Executive Summary of Advocacy Efforts : ANPA Week In Nigeria, March 21-27, 2016

Dear All,

Below is the Executive Summary of the activities of ANPA’s team during the “ANPA Week in Nigeria” of March 21 to 27, 2016.

Team Members: Nkem Chukwumerije (ANPA President), Barbara Onyia (Houston Chapter’s Chair-elect), Clifford Eke (Chair, ANPA’s Medical Missions Committee), Adebola Giwa (Pediatric Resident and Member, Medical Missions Committee), Abraham Osinbowale (Chair, Advocacy Committee).

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Nkem Chukwumerije (ANPA President) Barbara Onyia, Abraham Osinbowale, Cliff Eke and Adebola Giwa.

Logistics:  Cliff Eke arrived in Abuja on Saturday, March 19, 2016 to supervise the extensive arrangements he had made for our accommodation and transportation. He was later joined by Adebola Giwa who flew in from Lagos on Sunday, March 20, 2016. Nkem Chukwumerije, Barbara Onyia and Abraham Osinbowale flew in from Lagos to join them on Monday, March 21, 2016, prior to our first advocacy meeting with Junior Chamber International, Nigeria (JCI Nigeria). Kudos to Cliff for the perfect arrangements.

Our team of five had a one hour strategic meeting from 11:00 am to 12:00 noon in our hotel to rehash the agenda for the ANPA Week, talking points for each meeting, possible areas of cooperation, anticipated next steps  and deliverables, outcome measures.  We adjourned to conduct our first advocacy meeting with JCI Nigeria.

Advocacy meeting with JCI Nigeria

Location: Ashville Hotel, Kwame Nkrumah Road, Asokoro, Abuja

Present: Nkem Chukwumerije, Cliff Eke, Barbara Onyia, Adebola Giwa, Abraham Osinbowale (ANPA) and Olatunji Oyeyemi (President, JCI Nigeria),  Richard Ojo (National Executive Vice President, Area C, JCI Nigeria) and three other members representing JCI Nigeria.

The meeting commenced at 12:00 noon on Monday, March 21, 2016, after formal introductions had been made. Abraham Osinbowale briefly described his encounter with JCI through the organization’s worldwide President at the Malaria Summit in Washington, DC, in February 2016 and how this organization of young people aged 18 to 40 years can help ANPA accomplish its advocacy mission in Nigeria. The President of JCI Nigeria then gave a history of his organization as a 100 year old organization founded in the United States of America but has now grown to be a worldwide body with membership in the Nigerian Chapter alone being in excess of 200,000 members. He talked about their advocacy efforts in the area of smoking cessation, malaria control, youth empowerment, collaboration and partnership for community development and sustainability, maternal and child health, tuberculosis prevention and control. He stated that most of their members joined the organization while in Colleges (Universities) and grew in the organization as they entered into the corporate world. Majority of their members work in large multinational  corporations like Microsoft, Apple, General Electric, Procter & Gamble and they leverage their positions to promote the community outreach goals and objectives of JCI Nigeria for funding. He stated that JCI has existing partnership with various State Governments, Microsoft, Leap Africa, Unicef, UN and many other international agencies. He stated that JCI Nigeria will like a longitudinal, meaningful and sustainable relationship with ANPA instead of a one time or occasional project together. He concluded that they are very excited about the opportunity to partner with ANPA in areas of common interests in our advocacy efforts in Nigeria. He submitted a Memorandum of Understanding (MoU) to ANPA’s President to reflect the seriousness of our potential partnership. ANPA President thanked him and his colleagues for honoring our invitation to come to Abuja from their headquarters in Lagos. He commended them for the good work they are doing and promised to review the MoU and revert back to them after discussing with ANPA’s Executive.

The meeting was adjourned at 1:30 pm.

Meeting with Channels TV, Abuja

Location: Channels TV Station, Abuja

Present: John  Momoh (Chairman/CEO, Channels TV), Yemisi Ipaye (Senior Manager News, Abuja); Nkem Chukwumerije, Barbara Onyia, Cliff Eke, Abraham Osinbowale (ANPA)

The meeting started at 2:00 pm on March 21, 2016. Mr. Momoh welcomed ANPA to Abuja and the Channels TV, Abuja. He apologized for not being able to attend the 2015 Convention and promised to be at the Las Vegas Convention. He encouraged ANPA to participate in Channels Television’s  Saturday Sunrise program to inform the Nigerian public about ANPA’s activities in general and the ongoing ANPA Week of 2016.  ANPA President later thanked Mr. Momoh and Channels TV for covering ANPA’s past Conventions and ANPA’s contribution during the Ebola epidemic in Nigeria. He asked if Channels will cover ANPA’s Senate meeting of  March 22, 2016. The request was granted.

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Meeting with the President of the Nigerian Medical  Association, Dr. Kayode Obembe

Location: NMA Headquarters, Abuja

Present: Nkem Chukwumerije, Cliff Eke, Barbara Onyia, Adebola Giwa, Abraham Osinbowale for ANPA and Dr. Kayode Obembe, Personal Assistant to Dr. Obembe for NMA.

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Abraham Osinbowale, Barbara Onyia, Kayode Obembe (NMA President) Nkem Chukwumerije (ANPA President), Cliff Eke and Adebola Giwa

The meeting started at 4 pm on Monday, March 21, 2016. ANPA President thanked Dr. Obembe for attending the 2015 ANPA Convention in Orlando and implored him to attend the Las Vegas Convention also this year. He stated that his term will expire this year but he has noted the date of the Convention in his calendar. He promised to inform whoever will succeed him as NMA President about the Convention and encourage him or her to attend also. He thanked ANPA for sending Prof Scott-Emuakpor to the last National Executive Council (NEC) meeting in Ado-Ekiti. He reiterated to ANPA that ANPA now has a seat in NMA’s NEC and it is therefore necessary for ANPA to make the organization visible in all NMA’s important events. He seized the opportunity to remind ANPA President that ANPA is yet to respond to NMA’s invitation to the forthcoming annual meeting scheduled for late April/May 2016  in Sokoto. ANPA President then talked about the theme of ANPA’s 2016 Convention as a team approach to healthcare delivery in that  the 2016 Convention is a joint meeting of physicians, pharmacists and nurses, He also spoke briefly about the three pronged approach to the present ANPA Week namely Continuous Professional Development, Advocacy and Medical Missions.  Dr. Obembe agreed with ANPA’s theme for the 2016 Convention and he believes that  if the various professionals work together, there will be less industrial strife in Nigeria’s healthcare sector and this collaborative effort will lead to better patient outcomes. He gave an example of how he attended the 2015 Nigerian Nurses meeting with five other doctors in addition to himself and how the nurses were pleasantly surprised to see them at the meeting. He stated that annual CPD units are now required for annual registration renewal to practice Medicine in Nigeria. When ANPA President asked if there are requirements for recertification for specialty programs, he stated that is not the case yet in Nigeria. Dr. Adebola Giwa talked about his experience during a clinical rotation at the University Hospital and that the faculty/physicians had no feedback from the students or patients about customer satisfaction and that it will be a good idea for accountability. Dr. Obembe agreed and he stated that some HMOs operating under Nigeria’s Health insurance scheme are already implementing that idea in grading or retaining medical providers in their system. On medical missions, he advised ANPA to work closely with the national NMA because the program can be better enhanced through participation with the local NMA Chapters especially for proper follow-up care and management after the ANPA team leaves. He also encouraged ANPA to continue their interest in Private Public Partnerships (PPP) to bring quality world class medical care to Nigeria thus contributing to capacity building. ANPA President indicated ANPA’s interest in a seat in MDCN (Medical and Dental Council of Nigeria) and wondered if NMA can help through its nine seats. He stated that the nine seats have to be reflective of Nigeria’s 6 geopolitical zones  and there are other political factors involved. He agrees that the Diaspora needs to be represented in MDCN to be effective in Nigeria’s healthcare. He advised us to discuss it at our meeting with MDCN and used the opportunity to advise ANPA to come to the next NMA meeting in Sokoto in April/May 2016 to make our presence known.  He advised ANPA to be more proactive in Nigeria and not limit our activities to one time events like one medical mission or one week in a year.

Meeting with National Universities Commission (NUC), Tuesday, March 22, 10:00 am

Location: National Universities Commission, Abuja

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Completed minutes will be forwarded in a separate email.

Meeting with Nigerian Senate Committee on Health, March 22, 2016, 2:00 pm

Location: Senate Chambers, National Assembly, Abuja

Present: Senator (Dr.) Olanrewaju Tejuosho (Chairman, Senate Health Committee); Senator Matthew Urhoghide (Vice Chair), Senator T.A. Orji (Member), Dr. Rukevwe Ugwumba (Consultant)

Nkem Chukwumerije, Cliff Eke, Barbara Onyia, Adebola Giwa, Abraham Osinbowale for ANPA

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ANPA President and Team with members of the Senate Committee on Health.

The Chairman of the Committee welcomed the ANPA team to Nigeria and apologized that the full Committee could not be convened in time for the meeting but that key members of the Committee were present to listen to us. ANPA President in turn thanked the Committee for accepting our request for a meeting. He then talked about ANPA’s vision od a healthier Nigeria in a healthier world and ANPA’s interest in contributing to quality healthcare in Nigeria. He asked for the cooperation and support of the legislators in facilitating opportunities that will enable ANPA members to set up world class health facilities in Nigeria through the provision of low interest loans, tariff reduction and waivers for medical equipment and essential medications and facilitation of a cooperative work environment for all healthcare workers in a collaborative way. The Senators stated that finance is a big problem in Nigeria at the present moment but they encouraged Nigerian doctors in America and other developed countries to participate in Nigeria’s healthcare delivery through Public Private Partnership (PPP). The Chairman stated that the present ANPA week and visit is timely in that the Senate Committee was getting prepared to start a road show to North America and Europe to turn the brain drain into brain gain by interacting with Nigerian doctors and seeking their support and input. He stated this was very important because of the amount of money Nigeria was losing to medical tourism. He then introduced their consultant who was arranging the program for North America to the ANPA team. He also introduced the Physician Consultant who is a CANPAD member. ANPA encouraged the Senate team to come to the Las Vegas Convention for better contact with more Nigerian doctors instead of visiting individual cities. The Senate Chairman asked ANPA President to invite the whole Senate Committee on Health instead of inviting the Chairman alone so the Committee members can have the opportunity to participate in the joint healthcare theme this year’s convention will be addressing. He implored ANPA and CANPAD to come together as one organization since both are in North America. He was informed that CANPAD members used to be ANPA members prior to forming their own organization of Nigerian Physicians in Canada (CANPAD).

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The Senate meeting was covered by many print and electronic media houses.

Meeting with Medical and Dental Council of Nigeria (MDCN), March 23, 2016, 11:00 am

Location: MDCN Office, Abuja

Present: Dr. Abdul Ibrahim (Registrar), Dr. V.K. Gbenro (Head of Department, Registration), Dr. N.U. Nwakanma (Head of Department, Education), Mr. Ahmed Aliyu (Head of Department, Accounts), Mr. G.O. Oladokun (Acting Head of Department, Admin/Human Resources) for MDCN. Nkem Chukwumerije, Cliff Eke, Barbara Onyia, Adebola Giwa, Abraham Osinbowale for ANPA.

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ANPA President and Team with Abdul Ibrahim Registrar MDCN

The Registrar thanked and welcomed ANPA to MDCN and Abuja. ANPA President talked about ANPA’s three pronged approach of Continuous Professional Development (CPD), Advocacy and Medical Missions. He asked about renewal of registration and CPD requirements and he highlighted the problems ANPA members are having in registering or renewing registration with MDCN. The Registrar and his team responded that registration has now been streamlined and this can be done online now. The only problem is in payment because the country now has a Treasury Single Account (TSA) into which all payments going to all Federal agencies have to be deposited. This form of payment is easier for people in Nigeria than for people outside Nigeria. He stated that they are working on how people abroad can make their payments once they have completed the application online.  He stated that CPD is now a requirement for renewal of registration and the process is going on smoothly. ANPA President raised the issue of recertification and professional ethics. The Registrar stated that there is no recertification in Nigeria at the moment but he will report the topic to the next MDCN Board meeting. ANPA President also mentioned ANPA/Diaspora seat on MDCN. The Registrar and his team stated that there is no provision for Diaspora seat on the Council at the moment and that Board members are determined by multiple criteria based on national interest. He encouraged ANPA to continue the discussion on the topic. On professional ethics and discipline, he stated that MDCN has been very proactive and continues to be proactive in this direction. He further stated that lack of work even in the healthcare field due to lack of funds in some of the health institutions is responsible for some of the problems. ANPA raised the issue of high failure rate in the National Postgraduate examinations reported by some of the examinees due to lack of proper tutoring/mentoring and preparation of the examinees by the faculty. He promised to take the information to the next Council meeting where some of the Chairmen of the various postgraduate colleges are represented. The registrar and his team then asked for the cooperation and support of ANPA in IT training, digitalization of ANPA physician information, training in customer relations, electronic data of physicians in the United States. ANPA President promised to look into these requests with a view to working with MDCN to facilitate registration of ANPA members with MDCN. The Registrar promised to attend ANPA’s next Convention in Las Vegas.

Meeting with Federal Minister of Health, March 23, 2016, 4:00 pm

Location: Federal Ministry of Health, Abuja

Present: Prof I.F. Adewole (Hon. Minister), Dr. E. Osagie Ehanire (Hon. Minister of State), Dr. (Mrs.) Shamaki (Permanent Secretary), Dr Ngozi Azodoh (Director), Bolaji Oladejo (Deputy Director), Omatie Chukwumah (Director), Dr. O. R. Olowu (Head, PPP/Diaspora Unit), Wura Ozimede (SSO, PPP/Diaspora Unit), Dr. Onwudiwe (Head, FMC, Rep DHS), Dr. Wapada I. Balami (MM, DFH), Dr. P. Osinubi (Hospital Services), Dr. O.S. Sotiloye (MD, FMC, Abeokuta) for Federal Ministry of Health.Nkem Chukwumerije, Cliff Eke, Barbara Onyia, Abraham Osinbowale for ANPA

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The Honorable Minister welcomed ANPA to Abuja and he stated that he was looking forward to our presentation. ANPA President made a presentation about ANPA’s history, its vision of a healthier Nigeria in a healthier world and the burning desire of ANPA members to contribute to Nigeria’s healthcare. He mentioned ANPA’s contribution of PPE and efforts in support of combating the Ebola crisis as well as ANPA’s dedication of the 2015 convention to the Ebola crisis including delivery of a physician Ebola survivor by an ANPA member. He stated that ANPA will like to explore ways of engaging the ministry of Health in meaningful ways to forestall the incessant strikes in the health sector in Nigeria and elevate the quality of Health in Nigeria. He talked about the theme of a joint Convention with the pharmacists and nurses at this year’s Convention in Las Vegas and he reiterated ANPA’s invitation to the Minister as our Guest Speaker for 2016 Convention. The Minister thanked ANPA President for his presentation and accepted the invitation to be this year’s Guest Speaker.  He commended ANPA’s effort on Ebola. He wants to engage ANPA in reversing the brain drain and medical tourism by utilizing the skill sets available within ANPA. He talked about the efforts of the Federal Government in curtailing the incessant strikes in the healthcare sector in Nigeria while working feverishly on containing/controlling Lassa fever and other emerging diseases in the country by strengthening the capacity of Nigeria’s CDC (NCDC). He stated that he has proposed that the budget for Health be increased to 15% for 2017 since the 2016 budget is already done. He also talked about the ministry’s effort to increase and improve the Universal Health coverage with primary care as a focus with a well-oiled referral system providing healthcare to 100 million people. He also wants ANPA members to be engaged in relevant research pertinent to healthcare in Nigeria. He stated that he has set out to accomplish the following Rapid Result Initiatives in 100 days: 10,000 surgeries, open and activate 110 primary care centers, treat 200,000 malnutrition cases in the Northeast, build NCDC to full capacity and improve the National Health Insurance scheme. He stated that he believes in ANPA, cross-fertilization of ideas  and continuous engagement between the parties will result in better healthcare in Nigeria. He will like to explore an opportunity whereby ANPA members who have special skills can home as consultants for a two weeks to a month in a year to the various tertiary centers, use their skills while imparting knowledge to their colleagues and these programs will be fully funded. He would like to do this program on a pilot scale within the next 100 days if ANPA is willing to explore the opportunity with the Ministry of Health. The program can be extended depending on the outcome of the pilot. He also expressed his support for ANPA’s medical missions in serving needy populations. ANPA President also mentioned the need for Nigeria to tap into USA’s Global initiative and that ANPA has a contact in the Department of Health and Human Services in the office of African Affairs. The Minister said that is good but Nigeria should tap into its own human and material resources also. The Permanent Secretary wants ANPA to look into sourcing Medical Physicists for Nigeria’s Radiation Oncology Units. She stated that the machines are available but there is acute shortage of Medical Physicists to maximize the use of the machines. ANPA President promised to take the issue to ANPA members who are knowledgeable in radiation oncology

We left for Jos early on Thursday, March 24, 2016 for the Medical Mission to Faith Alive Hospital in Jos. It was quite a humbling experience to witness the wonderful work being done in that institution. We are no doubt quite blessed to be here in America where we take many things for granted. I was able to use my clinical skills again without relying on all the gadgets and tests we order so frivolously here. It was also gratifying to know that when I needed a test, I could still order it as exemplified by the case of one 10 year old  who was on antiretroviral  therapy and Tb treatment but had a dependent edema and ascites which the physicians thought could be CHF. I suggested we do liver profile with an eye on possible hypoalbuminemia and BINGO, cardiac tests came back negative but her albumin was 1.5! ( Normal: > 3.5). Her CD4 count was good and CXR was fine  (she has obviously responded to the ART and Tb treatment). We started her on high protein diet (her appetite was quite good). Her edema and ascites  started improving in 48 hours- we obviously got her oncotic pressure better! Cliff already told you about the post prostatectomy SVT case. We saw many other good clinical cases  that made us feel good about going despite the initial temerity about security in that part of Nigeria.

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Patients in the waiting room
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Dr Cliff Eke with Team members and volunteers.
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One of several surgeries performed during the medical mission.
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A grateful patient

 

We wrapped up the week with the Sunrise program at Channels TV in Lagos on Saturday, April 2, 2016.

 

 

Thank you to all the members of the team and to ANPA in general.

Prepared by:

Abraham Osinbowale, MD                                                              Barbara Onyia, MD

Chair, ANPA’s Advocacy Committee                                              Chair-elect, Houston Chapter

 

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