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We’re keen on providing strong health system – Okpala



WHAT are your plans in ensuring the spread of Lassa fever is contained and Coronavirus does not infiltrate into the state?

The outbreak of Coronavirus in China is not our key concern. Our key concern is everything in health but what we actually do is to prioritise on what is giving us headache which is Lassa fever and the mortality rate is 1per cent; the admitted persons measure up to 15 per cent.

  We have an emergency operation centre that helps maintain surveillance for infectious diseases and outbreak of epidemic  in Awka. The state government is determined and has the capacity to respond to any outbreak of Lassa fever in the state.

What are your goals for this year in the health sector ?

The ultimate goal for the Ministry for Health is to continue to strengthen the health system that we have been working on since I came in last year; because without strong health system, you cannot deliver health care delivery. Health system deals with the basic building blocks of a functional health care, so without building the health care system and strengthening it, we cannot have good service delivery and we will not have good healthcare.

In respect to the systems, we are discussing manpower, we are discussing essential medications availability, we are discussing health management system, health financing, governance and leadership. These are the different components of the functional health system.

  Basically, what we did was, with the system in mind, we were able to look at the different components of a functional health care system and try to design what we want to achieve in 2020 and how we want to achieve it. So, the goals of 2020 has been captured in the 2020 budget which we have previously discussed. We will see our health care indices improve- like decrease in maternal mortality rate, decrease in infant mortality rate, improvement in our nutrition indices for kids, universal health coverage, an increase in the number of covered citizens in the state. All these will lead to improved indices and great health care delivery.

  Looking at individual target for the year, some major things we want to accomplish this year that we are looking at include availability of essential medication, which is component of a functional health system .

How do we want to do that?

 Soon, we would be launching a drug revolving fund. A drug revolving fund will help us have a centralised delivery of medications. It makes delivery more centralised.  We would have more qualitative medications and we would have decrease in price  and more affordability.

  Now access to these medications is one of the key things we want to achieve this year- reduction in certain types of death through availability of medications or blood. When you go to under served parts of the state, some of these places in  Anambra North – places like Ayamelum, Nando, Orumbanasa in the Anam axis, etc. Sometimes,  pregnant women that have complications of delivery during child birth, sometimes they have what we call post partum hemorrhage (they start bleeding). Usually, you may have a health care personnel available but may not have any medication or a coach in medication might be available but not therapeutic,  not optimal, because it is no longer potent or they might bleed out but no available blood to save.

  To get that blood; blood storage in the state is a big problem, so we want to design a centralised blood distribution system. If someone who is one hour far away is hemorrhaging to death, we can get that blood to them in a space of 30 minutes i.e. availability or accessibility to medications in a quick way is key.

  Now, how do we achieve that? In last year’s budget, we designed the medical drone drug delivery programme, so, we are currently in discussion to see how we can achieve the drug drone delivery programme in Anambra State. If we are able to achieve that, it will lead to improved health indices around the state. Getting  vaccination for the far to reach areas.

  There are many reasons that leads to poor vaccination coverage. Lack of availability of vaccine is one of them, so this programme will help take care of that component, the other thing that can help decrease mortality will be in respect of death from post-partum hemorrhage, which we already discussed and we see this program happen in some parts of African countries like Rwanda, where it crushed mortality rate down to zero.

  So, there are many other benefits of this drug drone delivery programme which we intend to deploy with the support of Governor Willie Obiano. He believes in the project. If we see it happen this year,  it will be a big plus to Anambra State and it will be  big plus to the state and the state will be number one to deploy such a service in the country .

  Sir, you made mention of decrease in price for ndi Anambra and this brings us to Anambra State Health Insurance Agency (ASHIA). Reports indicate that  many are yet to know about the scheme, especially at the grassroots. What are you doing about it?

Thank you very much for that question.  You know I did not exhaust all our goals for the year. If I keep talking about it, it will take the whole day. One of them will actually be attaining  universal health coverage in the state, so the percentage to cover citizens this year will increase significantly

We have spoken about health insurance for as much as we can. We have been speaking this in our communities. We have used August Meeting to broadcast it in the churches – every opportunities we had from the podium, every public function. We have used the media, jingles, apps in social media, print and electronic media; we have spoken to our people in diaspora to help us keep broadcasting this and asking people who have the means to help buy insurance for those who are not well to do.

We have done that, we will continue to do more now that we hear that people are not aware. Last year, when we were designing what we call the Basic Health Provision Fund Casket Programme, do you know that in every political ward in the state,  we have the presence of one primary health care centre and we have 330 political wards. We have at least one PHC and  we have ward development committees in each political ward attached to the primary health care centers.

  Ward Development Committees are individuals from the ward, chosen from the community, numbering from eight-15 persons. The only persons that might not necessarily be indigenous to the community are officers in-charge of the PHCs. In some situations, we might actually have them mainly from the communities.So, one of their key jobs is to ensure that the PHC in the community is functional. Now, what have we done last year? We tried to sensitise all the WDC. We got to every one of them in the state, and they are being trained.

  Last year Nov\Dec, we gave them a five- day training for them to understand the value of ASHI Scheme, universal health coverage and basic health provision fund that is coming down the road, which we are already qualified for so it took us a lot of resources, money, man power, time, to do this training but the goal is not just in the training process or outcome. Our goal for that training is to make sure that by this year, if we want to deploy information to every community, we have to go through this WDC ultimately so that everybody around the community will be carried along. These are people you see in the church community meetings, regular members of the community.

  So if we cannot disseminate information through them ultimately, to come down to communities becomes a problem because we have identified them as our key players in the communities and we have chosen to make them our partners in care,  so they will be the ones to help us for the last man that have not heard of the health insurance scheme; they will help us achieve that. We are also planning through this WDC to start a programe which is called ‘Akwukwondu’ you might call it green card but ‘Akwukwondu’ for me is the book of life.

What does that mean?

So, if you go around Nigeria, especially in Africa, if you ask a white man what is the most common cause of death in Nigeria, they will say it  is infectious diseases but down here, we know that it’s not true anymore. The most common cause of death  in Nigeria is non-communicable diseases and non-communicable diseases are hypertension, diabetes, asthma, chronic obstructive pulmonary diseases and cancer, as well as road traffic accidents. So awareness for this  diseases is not yet up.

  One of the goals for this year is to increase the awareness for these non-communicable diseases among the communities. We have a lot of citizens coming down with kidney failures needing kidney transplant and  cancer from the things we eat.  What we want to do this year through the WDC- we have eight -15 members to reach out to the political wards. Through them, we would reach to the people of these communities.

  We have a booklet of 24 leaves. In one of the leaves, we have columns where you can record blood pressure, blood sugar on the other part of the booklet. We would write what the normal blood pressure range or blood sugar range is that is acceptable in the society. This booklet will have the individual’s name and all the information and it belongs to the individual.

  So, we encourage everyone to come to the primary healthcare centre, we will take their blood pressure, blood sugar and we would find a way to deflate the cost either through insurance health coverage or through health care provision fund.

  So, when they go there to check their blood sugar and blood pressure, we encourage the health personnel to record it, the date and the reading in the booklet. The individual will take the booklet home. We encourage the women to always have it in their purse; if it gets damaged, we can replace it and transfer the information to the next card and  the men who don’t usually keep purse can leave theirs at home. If they’re in a meeting and having a conversation, they can actually discuss their numbers and health status. So people can start discussing their health issues freely and if  they don’t know it, they can go to the health care centre and get their card, it’s free. That’s why we call it ‘Akwukwondu’- the more you know about your numbers, the more the chances of your wanting to get intervention.

  I actually started this experiment late last year. We had a number of people (civil servants) and some health care personnel in a room. I asked them to do a small exercise.  I discovered that half of them have not checked their blood sugar and blood pressure in the last six months. So, it becomes a challenge that will become a major goal this year.

  By the time we embark on it, at least 50 per cent ndi  Anambra will have known their blood pressure. That has not been done anywhere in Africa. If we are able to achieve this, that will be a great plus for the Ministry for Health, because awareness is paramount. In Igbo parlance, it is said that “if you want to stop a fight, you first of all prevent people from pointing at each other,” so, that is a major goal and we have started talking about designing these project. When we talk about universal health coverage, we are actually preaching about health insurance as they go along. This will be a year that will go along seeing the WDC fully engaged by the Ministry of Health because they are our partners.

Sir, before you came into office, many activities took place in government hospitals, what can you say about the government hospitals today?

When we say government hospitals, that includes the PHCs and the teaching hospitals.  A lot of money have been put into the public health sector.  Remember in Anambra State, when you talk about access to health care, 75 per cent of healthcare is accessed in private hospitals while 25 percent are accessed in the public hospitals.

  When we talk about the public, we talk about the number  of PHCs we have. About two years ago, 63 PHCs were refurbished. This year, we will refurbish another 63 PHCs to get them to standard and we don’t seat around in the office. We go to the field accessing these facilities, evaluating them to see what needs to be done. When interventions are made, it will be made in a responsive and responsible manner, where we evaluate and make sure that work is done as agreed. Sometimes around the state, you notice that work are given and contractors will go and do what they want to do.

  The message from the new administration is that they ought to be more involved in the process, so that job is done the way it needs to be done for the benefits of ndi  Anambra. So, much has been done in the healthcare sector. We put a lot of energy to upgrade our facilities and to make them functional. Sometimes, we pay more

emphasis on “oh this facilities looks nice” but it’s not functional. We make them more functional. Functionality is the key for us.  Really, we are dealing with scarce resources at this point, so we manage what we have. If we don’t have wonderful facilities in all the communities, people should bear with us. We want to pick key facilities in key areas and make them look nice but our focus is on accessibility to a given community.

  For public hospitals and the general hospitals, what we have done is to choose three general hospitals and elevate them to a certain level. Those elevated were  Onitsha, Enugu-ukwu  and Ekwulobia General Hospitals. Work continues in those places and we are  99 per cent done with Onitsha. We are looking into inviting some international partners to help deploy the best care that we can have. We see people come in to access and evaluate things and more are still coming – like next two weeks, we have a group coming from U. S to evaluate things and see the ones they can organise and deploy care best possible. Enugwu -Ukwu is coming on board and  in Ekwulobia, work is going on there. You will see a real improved service delivery and facilities.

  Coming to the teaching hospitals,  Chukwuemeka Odumegwu Ojukwu  Teaching Hospital(COOUTH) , over N2billion  have gone in there while trying  to make it look nice and to improve the morale of the workers. If you remember, sometime ago, the doctors agitated for the right reasons – improvement in condition of service and all those stuff . The three things they actually asked the government to do for them were: Improved diagnostic ability for the hospital, improvement for the condition of service, Increase in salary. And all these three issues were addressed for the first time in the history of the hospital. They got improvement on the condition of service. This government actually went ahead to develop it to standard.

 In respect to equipment,  this is the  first time the state is getting 54 slices computer tomography (CAT) scan machine – this is a big machine that scan the whole body within seconds. It will tell if a person that just had stroke has  bleeding in the brain or not and if there is no bleeding , we can give a medication that can reverse the stroke. So the machine is there. It was brought in December and it is still being installed. By February, it will be  functional.

  The x-ray equipment is also being installed and the mammography machine is also coming on-board too. If you go there, you will be amazed at the level of work going on there.

  We have also improved in diagnosis so that it will truly be a teaching hospital both in name and in function. So, a lot of things is coming down the stream and a lot of money have been put in by the government.

  With respect to doctors allowances, it has been  addressed. Our goal ultimately, through supervision, is to get more health care provider to be more responsible and responsive to the patient . We want to have a health care provider that understands that the patient is the king.

That is what we want to achieve, if we are able to have an attitudinal change in health care providers, we would have achieved a lot.

  That is if we start realising that the patient is king, then equally have that empathy towards care, we would have achieved a lot.  So we see a lot of activities go into training manpower development, capacity building.  This year, we’ve procured Automated External Defilberator (AED).

  This is a machine that when applied on a patient that had a sudden cardiac arrest.  The machine will wheel the person and bring the person back to life.

 The goal is to have it in key places  where we know that many people come around actually and we follow it up with training on how to use this machine. In the next one month, we’ll start training on how to use this machine; so our nurses will be trained on how to provide basic life support. Not just the nurses, our regular citizens too, so that if a health care provider is not around, they will be able to use the machine. They will rush and get the machine and apply it on the patient, in case of emergency.

  In a case of a cardiac arrest, what is the survival rate? How long can one stay before finally giving up?

  That’s a very intelligent question. In cardiac arrest, for every one minute that passes, the survival rate decreases by 10 per cent. In 10 minutes, the person is gone so, time is important, it’s everything. But, people don’t die in our hands. Actually by training, we are trained to keep people alive; until we move like that, if we don’t have resources to work with, we get shackled.

  When I came to office and looked around, I was taken aback by what I saw and I asked, how do I function? You need equipment, resources and manpower but you cannot do it in one day. So, you have to start with the most important thing and start building on them, the AED is one of them.

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