Nutrition: Lagos Moves To Scale Up Action, Develops Five-Year Policy

Chioma Umeha

The Lagos State Committee on Food and Nutrition in conjunction with Civil Society Scaling-Up Nutrition in Nigeria (CS-SUNN) have domesticated the National Policy on Food and Nutrition to Lagos specific.

Speaking during the opening remark of the validation meeting of the Lagos State Specific Plan on Food and Nutrition (SSPFN) and State Multi-Sectorial Plan of Action for Nutrition (SMSPAN), Mr Shola Fadorun, representing the State’s Permanent Secretary,  Ministry of Economy Planning and Budget, Abayomi Adebisi Kadiri said malnutrition is a key health challenge in the State.

He said the validated policy will serve as a direction for the execution of programmes and projects that will address nutrition matters in the State.

Kadiri said the main objective of the validation exercise is to cross the‘t’s, dot the ‘I’s and confirm the data referred to in the document, adding that the exercise will address the cross cutting issues among the lines Ministry, Department and Agencies, (MDAs).

Giving further insights, he said that the domesticated policy document is accompanied with strategic five-year costed work plan that will be used as a guide in the execution of Food and Nutrition programmes in the State by harnessing available resources from Government budgets, as well as from development partners to support a harmonized, strategic and costed work plan for effective implementation.

He said malnutrition is widespread in the entire country, although the scale and scope varies between regions and states, adding that it manifests mainly as under nutrition, over nutrition and micronutrient deficiencies.

According to the Permanent Secretary, “reducing malnutrition is an important goal of development, since malnutrition not only slows down development, it directly leads to morbidity and mortality.

A member of the Board of Trustee, CS-SUNN, Dr. Phillipa Momah said the vision of the organization as well as its mission is to mobilize facilities and scale up nutrition across board in the country.

Expressing her gratitude and appreciation to all that made it to the program, Momah said CS-SUNN is looking forward to seeing an improved food security in the country, reduce under nutrition among infants, children and adolescents in the country.

Making his presentation, the Project Manager of CS-SUNN  Mr Sunday Okoronkwo said “every single day, Nigeria loses about 2,300 under five year’s and 145 women of child bearing age. This makes the country the second largest contributor to the under five and maternity mortality rate and the cause is malnutrition.”

Okoronkwo added that those children who survive malnutrition often become stunted. Stunting is the major indicator used to measure childhood malnutrition.   Malnutrition comes in different form.

“Stunting: too short for the age (chronic malnutrition).Wasting: too thin for their age (Acute malnutrition). Obesity: overweight.

 “The trend of nutritional indices from 1990 to 2015. Stunting reduced from 43 percent to 33 percent. Wasting from 9 percent to 7 percent, Underweight from 36 percent to 19 percent. Exclusive Breast Feeding (EBF) increased from 2 percent to 25 percent, which is an improvement but the target is 100 percent. 

“When a child don’t get the required EBF, that child will be malnourished when compared to a child that has 100 percent EBF”, Okoronkwo explained. 

He further said that a child with stunted growth will not be able to achieve potentials, adding that in Lagos State, wasting is now a serious issue and something need to be done stressing that the basic causes of malnutrition include: economic structure, lack of food, inadequate care for children, insufficient health service and unhealthy environment, diseases which can lead to malnutrition.

CS-SUNN’s Project Manager said that some of the causes are interconnected and the fight against malnutrition is a fight for all, hence all need to invest to prevent under nutrition, build human capital, boost shared prosperity and improve health outcomes.

He added that there is need for team work as the team movement recognizes this fact and also individual support are needed.

He stated that, “the policy of malnutrition was launched in 2013 and it is a key challenge in Lagos state. The guiding principle of the State policy for food and nutrition include is reduction of malnutrition through SUN activities with high impact and low cost intervention, recognition of nutrition as a developmental issue and incorporating food and nutrition consideration into development plans at all levels of government amongst others.

“The strategic objective includes reducing micronutrient deficiency disorder in the country.  Our target is to reduce the proportion of people who suffer hunger and malnutrition by 50 percent by 2025.”

The Lagos State Team Lead of Alive and Thrive, Dr Uche Ralph- Opara commended the partnership and support  of all stakeholders, with hope that the team can translate the plans to action in order to achieve a great Nigeria.

Foundation Moves Reduce Scourge Of Fibroids

...Says It’ll Provide Free Surgeries For 1000 Women

To tackle  the growing prevalence of fibroids among women, Benjamin Olowojebutu Foundation (BOF), weekend unveiled its Love story to offer free fibroids surgeries to 1000 women free of charge.

The Executive Director of the Foundation,  Dr. Benjamin Olowojebutu  who  announced this in Lagos described fibroids as a benign mass that grows in the womb even as he regretted that fibroids ranks among one of the conditions affecting women across Africa.

According to him, a lot of these superstitions, myths and fallacies surrounding the condition are the main reasons women are dying from fibroids.

He said, however, the risk of developing fibroid could be reduced if a woman married early and there was a break in their menstrual flow.

He said the major challenge contributing to the reason many people seek for other alternatives was due to the cost of surgery which he said ranges from half a million, adding that the foundation was ready to meet the needs of indigent women who could not afford to pay for surgeries.

Unveiling the Love story of BOF and journey to a 1000 free surgeries this year, Olowojebutu who is also a surgeon disclosed that BOF carried out no fewer than 626 free surgeries last year.

He explained that the BOF was a dream birthed and driven by love and compassion to help indigent people suffering from various diseases such as Fibroids, Lipomas, Breast lumps, Hydrocele and Hernias.

Recalling that the in 2018 Vision36 was born, to treat a minimum of 36 indigent women free of charge in each of the six Geo political zones of Nigeria, he said: the goal of BOF is to in the long run change the health care space with love and compassion.

He said this year, the foundation’s project tagged: ‘Journey to 1000 free surgeries” will be helping 1000 indigent patients suffering from Fibroids, Lipoma Breast Lumps and Hernia.

“We have started already we just concluded the Ikorodu outreach where eight fibroid surgeries took place.  We will be going to Cross River, Imo, Abia Edo and Ondo and Rivers State from the 1st of February, 2019.”

He said that BOF would be having its first out station outreach in Gambia and South Sudan July, 2019.

‘Creating Awareness For Social Health Insurance Programme’

Chioma Umeha

Dr Olusola Akande, Executive Secretary of Oyo State Health Insurance Agency (OYSHIA), has called for increased awareness among Oyo citizens on social health insurance programme in the State to enable them to embrace the scheme.

Akande said adequate sensitisation on the importance and benefits of health insurance are required for the programme to really gain ground sufficiently.

The health insurance agency boss spoke at a media dialogue on improving access and uptake healthcare for marginalised women and children in Oyo State which was organised by Oyo State Ministry of Information in collaboration with OYSHIA and the United Nation Children’s Fund (UNICEF).

According to him, the agency has recorded 100,000 enrollees in the last 18 months of its operations and that it targets was to hit 450,000 to cover five percent of the population of the state before June.

He listed the efforts of the agency aimed at providing quality healthcare services for the people of the state without experiencing catastrophic health expenditure.

He also said, no fewer than 100 pregnant women in the state have delivered through Caesarean Section (CS) done under the health insurance scheme and that thousands of residents of the State have benefited from the scheme.

He was worried that many people are still unaware of the activities of OYSHIA and sought the support of the media to propagate the importance of health insurance to the people so that more people would enroll in the scheme.

Akande said OYSHIA has been rated very high in terms of performance and assured that the agency would not relent in making sure that the people of the state enjoy quality healthcare without expending their entire savings on medical bills.

Contributing, Mr. Rotimi Babalola, Director, Press and Public Relations, Oyo State Ministry of Information, Culture and Tourism,  praised UNICEF for its efforts in ensuring the wellbeing of children and women.

Mrs. Blessing Ejiofor, UNICEF Communication Specialist, in her remarks said access to quality healthcare is a right of every child and charged the media to assist in reporting issues that would prompt the policymakers to take proactive steps and implement policies that would make life better for children, women and other vulnerable groups.

She explained that the objective of the dialogue was to create an opportunity for media advocacy on increasing access and uptake of healthcare services for children and venerable populations through the health insurance scheme using Oyo State Health Insurance Agency (OYSHIA) as a case study.

Ejiofor said the initiative was also designed to provide media partners with the knowledge and material that would assist them to understand the issues, advocate and report health insurance scheme to create more awareness of it and encourage more people to enroll in the scheme.

Similarly, Dr Adebola Hassan, UNICEF Health Specialist and other experts in their various presentations dwelled on the importance and benefits of health insurance and stressed the need to attain Universal Health Coverage (UHC) and ensure good health for the citizens.

Lagos Health Insurance Scheme Will Be Accessible, Affordable To Residents – Adenusi

 Chioma Umeha

Dr. Peju Adenusi is the General Manager of Lagos State Health Management Agency (LASHMA).Recently, she  spoke to select journalists on the operation of the newly launched Lagos State Health Scheme  and the role of individuals and families in making it successful. CHIOMA UMEHA was at the briefing

On the unique features of the Lagos State Health Insurance Scheme

I will start by giving an overview of the scheme. The Lagos State Health Insurance Scheme (LSHS) came about through a law that was enacted in 2015 and that law makes health insurance mandatory for every resident of the state. Its main objective is to provide quality healthcare services, which is accessible, affordable to the residents of Lagos state and in so doing, reduce, if not eliminate the financial catastrophe that arises from huge medical bills.

Three entities were derived from the law. We have the LSHS which is the programme, we have the Lagos State Health Management Agency, (LASHMA), which is the agency that has been established to supervise and coordinate the health scheme activities in Lagos state. The third entity derived from the law is what we call the Lagos State Health Fund. The Lagos State health fund serves as a basket of funds with various sources.

Insurance generally is a relatively new concept to us in Africa and Nigeria is not an exception. Insurance is just a culture that we are not used to and health insurance is not an exception. When you tell people to come and pay money for a health event that can take place in the future, the quickest thing that comes to mind is that there is a sickness/illness. So, why do I want to pay for sickness in advance? Am I praying for illness? With our religious background, the first reaction would be: “God forbid! I reject it. It is not my portion.” So, it becomes very hard to convince people.

The irony in it is that it is a practice that is common among us, but we don’t know that that is what we have been doing. For instance, if someone in a group runs into trouble related to health and that person can’t afford it alone, that person would rally round and people would begin to contribute money for her. So, the concept is there with us.

Health insurance is just putting that practice that is already with us in a structured manner. It is a communion thing. It is a form of solidarity. So, we come together, we pull our funds together, we pull our risks together and we pay for one another. When I say health insurance, we are just putting it in the right structure.

From what I have said, you know that those that are worst hit are the vulnerable, the poor people in our society, and so, in coming up with what is it that can be of benefit to everyone regardless of their social status, their financial background and that is where the issue of equity comes in, the state government came up with health insurance scheme.

LSHS and Universal Health Coverage (UHC)

Just as it is on the global movement, we are talking about Universal Health Coverage, (UHC). That means everyone should have access to health, regardless of their background and one of the ways of achieving this is through health insurance. If it is implemented the way it should be implemented, there will always be funds which are the financial in the pool to take care of health issues.

However, it is also important to note that there is no health insurance programme that covers all health conditions and for us also to be able to demystify the issue of insurance that it is only for the sick, pregnancy is not a sickness, and that is why I like using the word health condition. Going to the hospital to give birth is not a bad thing. That is something that is exciting and we all look forward to and we can also say that this is something that is planned, but there are other health conditions that come and are not planned for. Sickness does not write to anyone to say I am coming, so, prepare for me. When it comes, there has to be a way to cover the cost that may arise from such a condition.

Should Lagos residents trust the scheme?

When the National Health Insurance Scheme (NHIS) came, I am sure people have trust and that is why people enrolled into the scheme. But let us keep that aside. The healthcare delivery system may not be at the level that we want it to be. I talked about the UHC and I also talked about the main pillars which are accessible, equitable, quality and financial protection. I believe that the Lagos state government has thought this through and has taken this as part of the health sector reform strategies. I also did mention to you that one of the things that will be happening within the scheme is the quality improvement programme that is engaging the providers on a continuous basis to make sure that what is being provided is what is promised to the people.

Services provided under the LSHS

So looking at all these, the Lagos State Government decided to come up with the LSHS and looked at what are the common ailments that make people come to the hospital and can actually cause a financial burden to the people. Health insurance is always developed to address the needs of the people, at least the basic needs. So, if we look around us, we would find out that the common illness are malaria, common childhood diseases that are preventable through immunisation, diarrhoea and the long communicable diseases like hypertension, diabetes, and all these services can be rendered at the Primary Healthcare (PHC) level, which is what the benefit package seeks to address.

However, we also know that there are some conditions that go beyond the PHC level and these are the things that we considered before developing the benefits package. It is a starting point. You start small, and then you can build on that package. It is a dynamic package. However, we have to take a step at a time and that is why what is being pushed forward now is just one single health benefit package plan that cuts across and like I did mention earlier, these are conditions that we have seen that regardless of who you are, your social status, your background, where you live, whether urban or rural, these conditions can happen to anyone.

Relationship with the Lagos state chapter of NMA regarding the scheme

The unit of participation concerning the scheme is at the facilities and not membership, it is not as an association. So you come as a facility. LASHMA  is dealing with all facilities as a facility. I have not encountered any challenges. There was an advert toward the end of 2017, asking facilities to indicate interest to come on the scheme. I told you that they have to express interest, it is not automatic, so you have to say, I want to be part of the scheme and as many that have said that and have been assessed by HEFAMAA  and have scaled through the HEFAMAA process and have also scaled through the procurement process of Lagos state, are on board. Those who are yet to join have come to make enquires, we hear from them almost on a daily basis that they want to be part of the scheme and they are well informed on what to do to come on board.

Immunisation: FG Reaffirms Commitment Through Innovative Financing Agreement With Gates Foundation

Chioma Umeha

By harnessing complementary donor resources, agreement ensures that increased government funding for routine immunisation will further strengthen primary healthcare for Nigeria’s poorest

The Federal Government of Nigeria, represented jointly by the Honourable Ministers of Budget and National Planning, Finance, and Health, today announced a new innovative financing agreement with the Bill & Melinda Gates Foundation aimed at strengthening both routine immunisation (RI) and broader primary healthcare (PHC) services.

Under the agreement, Nigeria will receive incentive financing of up to US$75 million over five years from the Gates Foundation as the government meets existing commitments to increase domestic funding of its RI program. The incentive financing will be directly invested in Nigeria’s Basic Healthcare Provision Fund (BHCPF), strengthening other PHC services for the poorest. Coming at a time when the overall national budget is under pressure, the deal will direct new funds to Nigeria’s broader health sector even as more domestic resources are dedicated to critical childhood vaccines specifically—creating a win-win opportunity for essential PHC services to grow in tandem.

In April of last year, the Federal Government—led by the National Primary Healthcare Development Agency—finalized its Nigeria Strategy for Immunisation and PHC System Strengthening, 2018-2028 (NSIPSS), which outlined plans to spend US$1.95 billion on immunisation services over ten years via the national budget and some World Bank loan financing. In June, Gavi, the Vaccine Alliance, committed to supporting the NSIPSS with extended donor financing as domestic resources scale up. During this extended transition window, international donors via Gavi will provide Nigeria with US$1 billion, on top of the US$1.95bn domestic commitment. Together these funds will cover procurement of vaccines—the lion’s share of the costs—as well as operational costs for routine and supplementary immunisation activities, and PHC system support.

However, even with the additional Gavi support and loan options, the NSIPSS financing strategy requires significant annual increases in funding for vaccines until the government assumes full responsibility after 2028.

While Federal Government planning accounts for this, the incentive financing with the Gates Foundation will help reduce the pressure this creates on the overall health budget by providing new grant financing for PHC each year as domestic vaccine financing commitments are met.

25m Children Suffer From Malnutrition In Nigeria – UNICEF

Chioma Umeha

Dr. Davis Bamidele Omotola, a Nutrition Consultant, has said that about 25 million children under the age of five are currently affected by malnutrition in the country, adding that the high prevalence rate of malnutrition has remained precarious in Northeast Nigeria.

Speaking recently  during a presentation at the Media dialogue with Journalists and interface with OAPs on Child Malnutrition in the Northeast organised by the United Nations Children Fund (UNICEF), and Child Rights Information Bureau of the Federal Ministry of Information and Culture in Yola, Adamawa State,Dr. Omotola said that monies wasted on needless programmes can be invested in malnutrition.

Dr. Omotola who spoke on the topic “Child malnutrition and the emergency in northeast Nigeria,” also disclosed that Nigeria currently requires about $100 million to curb the menace of malnutrition in the country. According to him, every six children is reported to have chronic malnutrition or stunting in three northeast emergency states. He observed that Children in Northeast Nigeria are the most hit by the malnutrition crisis in Nigeria.

“Child malnutrition is recorded very high mostly in northern states. One Severe Acute Malnutrition (SAM) case is reported in every seven children in nine north east emergency states.

“Prevalence rate of acute malnutrition among children under the age of 6-13 has stood nationally at seven per cent.

While Northwest has 50.4 per cent of stunting malnutrition, Northeast has 42.8 per cent, North-Central 29.8 per cent, Southwest 20.8 per cent, South-South 20.4 and Southeast 7.1 per cent,” he said.

While identifying malaria and diarrhea as the main killers of children under the age of  five, Dr. Omotola said that 30 per cent of these deaths would have been prevented if adequate care was given to the children.

He stressed that the first 1000 days in the life of every child is very crucial. “That is from the day the child was conceived to when he is  two years,”  he added.

He further identified poverty, maternal nutrition, insurgency, high food insecurity, increasing the spread of endemic diseases and low coverage of immunisation programmes as factors affecting malnutrition in the northern part of the country.

While calling for collaborative efforts towards investing in child malnutrition for a better future, Dr. Omotola called on the Federal Government to do more in terms of releasing funding meant for addressing health-related issues in the country.

On his part, Minister of Information and Culture, Alhaji Lai Mohammed, said that while malnutrition constitutes a serious setback to the socio-economic development of a nation, sustainable growth in Nigeria cannot be achieved without prioritised efforts to scale-up and sustain investment for nutrition.

Represented by Olumide Osanyinpe, Deputy Director/Head, Child Rights Information Bureau, Federal Ministry of Information and Culture, Mohammed lamented that the country is bearing a large burden of malnutrition.  Mohammed  called for collaborative efforts toward investing in child malnutrition for a better future.

“Malnutrition is a large burden to a country, and tackling malnutrition entails empowering and educating people. Improved nutrition is key to improved national and human development and this can be done by educating the populace and creating a positive approach towards nutrition.

“Addressing nutrition is one of the ways through which sustainable development goals can be achieved, therefore investment in nutrition will help reduce the negative trend of malnutrition which has been ensured by creating this dialogue,” the Minister said.

While calling for a collaborative effort to reduce the tide, he  further commended the effort of UNICEF and DFID over the priceless contributions towards promoting the health of Nigerian mothers and children as well as ensuring that the goals of health strategies targeted are met through constant dialogues.

Also, Dr. Martin Jackson, UNICEF nutrition officer, Bauchi while speaking on the topic, “DFID support for child malnutrition in the northeast,” said that the DFID has so far distributed vitamin A supplement in some local government areas in Borno and Yobe states.

He advised fathers to be fully involved in the nutrition of their children, adding that exclusive breastfeeding improves the growth of a healthy child.