The President's Message

The Association of Nigerian Physicians in the Americas: An Idea Whose Time Has Come
Fiemu E. Nwariaku, FACS, FWACS
Saturday July 3rd, 2010

It is an honor for me to deliver these remarks at the commencement of my term of service as the President of the Association of Nigerian Physicians in the Americas, ANPA. Our organization is indeed an idea whose time has come! If I seem to stand tall here today, it is because I stand on the shoulders of giants. Giants who are responsible for the durability of this organization to this day. On this note I would like to thank the past Presidents of our organization present today. Please stand and be recognized.

From humble beginnings in the Southern Valley of California 15 years ago, ANPA has become the ‘go to’ organization of Diaspora health professionals from Sub-Saharan Africa. Whether by design or destiny, we find ourselves in this position. Twenty five percent of U.S. physicians are foreign-trained. Ten medical schools in four African countries provide 86% of all Diaspora physicians from Africa. Five of those ten medical schools are in Nigeria. “Given these statistics, we have no choice but to leverage this position for the better health of our fellow citizens.

I do not undertake this position lightly, nor do I underestimate the degree of difficulty associated with leading our organization. Our country of birth, Nigeria has one of the worst health and human development indices in the world, despite having one of the fastest growing economies in the region. This paradox is in no small part because of mismatched resources, ineffective leadership and lack of prioritization. While ANPA can not solve many of the problems with Nigeria, we certainly bring tremendous value to the process of improving healthcare in the region. Our members are by default successful in one of the richest countries in the world. They consistently provide financial and technical support to Nigeria despite inherent personal and professional difficulties. No where was this more apparent than in the recent tragic loss of two of our giants, Dr Enyi Okereke and Dr Nurudeen Olowopopo, both of whom passed on, while in the active service of this organization and of their country. The sudden and tragic loss of our dear friends while saddening gives me renewed sense of purpose to continue the work that they both fought and died for. I believe that this is the reason that we are here, this is the reason that we must continue this work and this is the reason to persevere, even now. I believe that their efforts shall not be in vain. My strategy for the next two years is four-fold. We will work hard to improve graduate and postgraduate medical education in Nigeria, provide technical assistance to strengthen health systems, engage in effective healthcare advocacy within and outside Nigeria, and serve as a catalyst for involvement of international development agencies in the country.

Education
Since the establishment of the first medical school at the University College Hospital, Ibadan, at least four generations of medical schools have been created. With approximately 306 health training institutions and ~26 accredited medical schools, Nigeria graduates approximately 2300 medical doctors each year. As stated earlier 10 medical schools in Africa produce 86% of the doctors who migrate from Africa to the United States, and five of those ten medical schools are in Nigeria. These include the University of Ibadan, University of Lagos, University of Nigeria, University of Benin and University of Ife. In fact the University of Ibadan is the third largest donor of sub-Saharan African doctors to the United States of America.  Nigeria has one of the largest stocks of human resources for health in Africa comparable only to Egypt and South Africa. In 2005, there were about 39,210 doctors and 124,629 nurses registered in the country, which translates into about 39 doctors and 124 nurses per 100,000 populations as compared to the Sub-Saharan African average of 15 doctors and 72 nurses per 100,000 population. Despite these large numbers, healthcare and development indices in the country remain at the bottom of the list. Specifically, life expectancy at birth is 44 years, infant mortality is 100 per 1000 live births and maternal mortality is over 800 per 100,000 live births, under five mortality is 201 per 1000 live births. Multiple factors that contribute to this disparity include underfunding of the healthcare sector, maldistribution of healthcare workers and poorly skilled healthcare workers.

Pre-Service Training
The medical school curriculum in Nigeria has not changed significantly in 50 years, and is in serious need of reform. As a result Nigerian medical graduates enter the global workforce at a significant disadvantage to their peers. First, the curriculum needs to mandate the widespread use of the Objective Structured Clinical Examination (OSCE). OSCE is a modern type of examination used in health sciences to test clinical skill performance and competence in skills. Medical schools worldwide have adopted this technique because it is competency-based and ensures a much more uniform end-product. Similarly, technological advances in disease diagnosis and testing have not been integrated into a new curriculum. This can be accomplished by introducing modern electronic learning tools such as distance – learning and web –based self instruction. While these techniques have been shown to be effective for transferring knowledge and skills, they will require a modest investment in infrastructure for information and communications technology (ICT) within each medical school. ANPA proposes to address this by bringing together a working group to assist with curriculum reform. ANPA stands ready to partner with medical schools and teaching hospitals to provide technical assistance including curriculum development, identifying international (public and private) partners to collaborate on content and platform.

Re-introduction of ‘outside postings’ will also ensure that Nigerian medical graduates obtain a broad-based experience in healthcare. ANPA already has a mentoring program in place. It is my hope that we can expand this to include opportunities for research and clinical observerships in the U.S by Nigerian trainees and physicians. ANPA has the administrative infrastructure to provide short term postings for students and trainees in the U.S. We hope to work with  international donor agencies (USAID, DFID etc) and other diaspora organizations (Medical Association of Nigerians across Great Britain, MANSAG, Canadian Association of Nigerian Physicians and Dentists, CANPAD, Nigerians in the Diaspora Organization, NIDO), to facilitate these initiatives. Creation of Departments or Divisions of Medical Education will also facilitate the development of relevant, dynamic and innovative curricula for education in healthcare.

Similarly, our medical student affiliate, Distinguished Nigerian Physicians of Tomorrow, DNPT is actively engaged with medical student organizations in Nigeria to improve medical education. ANPA continues to support these energetic young men and women who make us proud.

Post-Graduate (In-service) Training
While many medical graduates receive adequate broad-based instruction during medical school, the lack of infrastructure in many public hospitals limits opportunities for continuing professional development (CPD) after graduation. Fortunately most physicians in practice are self-directed and seek their own opportunities for knowledge acquisition and skills advancement within and outside Nigeria. However, this creates a wide range of knowledge and skill levels among Nigerian physicians. A formalized approach to CPD will greatly eliminate this variability. ANPA is currently exploring an opportunity to work with local Nigerian regulatory organizations to provide assistance with the development of a format for CPD and a mechanism for enforcement.
 
Health Systems Strengthening
The role of government relates to regulation and funding. In general, the strategic health workforce policy document for Human Resources for Health approved at the 50th National Council of Health meeting in Abuja in January 2007 needs to be implemented. This will be crucial if Nigeria is to achieve the Millennium Development Goals. Recent initiatives by the Federal Ministry of Health to ensure that health workers have safe working conditions, adequate compensation, and sufficient levels of medicines, supplies, and equipment is laudable. ANPA is willing to work with local and State Government Health Systems to provide leadership and management training so that they make better use of their resources. With appropriate funding, I propose a regular training workshop/course in healthcare leadership and management to be administered to all Chief Medical Directors, Board Directors and Unit managers in all State and Local Government Agencies.

We also plan to work closely with local regulatory agencies such as the Medical and Dental Council of Nigeria, MDCN to develop and enforce continuing professional development initiatives to ensure that the majority of healthcare practitioners in the country maintain the highest intellectual and professional standards.

Advocacy
At 50 years, Nigeria is still to enjoy the benefits of a functional health bill. This significantly impairs strategic planning for the healthcare sector. Therefore, one of my immediate goals is to advocate for signing of the healthcare bill which has been in limbo for years. We will also work with local agencies to further patient advocacy and physician accountability in the system. The Nigerian Medical Association, NMA, remains a strong voice in the healthcare sector, and continues to be a powerful advocate for the Nigerian doctor. However, the long term success of these efforts will require expansion of advocacy efforts to include patient advocacy, as well as recognition of non-physician healthcare providers as important stakeholders in the process. We propose better enforcement of professionalism standards currently on the books. ANPA now has a formal relationship with the NMA and hopes to have an active voice in their deliberations in the near future.

International Development Agencies
As a result of our activities during the past 15 years to improve healthcare in Nigeria, ANPA is increasingly recognized as a credible and effective catalyst to produce change in the Nigerian healthcare sector. We hope to leverage this recognition by actively seeking partnerships with donor agencies and international development groups to channel their resources efficiently in the healthcare sector. We are currently in discussions with several groups including the World Bank, US Agency for International Developments and others, to identify specific programs which will benefit from our joint expertise and resources.

I conclude that while our organization has enjoyed significant growth during the last decade, I see major challenges ahead if we are to produce measurable improvements in Nigerian healthcare indices. However I believe that we are faced with a tremendous opportunity to chart the course for a brighter future in Nigerian healthcare. I thank you all for your continuing support and look forward to working with you on this worthwhile effort.