre for Documentation and Research. (1994, NOVEMBER 1). UNHCR CDR Background Paper on Refugees and Asylum Seekers from Romania. REFWORLD. Retrieved from http://www.refworld.org/docid/3ae6a6414.html
3.       Cooper RS. (1993, MARCH 03). Health and the social status of blacks in the United States. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/8269065
4.       Domagoj Šegregur, a. J. (2017, MARCH). Antenatal characteristics of Roma female population in Virovitica-Podravina County, Croatia. 56(1). Retrieved from https://www.degruyter.com/view/j/sjph.2017.56.issue-1/sjph-2017-0007/sjph-2017-0007.xml
5.       Dovidio JF, Gaertner S. (2000, JULY 11). Aversive racism and selection decisions: 1989 and 1999. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11273391
6.       Ferák V, S. D. (1987, FEB 08). The Slovak gypsies (Romany)--a population with the highest coefficient of inbreeding in Europe. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/3580917?access_num=3580917&link_type=MED&dopt=Abstract
7.       Hajioff S, M. M. (2000, November). The health of the Roma people: a review of the published literature. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/11027202
8.       James SA, S. D. (1987, OCTOBER 12). Socioeconomic status, John Henryism, and hypertension in blacks and whites. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/3631056
9.       James Y. Nazroo and Saffron Karlsen. (1997). Ethnic inequalities in health: social class, racism and identity. RESERACH FINDINGS. Retrieved from http://www.lancaster.ac.uk/fass/projects/hvp/pdf/fd10.pdf
10.   Jan Dejmek, E. G. (2013, March 14). Vitamin C, E and A Levels in Maternal and Fetal Blood for Czech and Gypsy Ethnic Groups in the Czech Republic. International Journal for Vitamin and Nutrition Research. Retrieved from http://econtent.hogrefe.com/doi/abs/10.1024/0300-9831.72.3.183
11.   Jeremiah A. Barondess. (1998, December 1). Care of the Medical Ethos: Reflections on Social Darwinism, Racial Hygiene, and the Holocaust. Retrieved from http://annals.org/aim/article/712357/care-medical-ethos-reflections-social-darwinism-racial-hygiene-holocaust
12.   Kaufman JS, L. A. (1998, MARCH 08). The relation between income and mortality in U.S. blacks and whites. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/9504282
13.   Krajcovicova-Kudlackova M, B. P. (2004). Cardiovascular Risk Factors amon Young Gypsy Population. 256-259. Retrieved from http://bmj.fmed.uniba.sk/2004/10578-03.pdf
14.   Krieger N. (1990). Racial and gender discrimination: risk factors for high blood pressure? Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/2367873
15.   Martin McKee, E. N. (2004). HEALTH POLICY AND EUROPEAN UNION ENLARGEMENT. Retrieved from http://www.euro.who.int/__data/assets/pdf_file/0004/98392/E82999.pdf
16.   Melvin L, O. a. (1997). BLACK WEALTH/WHITE WEALTH. Retrieved from http://ross.mayfirst.org/files/oliver-shapiro-black-white-wealth.pdf
17.   Nazroo J. (2001). Ethnicity, Class and Health. POLICY STUDIES INSTITUTE. Retrieved from http://www.psi.org.uk/site/publication_detail/1276/
18.   Philipa Mladovsky, P. (2007, JUNE). To what extent are Roma disadvantaged in terms of health and access to health care? What policies have been introduced to foster health and social inclusion? THE LONDON SCHOOL OF ECONOMICS AND POLITICAL SCIENCE. Retrieved from http://academos.ro/sites/default/files/biblio-docs/241/135.mladrom.pdf
19.   Program, Open Society Institute Network Public Health. (2005, DECEMBER). Mediating Romani Health: Policy and Program Opportunities. Open Society Institute Network Public Health Program. Retrieved from https://www.opensocietyfoundations.org/sites/default/files/roma_health_mediators.pdf
20.   Steve Hajioff, M. M. (n.d.). The health of the Roma people: a review of the published literature. BMJ JOURNALS . Retrieved from http://jech.bmj.com/content/54/11/864

21.   WHO. (2010, JULY 16). SANITATION. Retrieved from http://www.who.int/topics/sanitation/en/

Wednesday, October 11, 2017

The Biafra War In Nigeria: Causes, Development, And Aftermath

Nigeria is an artificial structure created by colonial powers in the 19th century. Although Nigeria has over 300 different ethnicities, unlike many other African nations, Nigeria is divided into three main regions which are composed of three distinct people, the Igbos of the south-eastern Nigeria, the Hausa-Fulani of northern Nigeria, and the Yoruba of southwestern Nigeria. These different groups have their independent customs, and values and as such, they historically remained separated from each other.

Because of the differences in customs and values, the political system became divergent. The Hausa-Fulani of the north are traditionally ruled by a strict, Islamic hierarchy. Leaders are obeyed without questions. The Yoruba of the south west are ruled by series of monarchs that are less autocratic compared to that of the north. The Yoruba social and political system provides a greater upward mobility. Very diverse of the Yoruba and Hausa, the Igbos live in autonomous and democratic communities.  Although there are few monarchs in some cities, decisions are mainly made by assemblies where every man had the right to participate. This system provides a social and political mobility greater than that of the Yoruba with high status obtained through personal ability and through acquiring wealth.

The British colonial authorities in Nigeria found it convenient to rule indirectly through an already existing tribal political system. In the north, the British ruled through the monarch-like emirs, to maintain a rigid social and political institution. The Christian missionaries were excluded from the north, leading to lack of education and social progression. This was an indirect contrast to the south where Western education was rapidly and effectively established by the missionaries. As a result, the Yoruba’s became the first group in Nigeria to introduce modern African civil servants, lawyers, medical professionals and technicians.

As a result, to the changes and progression, in 1960 Nigerian claimed its independence, and the northern side of Nigeria remained under developed with a literacy of 2%. In contrast, the Igbos became more politically and economically prosperous, with educated men dominating many fields throughout Nigeria.
During the colonial period, the British divided Nigeria into three regions intensified competitions between the three main ethnic groups. These ethnic groups formed political parties that are largely regional and tribal. however, the country was evenly divided to an extent, the north had a slightly larger population. The federal legislature created by the colonial authorities granted the Hausa-Fulani of the north the majority seat.

The ethnic tension because of the coup and counter-coup which increased among the rivaling ethnic groups, and mass pogroms which was committed in May 1996, followed by those in July and September, a large scale of massacres and horrific atrocities aimed at Christian Igbo living in the Muslim North, and the murder of soldiers and officers in the north became a frequent occurrence. It was estimated that 30,000 out of 13 million Igbo people lost their lives, resulting to a mass exodus of 1.8 million refugees to the Igbo South east.


REFERENCES


Wednesday, September 27, 2017

Dozens of Cases Approve Myanmarese Forces Rape Rohingya Women: UN Medics

The doctors of United Nations have confirmed several reports regarding sexual abuse committed by Myanmarese military against Rohingya women. According to Reuters, doctors treating hundreds of thousands of Rohingya Muslims who fled to Bangladesh from Myanmar in recent weeks have seen dozens of women with injuries consistent with violent sexual attacks, UN clinicians and other health workers said; "Since August 25, over 429,000 Rohingya Muslims fled to Bangladesh when Myanmar regime forces and extremist Buddhist started a new wave of crack down which the United Nations has termed as ethnic cleansing.  
 Recent exodus of Rohingya has brought the number of refugees from Rakhine living in Bangladesh to over 800,000.The UN medics’ accounts, backed in some cases by medical notes reviewed by Reuters, lend weight to repeated rape allegations leveled by women from the stateless minority group against Myanmar’s armed forces. According to Reuters report, eight health and protection workers  had treated more than 25 individual rape cases since late August in Bangladesh’s Cox’s Bazar district.
The medics say they do not attempt to establish definitively what happened to their patients, but have seen an unmistakable pattern in the stories and physical symptoms of dozens of women, who invariably say Myanmar soldiers were the perpetrators. It is rare for UN doctors and aid agencies to speak about rape allegedly committed by a state’s armed forces, given the sensitivity of the matter.

INHUMAN ATTACK:

The doctors at the clinic operated by The UN's International Organization for Migration (IOM) at the Leda makeshift refugee say they treated hundreds of women with injuries they said were from violent sexual assaults during the army operation in October and November.
Dr. Niranta Kumar, the clinic’s health coordinator, told Reuters they have seen have injuries among recent influx of refugees suggesting “more aggressive” attacks on women. Several health workers suggested that, whereas in October many women had initially remained in their villages believing the army sweeps were only targeting Rohingya men, this time most had fled at the first sign of military activity.

RAPE AS A WEAPON:

In April, the UN Secretary General reported that sexual assaults were "systematically employed to humiliate and terrorize their community". Before her rise to power, Suu Yi gave a speech concerning rape last year. It is used as a tool of division in the country's myriad ethnic conflicts. 
“It is used as a weapon by armed forces to intimidate the ethnic nationalities and to divide our country, this is how I see it,” she said in 2011 in a video message to a conference on sexual violence in conflict. However, the Buddhist Nobel laureate has chosen to keep silence when it comes to brutal sexual attacks committed by regime’s forces against Muslim women.
Her spokesman Zaw Htay said there was “nothing to say” when asked if her view had changed since then. “Everything should be according to the rule of law,” he said. “The military leaders also have said they will take action.”

REFERENCES:

United Nations. Dozens of Cases Approve Myanmarese Forces Rape Rohingya Women. UN Medics. 27th September, 2017
http://www.awdnews.com/index/dozens-cases-approve-myanmarese-forces-rape-rohingya-women-un-medics/

Monday, September 25, 2017

Health Workforce and Governance: The Crisis in Nigeria

All persons involved in activities primarily devoted to enhancing heath in the health workforce is an important block of any functioning health system in any country. In the absence of which clinical and public health services cannot be delivered to the population (World Health Organization, 2006). The health governance-led steering and rule-making functions targeted at achieving national health policy objectives for effective delivery of health services and attainment of universal health coverage (World Health Statistics 2014).

Experts have shown direct links between efficient health system governance and promising health workers outputs, which ultimately have positive effects on overall health outcomes (World Health Organization, 2007). However, poor administration and continued underinvestment in health even with the spread of HIV/AIDS, re-emerging diseases and persistent violent conflicts, have contributed greatly to the fragile health systems in many African states (Chen L, Evans T, Anand S, Boufford JI, Brown H, Chowdhury M, Cueto M, Dare L, Dussault G, Elzinga G, et al, 2004). While there have been calls for concerted efforts- social, economic, environmental and multisectoral towards health system strengthening in sub-Saharan Africa (Senkubuge F, Modisenyane M, Bishaw T, 2014), human resources' crises in the health sector have continued to be a major challenge (Dovlo D, 2003).

Many African countries' governmnets have reported challenges in training, funding, employment, capacity building and efficient deployment of the health workforce (Dovlo D, 2003). Consequently, the continent has continued to experience a rapidly progressive health workforce migration to high-income settings in search of better opportunities (Dovlo D, 2007).
Crises within the health workforce have been repoted as perhaps the biggest constraint towards global health system develoment and sustenance, particularly in Africa (Dovlo D, 2007).

According to the World health report in 2006, 57 countries were in severe health workforce crises, with 37 of these in Sub-Sahara Africa. A region with only 3% of global health workforce, despite contributing about a quarter to the global disease burden (World Health Organization, 2006).
Nigeria, the most populous country in Africa, possibly contributes even more to these crises in the region. Increasing annual rates of population growth, as observed in Nigeria, has been adjudged a major factor in countries with severe health workforce crises (Pacqué-Margolis S, Muntifering C, Ng C, Noronha S, 2011). Nigeria requires significant increase in the number of additional health workers to achieve desired population coverage. However, beyond the shortfall in health workforce, the Nigeria health sector has particularly experienced a number of other lingering crises inrecent times.
There are growing concerns locally and internationally over these issues with this linked to the overall poor states of health governance in the country (World Health Organizatio, 2016).  Persistently low and inequitable distribution of health workers remain a major challenge in the Nigerian health sector (Abimbola S, Olanipekun T, Schaaf M, Negin J, Jan S, Martiniuk AL, 2016). Bangdiwala stated that there is a global crisis in health workforce by acute shortages and uneven distribution of health workers in several settings (Bangdiwala SI, Fonn S, Okoye O, Tollman S, 2010). In Nigeria, experts have reported that historically, "brain drain", in the form of migration of health workers to high-income settings, has been a major setback in the country (Ike So, 2007).

Current statistics show that 1 in 4 doctors, and 1 in 20 nurses trained in Africa are currently working in developed countries, with this accounting for a shortfall of over 1.5million health workers in the region (World Health Organization, 2014). In Nigeria, the health workforce density is estimated at 1.95 per 1000 population (World Health Organization, 2016). According to the report of Abimola, this shortfall in Nigeria has been complicated by gross inequity in the distribution of health workforce, as there is no national policy guiding the postings and transfers of health workers-redeployment is often based on discretion of administrative officers with multiple influences and several competing interests (Abimbola S, Olanipekun T, Schaaf M, Negin J, Jan S, Martiniuk AL, 2016).

REFERENCES

World Health Organization. The World Health Report 2006—working together for health. Geneva: World Health Organization; 2006. https://books.google.ca/books?hl=en&lr=&id=taYsDwAAQBAJ&oi=fnd&pg=PR13&ots=9eg7-pFfy-&sig=rQqts3bHKOp6dhcfViLM2-AwYds&redir_esc=y#v=onepage&q&f=false

World Health Organization. Health systems. In: World Health Statistics 2014. Geneva: World Health Organization; 2014. p. 128–40.

Senkubuge F, Modisenyane M, Bishaw T. Strengthening health systems by health sector reforms. Glob Health Action. 2014;7:23568. https://www.ncbi.nlm.nih.gov/pubmed/24560261?dopt=Abstract

Dovlo D. Wastage in the health workforce: some perspectives from African countries. Hum Resour Health. 2005;3:6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1198245/

Dovlo D. Migration of nurses from sub-Saharan Africa: a review of issues and challenges. Health Serv Res. 2007;32(3):1373–88. http://onlinelibrary.wiley.com/doi/

Pacqué-Margolis S, Muntifering C, Ng C, Noronha S, IntraHealth International. Population growth and the global health workforce crisis. Washington: United States Agency for International Development; 2011. https://www.capacityplus.org/files/resources/population-growth-global-health-workforce-crisis.pdf

World Health Organization. Nigeria. In: Global Health Workforce Alliance. Geneva: World Health Organization; 2016.

Abimbola S, Olanipekun T, Schaaf M, Negin J, Jan S, Martiniuk AL: Where there is no policy: governing the posting and transfer of primary health care workers in Nigeria. Int J Health Plann Manage. Int J Health Plann Manage 2016, Epub ahead of print. http://onlinelibrary.wiley.com/doi/10.1002/hpm.2356/full

Bangdiwala SI, Fonn S, Okoye O, Tollman S. Workforce resources for health in developing countries. Public Health Rev. 2010;32(1):296–318. https://publichealthreviews.biomedcentral.com/articles/10.1007/BF03391604

Ike SO. The health workforce crisis: the brain drain scourge. Niger J Med. 2007;16:204–11. http://europepmc.org/abstract/med/17937154

Friday, September 22, 2017

In Country Retention Of Healthcare Professionals in Romania

Romania began its transition from communism in 1989, with an extinct  industrial base, and a profitable guide unfiting to the needs of the country. The recession of industrial output, service contracts, and the collapse in investment increased as the trade gap extended for a number of years. The recent shortcoming of account remained at 5.4% of the GDP in 1998. By 1989-2002, unemployment increased, many large scale businesses were under government control, yet to tackle the primary issues which empowers the growth of business in a competitive environment (Vlădescu & Scîntee, 2008).
Over the years, according to the world bank, there has been a rise in figures on the Romanian healthcare system, revealing that access to healthcare is biased towards the more privilege classes. In addition, according to Raiffeisen Bank Romania, the ratio of doctors to patients, is two doctors to 1000 of population, below average in Europe. On the account of Romania joining the EU, the availability of medical personnel declined, decreasing access to healthcare services among citizens (Oreste Ross, 2014).  
In 2006, the mass media raised awareness by predicting huge emigration of medical doctors and nurses that would threaten the health system. The emigration rate increased by 2007, 1421 medical doctors left the country which affected the most economical deprived area of Romania more than other regions (Suciu, Popescu, & Buzoianu, 2017).  
By the end of 2009, the economic crisis begun to impact the Romanian society deeply, including the health system. Furthermore, there were additional obstacles introduced in 2010 for  the healthcare professionals, as well as a 25% salary discount. As a result, there was shortage of staff, hence, developments regarding the domestic workforce combined with the emigration of healthcare practitioners became a critical problem in Romania  (Galan, Olsavszky, & Vladescu, 2006).  
The purpose of these measures is to straight-up a line with the priorities of the strategic partnership. Also, to support the network for the provision of healthcare services (hospitals), increase the services of medical practices increase the availability of primary healthcare at the community level and strengthen governance within the health system. The stakeholder for this responsibility is the World Bank.


LONG TERM MEASURES:-
Strategic Management:
Strategic management an organizational management activities that is used to set priorities, focus energy and resources, strengthen operations, ensure that employees and other stakeholder are working towards common goals and establish agreement around intended outcomes/results access and adjust the organization´s direction in response to a changing environment.
The efforts put in health planning are initiated by either the state or local government agencies (The Ministry of Health), through implemented legislation or private or non-governmental organizations. As a result, a variety of state health policy makers have designed to: enhance the quality of care, provide and control the access of care (through hospital survey), and contain cost (health insurance) (Swayne, Duncan, & Ginter, 2006).


MEDIUM TERM MEASURES:-
Improving Occupational Health in a Work Place:
The working condition of nurses are likely associated to the quality of care provided to patients and patients’ safety. This is also linked with the health and safety outcomes for nurses and other healthcare providers (Geiger-Brown J; Lipscomb J, 2010).
According to the 2005 survey by the National Institute of Statistics, more than half of the people working in Romania reported poor working conditions in the healthcare sector (European Observatory of Working Life, 2006). It has been statistically proven that nurses endanger themselves with the risk of exposure to infectious diseases, physical violence, ergonomic injuries related to the movement and repositioning of patients, exposure to hazardous chemicals and radiologicals, and sharp object related injuries. These risk threats could be avoided by the appropriate use of technology, environmental controls, and protective equipment. nurses are revoked in accessing these health cautions. It is upon the ministry of health, and private healthcare facilities to provide adequate workplace safeguards, enforce protective procedures, educate staff regarding the risks, provide protective equipment, utilize safety engineered sharps, and cooperate with research into actual and potential risk (American Nurses Association , 2007).
The code of practice for recruitment of international health personnel by WHO encourages countries to receive emigrant healthcare workers to assist in improving working conditions in developing countries. This has proven efficient mechanism for healthcare institutes. This is an economical advantage for the country as it increases the revenue per capita (Annalee Yassi, 2009).
The government should advocate some support provided for these initiatives, however, there should be collaboration between WHO, the International Labour Organization, the International Commission on Occupational Health, and the International Social Security Association and Public Services International (this is a representative for public sector trade unions) Romania would have a genuine responsibility to reciprocate with their resources as beneficiaries of healthcare worker migration. At university level, researchers and practitioners can contribute to the exchange of knowledge by aligning with their colleagues from other low-income countries (WHO, 2009).
To assure the development of information system, it is significant to promote evidence-based decision making, and share information with those who can benefit from it (integration of worker safety and patient safety).  This will aid in sharing jurisdiction. That way, millions of dollars won’t be spent annually to design, implement and maintain different systems that could be distributed and reproduced easily. To achieve this, there has to be an international agreement to reach consensus on data dictionary; establish programming of non-proprietary information system which can be tailored to different mechanical environment made available for easy licensing; train health and safety committees ( focusing on occupational health and infection control) to conduct workplace audits, use the information system and implement appropriate prevention mechanisms; conduct campaign studies to evaluate and refine approaches to improve working conditions among healthcare workers (Weerdta & Baratta, 2005).
Introduction to International Strategy:
The involvement of the state is essential to provide adequate workforce in any situation involving two sides of an equation; demand and supply regarding the workforce of health professionals. There are limitations and opportunities that apply to both aspect (Barriball L, 2015).
The government should be involved in the planning and managing of a healthcare sector because they have the power to sign a treaty among other EU countries (National Rural Health Alliance, 2008). For example; the WHO Assembly adopted the WHO Global Code of Practice on international recruitment of healthcare personnel in May 2010. This sketches a voluntary principle for ethical international recruitment, with the intend for improving the authorized and institutional framework for the enrollment practices (WHO, Managing health workforce migration - The Global Code of Practice, 2010).
As a result, the unilateral contract provides an extra tool for implementing the principles of the Code. Such agreement recognizes the need of the country to monitor the extent of migration and its impact on the country’s economy to ensure sufficient training and strategies for financial support to the health system (Global Health Workforce Alliance, 2008).


SHORT TERM MEASURES
Training of Healthcare Workers:
Hospitals should reintroduce demanding programs to train nurses in their specialties. This contributes in retaining nurses who are seeking for a transfer opportunity as well as recruiting new staff. It also establishes career development path for staff. These training are not inexpensive and nursing governance must be ready to justify the proposed budget. Given the cost of temporary staff, this aids as a logical solution for the organization’s leadership to approve (Watkins, 2005).
Shared Governance and Leadership:
This facilitates a steady condition in a healthcare environment. Reports done on magnet hospitals has proven that organizational characteristics that attract and retain nurses include professional practice models for care delivery with autonomy and responsibility for decision-making (Sebai, 2015).
Hence, effective administrative structure is significant for patient care quality, and investment in professional development of nurses. There must be an involvement of staff in defining and developing the practice of care in the institution due to their closeness with patients; In inclusive with participation in the financial management of their unit (Nevidjon & Erickson, 2001).
Introduction of Emergency Medical Services(EMS)
This is a comprehensive system that provides the arrangements of personnel facilities and equipment for the effective, coordinated and efficient delivery of health and safety services to victims of sudden illness or injury (Moore, 1999). This is essential for providing timely care to patients with life threatening emergencies to avoid unnecessary mortality or long-term morbidity (J & AL., 2002).
EMS is a job opportunity for nurses, as it is a mechanism to decrease the rate of emigration in Romania. Recent studies show that nurses are dissatisfied with the role of coordinating care. It is important that nurses are assigned to positions they are trained to. This prevents them from being overwhelmed with work load (DK, McNeese-Smith, 1999).
Reduction in patients´ length of stay.
The supply of nurses is not adequate to meet the current demand and the shortage is projected to grow more severe as future demand increases and nursing schools are not able to keep up with the increasing educational demand. Example of demand of nurses is the length of patients’ stay. As a result, hospital nurses today take care of patients who are sicker than in the past; therefore, their work is more intensive (Héctor Bueno, Joseph S. Ross, & Yun Wang, 2010). Research studies show that heavy workloads among nurses adversely affect patient safety. Furthermore, it negatively affects nursing job satisfaction, and as a result, contributes to higher turnover, and shortage in nurses (Clarke, 1996).
In addition to the higher patient acuity, work system factors and expectations also contribute to the nurses´ workload. Nurses are expected to perform non-professional tasks such as; delivering and retrieving food trays, housekeeping duties, transporting patients, and ordering, coordinating or performing ancillary services (Patricia W. Stone*, 2004). Certain establishment should be earned to reduce the workload of nurses like; unit level, job level, patient level, and situation level (Stone, Clarke, Cimiotti, & Correa-de-Araujo, 2004).
These measures lead to better communication between nurses and their patients, and also set an organized program for the nurses. Example; in a clinical unit, numerous nursing tasks need to be performed by a group of nurses during a specific shift (unit level workload). The type and amount of workload of nurses is partly determined by the type of unit and specialty. Example; intensive care unit (ICU), nurse versus general floor nurse (job level workload). When nurses perform their job, they encounter situations and patients (National Academy of Sciences, 2004).
Improving Data Collection:
According to Diallo, having reliale and valid data about health workforce is a key to better managment and planning. This acknowledges the difficulties in finding accurate data, and he recommends a process of triangulation of different sources to give the most comprehensive overall picture (Diallo K, 2004) .
For example; data can prove the significance of non-finanacial incentives in other developing countries. Such countries in Afrca. This can be adopted by the state in Romania, to improve their law enforcement in the healthcare system. Due to the underinvestment of the countries’resources, there has been a decrease in the wages, as well as working conditions (korte et al).
Studies have proven the effectiveness of non-financial incentives which include, training study leave, opportunites to work in teams, support and feedback from supervisors. As result, the performance of our healthcare practitioners will increase due to the enhancement of their job satisfaction (Stilwell B, 2001).
It is important that the country has an auditor who maintains and keeps records of the performance of the healthcare system. This will help in determing the flaws of the actions authorised by the state to improve the healthcare organizations.
EXPECTED RESULTS:
Raising funds for the health system.
Reducing financial barrier to access through prepayment and subsequent pooling of funds in preference to direct out of-pocket.
 Allocating or using funds in a way that promotes efficiency and equity.
Health system stewards must, therefore, seek ways to influence the motivations and behaviors of multiple actors and their diverse agendas, finances and organizational structures forming coherent arrangements for health system accountability. 
There should be adequate supply of Emergency Medical Services (EMS).


REFERENCES:


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