REPORT OF THE ANPA ADVOCACY MEETINGS IN ABUJA, NIGERIA, DURING THE 2019 ANPA WEEK OF APRIL 5 TO 12, 2019

PREAMBLE:

As part of the ANPA week, the leadership and advocacy team members meet with Healthcare leaders in the country to deliberate on possible opportunities to improve healthcare in the country. These meetings address the training of physicians, physician licensing and supervision, Federal Ministry programs and strategies to ensure adequate working circumstances for providers, provision of adequate care facilities for the community to receive care, be it at the rural, primary, secondary or tertiary healthcare level. We also meet with NMA (Nigerian Medical Association), the professional body representing Nigerian physicians and also responsible for advocating for the healthcare of the community and the wellbeing of the providers. Other parastatals such as the NCDC which oversees the prevention and control of communicable diseases and emergency healthcare preparedness for disease outbreaks as well as legislators (the politicians) who legislate on healthcare-related matters and ensure adequate funding for the healthcare sector through the national budgetary process are also visited. Finally, we ensure that we meet with the diaspora council representing Nigerian professionals living abroad during this time to liaise and strategize on how to improve relationships and programs for the country.
Our first meeting during this year’s ANPA Week was scheduled to be with the Chairman of the newly created National Diaspora Commission, Hon Abike Dabiri-Erewa but she had to be emergently pulled away by the President and so was unable to keep our appointment, unfortunately. We have historically enjoyed a cordial relationship with this office and hope to continue. The National Diaspora Commission was, however, represented by Engr. (Dr) Sule Yakubu Bassi who is the Secretary to the Commission. He attended the flag off/opening ceremony of the ANPA-NAPPSA Medical/Surgical mission at Jiwa and participated in our medical mission functions including the meeting with Federal Minister of Health, Prof Adewole at the Federal Ministry of Health in Abuja.
In attendance, this year at different meetings was: Dr. Charmaine Emelife, Dr. Jide Bamigboye, Prof Scott Emuakpor, Dr. Uzoma Chukwu, Dr. Chine Logan, Dr. Cliff Eke, Dr. Stanley Okoro, Dr. Leo Egbujiobi and Dr. Teresa Pounds.
On April 10th, 2019 at the NMA Secretariat in Abuja, we met with the NMA President, Dr. Francis Faduyile and his team. His team included different NMA officials both local and national. Also present, was the president of the Resident Doctors Association.
Following greetings and acknowledgements of need for improved communications most especially regarding ANPA visit, arrival in country, dates of the medical mission and its flag off event as well as ability of NMA to provide participants for the mission, discussions moved on to the status of the Diaspora Professional Healthcare Initiative (DPHI) and its stance with Nigerian doctors/NMA.
Our talking points were:
•Role of NMA/Nigerian doctors in the implementation of the pilot program and the actual program.
NMA indicated full cooperation and interest suggesting also that the Federal Ministry of Health should provide necessary information especially when final agreements are completed and institutions were chosen. This will enable NMA to assist.
•Where do we stand in promoting collaborative practices among physicians, pharmacists, nurses, and other allied health workers?
Collaborative practices among health care providers in Nigeria has been a big focus of NMA. There have been meetings between NMA and (Pharmaceutical Society of Nigeria (PSN). Progress has been made with the National Association of Nigerian Nurses and Midwives (NANNM) to promote collaborative practices with each professional working in their lane and obtain the buy-in. The update is that NANNM President and the NMA President have signed an agreement for the two organizations to work together It was also mentioned that the new PSN President, Mazi Ohabunwa aligns with the need for professional harmony and is working on a new committee to help implement the collaborative activities. There are ongoing discussions with the JOHESU Chairman – Mr. Olumide Akintunde, as well, regarding collaboration with the laboratory and other allied health professionals.
• What is the role of the NMA in ensuring and enforcing physician compliance with quality and ethical practice guidelines?
Discussions involved culture change in the practice of the physicians, improve assignment of a consultative fee to allow physician financial satisfaction where they work and curb the practice of diversion of patient care and time to private practice location to supplement income. It was noted that physician service is undervalued in its pay scale and so a core problem in job satisfaction and performance in the government setting. Lack of working amenities makes the work even more difficult, setting the stage for inefficiencies.
• On the NMA website, it says: ” The NMA plans to make inroads into the Federal Ministry of Health to ensure that it is involved in all aspects of policy formulation, especially in the planning stages.” Pls expatiate, are you not already involved in this, if not, then who is and how can that be?
ANPA requested that the NMA consider allotting ANPA a seat in the MDCN council (a diaspora seat) to allow us to help advocate where it matters for progressive healthcare in the country. A rebuttal was the question to wit: Is ANPA part of the NMA or is it a parallel organization? We ended the meeting on that note to continue in June 2019 in DC. The NMA President received the invitations and will be participating in the conference. Some of his members will attend with him.
Next meeting was with the MDCN at the MDCN office in Abuja. Present for the meeting were the Chairman of the MDCN, Prof Abba Waziri Hassan and the Registrar, Dr. T.A.B. Sanusi and a few other members of the MDCN. Leading into the meeting, we had the opportunity to sit in a Council court proceeding and witnessed the deliberations as the Council adjudicated the case of physician malpractice.
Our talking points were:
• What should the Nigerian and Diaspora Physicians expect, now that we have a Chairman of the Council after six years of the seat being vacant? We have to stay involved and find out. The chairman is interested in attending the conference as we requested and will make a presentation at the conference. Will be working on his visa with the receipt of the invitation to attend.
•Role of MDCN in licensure of volunteers/participants in the DPHI program: The chairman agreed that there should be no reason not to issue a license for short trips like participation in medical missions and the DPHI program. The registrar was asked to follow up on its implementation as the MDCN is in support of the initiative. The Chairman was also receptive to renewing the old agreement ANPA had with MDCN which was about to expire.
• ANPA will like to have a seat on the MDCN Governing Council AS THE LARGEST body of diaspora physicians; MDCN felt that it will need a change in the legislature but there may be ways to tackle it differently that will involve the NMA and/or the Minister of Health.
•Fixing the Licensing fees for the diaspora physician, reintroducing a waiver and pushing for registration: To be discussed in detail as the new chairman gets acquainted with the previous situations. It was clear that he is unfamiliar with the details and Dr. Sanusi will have to fill in the details for a response.

Next meeting was with the National University Commission. In attendance was a well-prepared team to receive us. It consisted of over 15 members and even though the Executive Secretary was called away, he received us, give a stamp of approval and assigned his representative to direct the meeting. In attendance was Dr. Noel Saliu (Director of Accreditation), Dr. Gidado Bello Kumo, Dr. Adesina, Mr. Chris Mayaki, Dr. Babatunde and Mr. Boniface Odom to mention a few. An agenda was provided by the NUC and this guided the conversation. The main issue was the Quality of education of the medical professionals in the country and the delivery of care. We had an extensive discussion surrounding the last revision of the medical school curriculum which was a multi-departmental effort including ANPA, NUC, FMOH, MDCN, UI REPS utilizing a USAID grant and completed in 2012 but yet to be widely implemented. It was noted that the University of Ibadan (UI) had graduated a few classes so far utilizing this curriculum but wide adoption did not happen. Due to discrepancies in the appreciation and adoption and the time elapsed, it was noted that the NUC has embarked on a new curriculum review for medical education since October 2018 and is currently accepting comments on their website. The goal is the revitalization of medical education in the country. They have evaluated the medical education curriculum in other countries, for example, Egypt and Sudan and our shortcomings are evident. Indeed, the NUC has in place a draft curriculum for comments already. Some takeaway and agreed upon points were:
• Implementation of reform in the education curriculum needs expedition.
• It may be wise to consider patch work review and implementation.
• There may be unavailability of competent academicians to implement a good curriculum
• A survey of academician’s competency is needed with a clear public knowledge of actual medical educators (Faculty) and their specialties.
• There has to be a clear policy for Relevant Manpower (Faculty) development.
• No curriculum succeeds unless there are dedicated Faculty to make the curriculum work.
• A viable curriculum must be one assembled by those working in the “trenches” (Teachers and Educators), rather than by staff of NUC who are not teachers.
• It was strongly reemphasized that the Fed Ministry of Health does not produce the curriculum for medical education
• It was noted that there may be an opportunity to take advantage of the expertise of the Diaspora physicians and academicians to help supplement medical education in the country – a low hanging fruit.
• There has to be a clear public knowledge of Medical Schools in Nigeria.
• We applaud the call for public scrutiny of what has been assembled as a new curriculum.
Next Meeting was with the Federal Ministry of Health which was chaired by the Federal Minister of Health, Prof Adewole. In attendance was the Permanent Secretary, Dr Abdulahi, Head of Public/Private Partnership and Diaspora Unit, Dr. Olowu, and many members of the FMH. Representing the Diaspora Commission was Engr Dr. Sule Yakubu Bassi. The FMOH had a well-prepared agenda for the meeting. We were prepared with our talking points. Following introductions and opening comments by Dr. Olowu, discussions centered around the following topics which were :
• Status of the DPHI: Noted to have been captured in the 2019 Budgetary request as the concept document has been finalized and submitted by the Diaspora team. It was noted that the monetary allocations for 2018 are inadequate. The FMH stated that the Accountant General of the Federation will need to release money from service worldwide for the implementation /initiation of the DPHI.
• Some expected activities of the DHPI program will include medical outreaches, professional exchange, prioritized care in the oncology, renal and cardiac disease disciplines.
• FMH will send a draft document of the above request within a week of this meeting
• Fed Minister agrees that the NUC leads the effort for medical school curriculum review and will definitely participate in a proposed Stakeholders meeting with the Diaspora et al
• The goal is to provide a current and globally acceptable training curriculum.
• FMOH should consider taking over the posting of physicians post training due to the 1 to 2 years waiting period graduating doctors experience before finding a place to do their mandatory 1-year Rotating Internship (House job). This seems to be a problem as the States are not paying appropriate doctors salaries and so the new doctors are gravitating to the cities, leaving the rural areas with no coverage. The Minister stated that he has presented this matter to the Executive Council and it has accepted that all House jobs will be paid for, henceforth, by the Federal Government.
• The FMOH feels that MDCN should consider the accreditation of hospitals where house officers can be trained to help assure adequate training and improved standards.
• It was suggested that Governors should prioritize Healthcare on their agenda. The Minister expressed concern that all of the States have not been very supportive of the efforts of FMOH. The States lack qualified personnel (Consultants) who can supervise trainees and pressure from FMOH has not yielded the expected outcome. Without qualified Consultants in the State Health Ministries, only Federal Government institutions remain available for such training, which is inadequate. ANPA applauded the FMOH for the steps taken so far and offered to help where needed to avoid concentration of new trainees in the established centers of Ibadan, Lagos, Nsukka, Ife, Benin, Zaria, and other major cities. ANPA also suggested that FMOH request the National Postgraduate Medical College to help develop a curriculum for House Officer training. ANPA requested FMOH to consider a “Post Medical School Graduation National Board Examinations” to ascertain that all Medical School graduates in Nigeria have met a minimum standard of training. The Minister agreed about the need for this and other well-thought-out ANPA suggestions/recommendations but pointed out the difficulty of implementation due to multiple factors including the impending change of government which is usually associated with personnel change. ANPA wished the Minister well.
• ANPA requested consideration of allocation of a seat in MDCN. It was suggested that while the Ministry evaluates the possibility, ANPA should consider requesting this from NMA who currently has many seats.
As part of the advocacy, we visited the National Reference Laboratory in Gaduma, Abuja at the invitation of the Chairman/CEO of the NCDC, Dr. Chikwe Ihekweazu. Present to give us a tour were Mr. Anthony Ahumibe and his colleague. Remarkable was the progress the NCDC had made with its efforts. We were able to see the huge refrigerated stores of serum samples from the different epidemiologic studies with the promise of further studies possible. New machines to test for HIV and Hepatitis in the country had just been installed and became operational in the last one month at the Reference labs. We were able to see and inspect it. The NCDC continues to make massive gains. This impressive facility which is still largely underutilized is definitely growing and there is now the capacity for hosting diaspora researchers in this facility. This is an opportunity for ANPA members and other Nigerians in Infectious Diseases and Epidemiology. Dr. Chikwe Ihekweazu was out of town with members of his staff on a work retreat that week, unfortunately.
Given the excellent relationships ANPA has established with physicians in Nigeria, thanks to Dr. Biodun Ogungbo (Neurosurgeon in Abuja) who hosted our team on a mission night along with Dr. Otabor (Alliance Hospital), the ANPA President was able to have a meeting with the President of the Guild of Medical Directors in Nigeria, Dr. Chito Nwana. These are Physician owners of private hospitals. We have always considered a partnership with this group and they are very interested. Indeed, Dr. Wada, a private practitioner, and ANPA friend, capped off our medical mission with a sumptuous dinner and dancing at his resort.
Respectfully submitted.
Charmaine Emelife, MD (ANPA President)
Abraham Osinbowale, MD (Chair, ANPA’s Advocacy Committee)

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