…Our inability to raise coverage of routine immunisation in Nigeria remains one of the biggest scandals of our age. Huge outbreaks are still happening in 2007! 3 years ago I had one of the most disturbing experiences of my public health career, working to manage an outbreak of measles in Adamawa state, with a case-fatality raion of 10%. I.e. 10% of all children with measles died. Measles can by prevented by a vaccine that costs less than 50 US cents. 50 cents = N60!!!!
Find below one of the reasons why!
THISDAY ONLINE on 10.17.2007 by Kayode Komolafe,Email:firstname.lastname@example.org
IT WILL SHOCK YOU…or not..)
For those interested in an authentic version of how health policies and campaigns have been distorted by mismanagement and sometimes fraud a new book entitled Academics, Epidemics and Politics: An Eventful Career in Public Health is recommended. The author is Idris Mohammed, a professor of Medicine and former Chief Medical Director of the University of Maiduguri Teaching Hospital (UMTH). It is a story of how not to implement policies in the name of the poor. Incidentally, the author dedicates the book to the “Talakawa of Nigeria of Nigeria whose suffering has grown exponentially over time, and to all the poor of sub-Saharan Africa who continue to live in dehumanising conditions in the midst of plenty- in an unjust world that cares little for regional or global ethical responsibility”.
Professor Mohammed insists that his work, published by Bookcraft, is not autobiographical. This column too is far from being a review of the magnificent book, which tells the story of Mohammed career in academics, politics (interestingly at an early age) and other areas of public service. Mohammed offers his perspective on the global politics of public health.
He gives his impressions about the primary healthcare delivery championed by the late Professor Olikoye Ransome-Kuti as well as the clinical trial of Trovan in Kano. However, it is what he writes in the book about the National Programme on Immunisation (NPI) that is isolated for this discussion. For any humane person the passion should be how diseases such as polio, which has long become history in most parts of the world, would be eradicated in Nigeria. But what Mohammed demonstrates lucidly and courageously in the book is that the passion of some other persons was for something else – how to make millions from a programme that was supposed to put an end to human misery. Little surprise that the author refers to a point in the writing of the book when “a threat to stop the publication of the book by external forces loomed large“.
Mohammed was on sabbatical and served as a consultant to NPI. He was later appointed as the Chairman of the Board of Management of the programme. Although the appointment was supposed to be part-time, Mohammed elected to serve full time without pay to cap his 30 years in public survive. He needed the time to cover the huge field that is Nigeria and to meet the poor people in the rural areas. He wanted to be fully involved. This was how he expressed his passion for immunisation. While Mohammed nursed his own passion, some others also expressed their own the passion for the funds meant to execute the programme.
According to him: “The NPI had been well known in Nigeria as a conduit pipe for diverting immunisation funds to private accounts of a few people on an unbelievably massive scale. How they managed to acquire notoriety in misappropriating funds on such large scale and in circumstances that made the average Nigerian to know almost exactly what was going on is a matter for deep regret. Many of my friends and professional colleagues admonished me to be careful”.
Mohammed reports how even former President Olusegun Obasanjo even acknowledged (in a conversation) the mess and the fraud being perpetrated with the NPI and how someone was invoking the name of the President to secure contracts from the programme.
Mohammed says that his position on the NPI was later vindicated by external observers of the programme. For instance he writes:” Towards the end of 2005, the World Bank country director for Nigeria, Mr. Hafez Ghanem, had to write to the ministers of finance and health in strong terms, complaining about the failure of the NPI to achieve its immunisation objectives and targets. The immunisation rate had remained low at 13 per cent, which was lower than in Nigeria’s neighbours ( e.g. Benin and Niger) and even lower immunisation than in many countries in conflict (e.g. DRC). The cost of immunisation was scandalously high and according to the bank chief, ‘ conservative estimates show costs in 2005 at $56 per fully immunised child. This is more than double the norm for developing countries’. Since 2003 the World Bank has provided about $80 million for polio eradication alone with little result. ‘I am concerned that unless the problems facing the management of immunisation services are addressed it will be difficult for the Bank to justify its continued support for immunisation’ warned Mr. Ghanem”
The author richly supports his arguments with documents in the appendix to the book. He has written an unambiguously provocative book that should attract readers seeking to know why programmes designed to help the poor become avenues for the rich to feed their avarice.
It is a story of the political economy of epidemics. It is about how smart guys first politicise an otherwise technical programme and feed fat on the mess so created. Significantly, Mohammed says he does feel triumphant to have been vindicated by the World Bank’s observation. He says that he is “saddened by the palpable failure of disease control and prevention, (a) sequel to poor performance in immunisation, classified by the United nations as a fundamental right of all people, most particularly women and children’. He adds that this is “indefensible and scandalous, because I know that for sure that the government has funded the immunisation programme on a massive scale”.
The reference to Mohammed’s new book is to show why development activists should be alert to ensure that programmes designed to curb poverty do not become moneymaking ventures for corrupt public officials. If this trend continues, poverty would be exacerbated rather being eradicated. The massive corruption that plagues programmes meant for poverty alleviation should be a major focus of campaigns by development activists.
It is not enough to fight for pro-people policies to be announced. The implementation should be closely monitored to ensure it does not end up serving the greed of corrupt officials. The cynical approach to poverty eradication should be combated mercilessly as poverty itself is being confronted. It will be illusory to imagine that poverty can be made history without tackling this monumental perversion of the development process.
Incidentally, poverty eradication is implicit in President Umaru Musa Yar’Adua’s seven-point agenda. The corruption inherent in anti-poverty programmes should, therefore, attract the attention of the President if he wants to develop a workable social charter as part of his development strategy.
The book is not on Amazon….if you find a copy..please let me know!
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