THE DECLINING IMMUNIZATION COVERAGE IN NIGERIA: THREAT TO NATIONAL DEVELOPMENT
Gentle Men of the Press
- The Physicians’ Week is an annual event of Nigerian Medical Association (NMA). Usually, it is a weeklong activity during which we celebrate ourselves as doctors contributing to effective healthcare services delivery and research in Nigeria; while the Physicians week celebration provides an opportunity for us as doctors to review the events of the health sector during past twelve calendar months. During the Physician week, we also use the period to celebrate our pati
- The Nigerian Medical Association in this 2017 Physician week celebrations is deeply concerned with the health status of our children who are the leaders of tomorrow as far as it concerns vaccines preventable diseases. It is for this reason that the theme for 2017 Physicians Week celebration is titled;
Declining Immunization Coverage: Threat to National Development and Security; Way Forward
Immunization and vaccination have remained two of the most important public health interventions world over, thereby constituting a cost effective strategy to reducing both the morbidity and mortality associated with infectious diseases especially in children.
As it stands, disease knows no boundaries and thus a disease threat anywhere in the world is a disease threat everywhere. While Nigeria celebrated the eradication of polio virus in 2015, the joy was short-lived as it resurfaced in 2016. It is most unfortunate that sporadic cases of polio are still reported in Nigeria and other countries like Afghanistan and Pakistan. However, it should be noted that the challenges of immunization coverage in Nigeria has been further worsened by insurgency especially in the North East Nigeria and among factors.
Therefore, the celebration of 2017 Physicians Week calls for sober reflection on the declining immunization coverage in our dear country. The 2016/2017 National immunization coverage survey (NICS) indicates that only 33% of children 12-23 months of age had 3 doses of pentavalent vaccine against the global target of 90% and only 23% were fully immunized. Forty percent (40%) do not receive any vaccines from the health system.
The implication of this finding is that a large population of our children particularly under 5 years of age are unprotected and are therefore at the risk of dying from vaccine preventable diseases such as measles, diphtheria, pertusis, tuberculosis etc; and also an infectious risk to other children in near and distant places. Another vaccine preventable infectious disease that is ravaging our country is Hepatitis B infection which is on the increase. Nigerian Medical Association calls on all Nigerians and especially healthcare providers who are greatest risk to take time and get immunized.
This scaring statistics is unacceptable to the Nigerian doctors. It is a great danger and threat to the survival of our great Nation as no meaningful development can take place in a society where disease and death is ravaging the potential leaders and our hopes of tomorrow. We must reverse this ugly trend as soon as possible; there is no time to waste.
The NMA acknowledged the ongoing efforts of the Federal Government of Nigeria through the Federal and State Ministries of Health and other stakeholders in healthcare i.e. WHO, UNICEF, Rotary international etc in providing vaccination services across the length and breadth of Nigeria.
The activities lined up for the week include: Prayers in Churches and Mosques, advocacy to critical stakeholders in all the 36 states and the Federal Capital Territory (FCT) to support immunization activities, media engagements to create more awareness on the importance of immunization among the populace, robust media engagement in various local languages must also be pursued highlighting the dangers of not taking children for immunization by parents and care givers.
The Road Walk tomorrow is to draw attention of government particularly the President, Federal Republic of Nigeria, His Excellency Muhammadu Buhari GCFR, the Governors of the 36 states, the Honourable Minister of FCT, National Assembly members, House of Assembly members, stakeholders in health like the WHO, UNICEF, traditional rulers, religious leaders, opinion leaders, market women, civil society organisations and the general public to this national disaster and the need to double our current efforts in line with increasing the uptake of vaccines, strengthening routine immunizations and the national immunization Days (NID).
During the week members of NMA will also participate in routine immunization activities in various health facilities across the country. This will improve the confidence of the uninformed populace on the vaccination processes and futher boost uptake of immunization services.
Your Excellencies the time has come to ask ourselves; what have we been doing? What do we plan to do differently this time around? I therefore call on government at all levels (federal, state and local government) to channel more fund to child health particularly routine immunization activities. Health workers in the rural areas should be provided with logistics and incentives to carry out regular outreaches at hard to reach areas and security compromised spots. There is urgent need for more direct community engagement on issues of routine immunization to improve community participation and ownership.
- We celebrate the Nigerian Doctors today for the great sacrifices offered to the country. Despite the poor doctor to patient ratio far short of the WHO standard of one doctor to 600 people and an apparently poor working environment in a resource poor country like ours lacking the necessary standards, Nigeria doctors have stood out prominently working day and night as the custodian of the peoples health.
- We also celebrate today many doctors who put their lives on the line on duty and subsequently paid the supreme price in caring for fellow Nigerians. Of recent memory is Dr. Ameyo Stella Adadevoh during the Ebola outbreak of 2014, many others in the Lassa outbreak and so many who were overwhelmed with workload and had stress related death. In the last 2 weeks a number of doctors have died leaving us in sorrows. They include:
- Dr Amos Jarafu, a Resident Doctor with FMC Keffi found lifeless in his hotel room in Zaria on 07.10.2017 after sitting for Primary Exams the previous day..
- Dr Popoola Ayodele Abiola, a Senior Registrar with FTH Gombe died 6days ago after a protracted illness
- Dr Chizi Ikeka, a Resident of Public Health with Rivers State..
- Dr Esther Iniobong James, a House officer with FMC Keffi, she died in the ER 24hrs after finishing her call on the 16.10.2017.
She had complained of headaches the previous day.
- Dr Linda Nwigwe,5yrs post MB;BS collapsed 2days ago whilst walking on the road & died before getting to the hospital, her wedding is for Sat 21.10.2017.
- Dr Popoola Bashir Zakarriya, a former NARD PRO & former General Secretary of ARD, ABUTH who died seven days ago from stroke.
May their souls rest in perfect peace.
- To this end, NMA demands an urgent restriction of maximum 40units per month of extra call duty per any physician in any employment. NMA members henceforth will not work for 70hours and be paid only for 40hrs in a month.
The NMA shall soon present to the public and the government the Rights of Doctors in accordance with the new Physician’s Pledge.
We may be compelled to take a Nationwide simultaneous holiday from the public hospitals for paramedics to run if urgent steps are not taken by the Authorities to curtail excesses of the JOHESU’s radicalism.
It is an irony that doctors are being trained but cannot be employed and the ones employed are receiving between 30-50% of their legitimate salary from all levels of government. This is promoting brain drain.
- I urge you my Colleagues to continue to do your good work with strict adherence to the Physician Pledge (WMA Assembly Chicago 2017 amendment):
I SOLEMNLY PLEDGE to dedicate my life to the service of humanity;
THE HEALTH AND WELL-BEING OF MY PATIENT will be my first consideration;
I WILL RESPECT the autonomy and dignity of my patient;
I WILL MAINTAIN the utmost respect for human life;
I WILL NOT PERMIT considerations of age, disease or disability, creed, ethnic origin, gender, nationality, political affiliation, race, sexual orientation, social standing or any other factor to intervene between my duty and my patient;
I WILL RESPECT the secrets that are confided in me, even after the patient has died;
I WILL PRACTISE my profession with conscience and dignity and in accordance with good medical practice;
I WILL FOSTER the honour and noble traditions of the medical profession;
I WILL GIVE to my teachers, colleagues, and students the respect and gratitude that is their due;
I WILL SHARE my medical knowledge for the benefit of the patient and the advancement of healthcare;
I WILL ATTEND TO my own health, well-being, and abilities in order to provide care of the highest standard;
I WILL NOT USE my medical knowledge to violate human rights and civil liberties, even under threat;
I MAKE THESE PROMISES solemnly, freely and upon my honour.
- We must keep our eyes on the Nigerian Government healthcare policies and working round the clock to confront the various affronts on the Physicians in Nigeria. With dignity, we will provide credible solutions to the myriad of challenges in the healthcare system.
- It must be stated quite clearly that while the NMA is not averse to improvement of welfare package in the health sector, however pay parity must necessarily factor-in the relative difference in favor of the medical doctors as it is obtainable in developed countries. We expect government not to toy with the lingering crises in the health sector.
Government should not allow itself to be intimidated with illegal bodies like JOHESU in the health sector. We expect each professional to stick to the ethics of their profession.
- Doctors are been envied by all in the health sector; however as the government strives to give her citizens quality health care, the divine call to the art of medicine should not be polluted with rivalry and rush to equate paramedics with medical degree. The surge by JOHESU parents to seek admission for their wards to read medicine, the high cut-off marks to gain admission into medicine, the 292weeks of tedious undergraduate training (cf: PhD that takes 272weeks from undergraduate degree to have), the appointment of MBBS holder as lecturer II in the university system (an injustice to Medical Doctors) are few testimonies for Physicians to enjoy relativity.
- Doctors are now endangered species in the community and her traditional hospital environment. The value for money and hospital titles have made the members of JOHESU to set up fellowship colleges with the aim of bearing the title of Consultant. We are not against professional development but holders of higher degrees are much useful in research centres not in the hospital wards. The NUC should stop the unnecessary meddling in the affairs of hospital practices. Hasty judgments are given by National Industrial Courts of Nigeria without recourse to expert opinions on professional issues. Laws are churned out without due process of public hearings
- I want to use this opportunity to re-echo the call on the federal government to fully operationalize the National Health Act, 2014 which made provisions among others the pooling of not less than 1% of consolidated revenue as Basic Health Provision Fund (BHPF) to cater for the vulnerables. This fund must be budgeted for in 2018 fiscal year and transparently utilized. We want this to be directly supervised by an agent under the presidency. The ongoing rehabilitation of our primary healthcare centres (PHC) is slow, we therefore call on the government to intensify their efforts on the PHCs and reposition them to deliver on their minimum service package thereby improving immunization coverage across the country.
- The attempt to stop private practice by doctors working in public health institution is against the law of the land. NMA frowns at our members who use the working hours to attend to their private clinics/hospitals. Government should enforce the laws by reconstituting the Medical and Dental Council of Nigeria (MDCN). Government must not dissolve the MDCN without immediate reconstitution, we want it in perpetuity. NMA will work in tandem with the government to discipline erring members by subjecting them to MDCNs disciplinary tribunal which has since being in limbo because of lack of MDCN.
- I call on all professional associations, civil society organizations, men and women of goodwill in this country to join us in this clarion call to ensure our children are well protected to grow to their full potentials and contribute meaningfully to the economic development of our great country in years to come.
Thank you and God bless
Prof Mike Ozovehe Ogirima
Professor of Orthopaedics & Trauma Surgery,
President, Nigerian Medical Association
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