Managing Nigeria's Public Health


Maybe because they do not die in aircraft crashes, in gruesome fires following oil spills or in similar tragic circumstances no voice is raised in anguish about the Nigerian children that die from vaccine preventable diseases everyday. When outbreaks are reported in our newspapers on an almost daily basis, nobody links these to the missed opportunities of vaccination.

In a recent conference on health and health care of Nigerians, that held in London on the 22nd of November, 2008, no presentation left a greater impact on me than this slide (above) presented by Dr Abdulsalami Nasidi, the newly appointed Director of Public Health at the Federal Ministry of Health in Nigeria. As reflected in the feedback, he won much respect in his honesty in depicting the sad state of affairs, but less so for the vague assurances about the future.

(this and all other presentations from the conference can be found here)

The graph above shows a truly Nigerian perspective of what happens to a problem when you “invest” resources in it. Every Nigerian will tell you a similar story about what happened to funds dedicated to power generation or to the building of roads.

The graph shows that funds available to immunise Nigerian children has increased exponentially from the late nineties, during exactly the same time period the immunisation rates of Nigerian children reached a low of 20 – 30% from about 80% in 1990.

Our thesis is that as much else in our country, this is simply a failure of leadership. For some insight into how the National Programme of Immunisation was led, please read the book Academics Epidemics and Politics by Idris Mohammed.

But now…the National Programme for Immunisation has now been disbanded, and absorbed into the National Primary Health Care Development Agency. Its roles and functions are now shared with the Department of Public Health of the Federal Ministry of Health with its newly appointed Director; Dr Nasidi. Recently, Dr Nasidi was also recently appointed Chairman, Presidential Task Force on Polio Eradication and Routine Immunisation.

Dr Nasidi talks a good talk, and the report here shows that he is also a man of action…

But now, together with the newly appointed director of the National Primary Health Care Development Agency, he carries a huge responsibility, both for polio and for other vaccine preventable diseases.

He has been placed with a unique opportunity to be the Director of Public Health when Nigeria saw its last case of Polio and got its routine vaccination coverage rates back to the numbers required to stop our children from dying from diseases no one else is dying from.

What a story that would be to tell…

He can make history..he truly can…but will he? Only time will tell…

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

Discussion3 Comments

  1. Many thanks for this reflective posting. The graph is particularly powerful. Chikwe, can you tell us whether the budget numbers in the graph include investments in polio, measles, etc? Also, what antigen is being plotted for the coverage?

  2. “…he immunisation rates of Nigerian children reached a low of 20 – 30% from about 80% in 1990.”

    Oh my God. As a parent, this information is damning to me. And, while I am shocked, I am really disappointed that not enough Nigerians either know this fact or challenge ‘leaders’ to do better.

    Anyway, thank you for sharing this.

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