Over-Population, Threat To Nigeria’s Development

CHIOMA UMEHA

Nigeria’s population is currently estimated at 190 million.  Experts claim that if nothing is done about the unusual population explosion in the country, by 2050 it could hit above 400 million.

Yet, Nigeria is special as it is already the most populous African nation and on the seventh rank in the world. If its population of 200 million people continues to grow at the current rate of 3.2 per cent each year, the country will have the third largest population worldwide with 411 million people by 2050.

“Although Nigeria has the largest economy in Africa, population growth is outpacing the economic growth and increasing the poverty risk for many Nigerians!”, explains Professor Robert Zinser, CEO of the Rotarian Action Group for Population and Development (RFPD). “More than half of the population already lives below the poverty line, while women and children continue to die from preventable causes.”

In 2012, the government pledged to increase the contraceptive prevalence rate (CPR) from 15 to 36 per cent by 2020 by buying contraceptives and providing them to women who need them. Today, the country has managed to increase the CPR to17 per cent, but there is still much work to be done.

Family planning is the conscious effort of couples using contraceptives to limit or space the number of children they want to have. Using modern contraceptives also helps reduce maternal and infant deaths. According to Nigeria’s Demographic and Health Survey (NDHS) 2018, out of 100,000 woman giving birth 576 die, and out of 1000 children being born 67 do not survive. In international comparison these Maternal Mortality (MMR) and Infant Mortality Ratios are very high.

Provision of modern contraceptive methods is one of the main components of sustainable development and poverty alleviation. When couples have fewer children, they spend less income on immediate survival needs of food, housing and clothing, leaving some savings for education or investment capital. Education and investment create productivity, make industries grow and raise employment. When people work, the government can tax their incomes and generate capital to invest in important sectors such as education, infrastructure, and health and food production. This contributes to long-term productivity and raises the living standards of the people.

So what is stopping Nigeria from achieving its desired family planning goals? And how can the country prevent more and more families from falling into a poverty trap without any chance of escape?

Nigeria’s Demographic and Health Survey states that one of the many ways Nigeria can avert this situation is by increasing the knowledge and use of modern family planning methods among women of reproductive age. It estimates that meeting women's need for modern contraceptives can prevent about one-third of all maternal deaths.

However, out of the 45 million women of child bearing age in Nigeria, only 7.6 million are using a modern family planning method. According to Nigeria’s National Family Planning Communication Campaign, the country wants to generate an additional 7.3 million new users of modern Family Planning methods in Nigeria.

The country has increased awareness of family planning to 85 per cent for women and 95 percent for men. Yet, Nigeria still grapples with the sad reality of little in-depth knowledge, low demand and uptake of family planning products and services.

And here lies the root of the problem.

Many women who expressed a desire to delay their next pregnancy by at least two years were not using a modern method of contraception because they lack access to contraceptives.

Many hospitals are not able to fulfill the needs for family planning products and services. And even worse: Primary Health Centres, which are the health institutions closest to the people, are often desperately lacking in trained staff for family planning services. Health centres are also hit with frequent stock-outs of contraceptive commodities and, where they are available, many centres still lack equipment to administer the contraceptives like implants and Intrauterine devices.

The second problem affecting uptake has its roots in myths and misconceptions of contraceptives, fear of side effects as well as widespread opposition to the use of contraceptives by women due to socio-cultural, religion and spousal objections.

Another, very important reason is a lack of education: About 47 per cent of women in Nigeria don’t have any form of education. Yet, going to school long enough allows girls to delay child bearing but also empowers them to make decisions about their bodies and future lives. Their low status leaves women at the mercy of their husbands to make their healthcare decisions.

"Changing this situation takes more than provision of family planning services. It requires helping people understand the personal benefits in health, wealth, and family harmony of limiting and spacing births,” says William Ryerson in his paper Unmet Need - Lack of Access or Lack of Cultural and Informational Support. “It also involves role modelling family planning use and overcoming fear that contraceptives are dangerous or that planning one’s family is unacceptable. It requires getting husbands and wives to talk to each other about use of family planning – a key step in the process to begin using contraceptives.”

What Nigeria can do

In 2012, the government pledged to provide US$ 8,3 million annually for the procurement of reproductive health commodities, which includes contraceptives. They also agreed to enlist the support of development partners like UNFPA, WHO, The Gates Foundation, and Rotary International to provide contraceptives, including oral pills, implants, injectables, IUDs and male condoms.

A robust national multimedia Family Planning and demand creating communication campaign was designed by Nigeria’s Federal Ministry of Health focusing on increasing the knowledge and uptake of Modern FP methods.

Using targeted media, the campaign will help to dispel myths and misconceptions about family planning that are stopping women from starting or continuously and consistently using contraceptives. With financial support from the Rotarian Action Group for Population and Development (RFPD), the US-based NGO “Population Media Center” will use targeted serialised dramas to dispel cultural barriers as well as myths and misconceptions. This will be complemented by community dialogues with support from traditional and religious leaders as well as engage men to support their partners in making decisions on desired family size.

The country is working towards increasing and improving its service delivery points from 31 to 89 per cent to take contraceptives closer to women who need them and make them available at any time and every day. This will further be supported with improved transport of contraceptives from national government stores to the state stores and further down to the nearest health centres in villages.

The Nigerian government’s efforts are supported by RFPD’s ongoing nationwide family planning campaign. This campaign builds on a model that was piloted in two northern states of Kaduna and Kano that saw a 60 per cent reduction in maternal deaths and 15 per cent reduction in infant deaths in participating hospitals.

A digital tool developed by RFPD for improving maternal and child health will now include family planning in 4000 health centres over all 36 Nigerian states and the federal capital. The tool is used to closely monitor the quality of hospital facilities and structures and the quality of care provided by the medical personal.

Participating hospitals can draw lessons from this analysis to improve the quality of care to mothers and babies. "Further training and education of medical staff and administrative officers will help to improve the quality of care provided”, explains Dolapo Lufadeju, RFPD’s National Coordinator in Nigeria. “This increased competency on the side of health staff will allow the established system to be fully run and be administered by local partners when the project ends.”

Finally, Pharmacists Endorse Proposed TAS

CHIOMA UMEHA

THE Pharmaceutical Society of Nigeria, PSN, has endorsed a proposed “tiered accreditation system” to control the flow and sale of medicines by patent and proprietary medicine vendors.

Under the tiering, proposed by the Pharmacists Council of Nigeria (PCN), medicine vendors will be accredited into any of around three tiers, based on their education, qualification and expertise.

Specific tier position will also determine what drugs they can stock from the approved patent medicines list.

But the tiering faced initial opposition from PSN over insufficient understanding and stakeholder discussion.

PSN, PCN, technical partners, pharmacists’ groups and the federal health ministry met at a “consultative engagement” this week for stakeholders to resolve differences over the tiering - and pave way for it to be piloted.

“We believe this system, if it goes well from the pilot they are doing, may be a greater opportunity to bring greater control in the pharmaceutical space and ensure there is high level of professionalism exhibited by all cadres of participants in the pharmaceutical chain,” said PSN President Sam Ohuabunwa, after the meeting in Abuja, supported by PSN-Partnership for Advocacy in Child and Family Health at Scale.

Earlier, the Association of Community Pharmacists of Nigeria (APCN) had faulted the proposal by the Federal Ministry of Health to create three tiers of eligible players in the sale of Over The Counter (OTC) drugs in Nigeria.

Ohuabunwa, however, noted that after a stakeholders meeting facilitated by PACFaH@Scale where the Pharmacists Council of Nigeria (PCN) explained the workings of the pilot scheme, stakeholders were convinced that it was worth supporting.

“We saw from the side of PCN that it is something that is not against pharmacists, but may end up giving pharmacists a greater opportunity to have a handle on the pharmaceutical space, because that is a critical thing where pharmacists are concerned.

 “For the good of the patient, we need to have a greater control of how drugs are distributed, who handles drugs, who gives it to the patient, is the patient properly counselled on how these drugs will be used,” Ohuabunwa said.

‘HIV Knows No Bliss; My Every Day Encounter With Stigma, Discrimination’

Chioma Umeha

Lagos

Yemisi hardly knew that her marital bliss would be short-lived barely after five years of nuptial knots to a royal father.  For her, it was also thing of pride to be Princess more so as she turned to be the most favourite wife, being the youngest, though third and last wife of a Lagos socialite. No doubt, Yemisi, a trained accountant lived a very comfortable life despite that her husband asked her to stop working being married to 'His Royal Highness.'

All her ecstasy became a fleeting one. This is because Yemisi dumped her marriage as soon as she tested positive to HIV in 2008. Today, the former Princess is forced to live in denial of her status due to fear of stigma and discrimination. Here is the story of Yemisi who recently spoke to DAILY INDEPENDENT:

“I have always been healthy and strong, my only serious problem was infertility. I couldn’t get pregnant. I married into a wealthy polygamous family and was the third wife of a caring and comfortable man. I had tried all I could but did not conceive. Years after marriage, I was still seeking the fruit of the womb. My husband had seven children from his two other wives but I was the youngest.

I’m a trained accountant but my husband would not allow me to work. He provided for me and gave me all I wanted, except a child, of course. The day I got to know I’m HIV positive was quite memorable. It all began in 2008. We had been married about five years at that time. I had been falling in and out of illness and hoping it was pregnancy.

I was being transferred from one hospital to another. The illness got so bad at a particular time

I was admitted into a posh private hospital on Victoria Island for about two months but didn’t really get better before I was eventually referred.

I was given a sealed letter and then transferred to one of the General Hospitals in Lagos, with stern instructions not to open the letter. At the General Hospital, I handed the letter to the health official that attended to me. He opened the letter, read it, stared at me and then said I should go for a particular screening test in another part of the hospital. I went and did the test. The result of that test was also not given to me, but later I was told by that doctor that I had tested HIV positive.

I felt bad at first, but later asked my husband if he had any idea of the content of the letter that I had taken to the hospital. He admitted that he did, but said that it was not the end of my life.

I didn’t initially understand what it meant to be HIV positive, but over time the harsh reality dawned on me and I came to terms with the fact that I had a very serious problem. The development affected me a lot and I felt quite bad. It was a difficult burden for me to handle and  I broke down completely. However, my husband was very supportive and its really thanks to him that I coped. He encouraged me a lot and vowed never to leave me. He kept the news of my status to himself. No one including any of his other wives knew I had HIV. The only other people who knew were my mother and sisters. I told them myself.

I started treatment and was placed on ARV drugs; and my health gradually improved, but I was still puzzled, how did I contract HIV? I kept asking myself this question. I began to research about HIV/AIDS. I went on the internet and read about it. I became aware that the most common mode of HIV transmission is through sexual intercourse.

I was in my mid 30’s, I was not sexually adventurous before I got married. Although I had a few boyfriends while in school and afterwards, I never had sex with any of them. I was a virgin until I met and married my husband. He was my first and only sex partner. I had never gone for surgery or had blood transfusion or been at risk of any of the other modes of HIV transmission. I realized my husband had never disclosed his HIV status. He had never even talked about it. He probably didn’t know his status, yet had two other wives, so it was quite logical to assume the HIV infection must have come from him or one of his other wives.

One day, I confronted him and demanded that he get tested too. From my research, I had gathered that when one person tests HIV positive the sexual partner(s) must be tested too. But my husband refused to get tested.

I begged him to go for the test and also inform his other wives to get tested, but he got angry and said he was okay and did not need any test. He warned me not to talk to his other wives about the matter. But I was really worried. We were looking for the fruit of the womb, I was desperately trying to get pregnant and had been taking fertility medication that required us to have sex regularly, but since he had other wives, I knew it was not healthy to continue like that.

I told him the dangers of continuing with unprotected sex while his HIV status is not established and also sleeping with his other wives as well as how the risk of transmission among us was high. But, he was not moved and we failed to agree on the issue. He stubbornly refused to get tested and also declined to let the other wives get tested or to know their status.

Gradually, we grew apart and our sex life suffered. One night, he came into my room while I was sleeping and began making sexual overtures. It had been a while since we made love, and since I was in the mood and he was my husband, I gave in. But during the act, I discovered he was wearing a condom. I was so infuriated I didn’t know when I violently pushed him off.

Do you want to kill me? Why are you punishing me like this? I want to have a child! I was shouting without realising it. He just lay on the bed staring at me in shock. There was a soft tap on the door and I heard the voice of the senior wife asking if all was well.

My husband slowly got up and without uttering a word left the room. I was in a dilemma. How would I get pregnant if we didn’t have sex or if he used a condom every time? I was desperate to conceive, yet I did not want to be responsible for transmitting HIV to the other wives.

I was confused and almost going out of my mind. Many times I was tempted to spill the whole thing to the senior wife. She is few years older than I am and a mother of three daughters. She was quite nice and understanding and like a big sister to me. I often confided in her about personal issues including my infertility problems, but I was unsure how she would react to the development on ground.

I think my husband suspected my intentions because early one morning came into my room and apologized for his behaviour. He promised to disclose to the other wives and also go for the screening, and appealed to me to give him a little time to address the issue. I agreed and waited, but he didn’t keep his promise.

We continued like this for months until one day, I just got fed up. So I confronted him point blank that I was quitting the marriage because he was not ready to do the needful. He looked down on the floor as I threw my bombshell. That day, I packed my belongings and left his house. If his other wives knew why I was leaving, they didn’t show it. They didn’t try to stop me. I saw my husband few times afterwards, but never went back to his house. That was how our marriage ended.

About a couple of years after we broke up, I heard that he fell ill and had passed away. Before he died, I had left Lagos for Ilorin where I received the message of his death. The cause was not disclosed. Could it have been related to HIV/AIDS? From what I knew about him, it’s a possibility.

I believe that my late husband did not disclose his status till he died. The senior wives need to know how to take care of themselves. I am thinking of a way to alert them so that they also get tested and take care of themselves. This is perhaps the best time to tell the whole story. I have called the senior wife and her junior and plan to visit them soon to tell them everything about this story.

Already, I have lost a lot of friends because they suspect am HIV positive. I’m currently staying with my junior sister who knows about my status, but I’m planning to return to relocate to Lagos.

Right now, I’m still hoping to have a child of my own. I’m now in my 40s wish I could afford IVF, but it would be nice to get married again. The man that would marry me would know everything about me. I would let him know that I am HIV positive. I’m still hoping to get married again, but men approaching me always leave when I tell them I am HIV positive. Of course they demand sex first and if I insist they go for their HIV test they begin to wonder. But, I insist that they must know and disclose their HIV status before we can date. The moment I make this demand and reveal my status, my suitors always leave me.

Lagos PSN Urges FG To Set Up Presidential Committee On Drug Distribution

Pharm. (Mrs.) Adeniran Bolanle F.O., Chairman, Pharmaceutical Society of Nigeria (PSN), Lagos State Branch, has made a case for appointment of a Presidential Committee on Drug Distribution to sanitise the chaotic drug channels in the country.

Speaking at the opening ceremony of the PSN Scientific Week at the Pharmacy Villa, Ogudi GRA, Lagos on August 22, 2019, Pharm. Adeniran said the call had become necessary because drug distribution had for long continued to be grounded in vacillations and had been at the whims and caprices of the vicissitudes of life which have almost snuffed life out of it.

She said that the reality today is that “we have made little or no progress in the quest to sanitise our distribution channels.”

“If we decide to call a spade a spade, the Federal Government actually needs to declare a state of emergency in the drug distribution bracket of our health sector to redress the unending cycle of unproductively.

“Even when the Pharmacy profession is famous as probably the most regulated endeavour in the land with legislations that are as old as over 132 years

(Pharmacy Ordinance 1887), it has amounted to zero impact,” she said.

Adeniran noted that under Obasanjo Presidency, a Presidential Committee was set up with requisite stakeholders to redress the ills of drug distribution with some seriousness.

She said the committee which was active till Jonathan era finally gave birth to the popular National Drug Distribution Guidelines (NDDG) with major recommendations to open new vista in drug wholesaling while emphasising an urgent need to seal all existing Open Drug Markets (ODM) in line with existing Acts of Parliament.

She lamented that four years after the first deadline was first announced by Mr. Linus Awute, the then Permanent Secretary and Acting Head of the Federal Ministry of Health in 2015, government has not been decisive on the closure of the obnoxious drug markets.

“In fact, the operations at the deadly Onitsha Head Bridge market are on record to have resisted monitoring and control by violently attacking a team of NAFDAC inspectors who routinely visited that market on an enforcement drive, without any accruing sanctions till now.

“One of the sore points in drug distribution remains Patent Medicine Vending in our clime. While we appreciate that there is an obvious dearth in all health services including pharma services and manpower, it appears as usual that the Federal Ministry of Health (FMOH) through the powers that be is only interested in tackling the challenges in pharma sector probably because of the commercial propensities associated with pharmacy practice,” she said.

Adeniran explained that Patent Medicine Vending which was meant to be a stop gap mechanism in service rendition to people in underserved areas has become a huge albatross on the neck of Practising Pharmacists because it has become an endless means of easy access to all categories of medicines from OTCs to PIMs, POMs as well as dangerous drugs and narcotics which are never monitored because of severe logistics challenges the regulatory agencies suffer.

She said that ordinarily one would imagine that because healthcare is a globally inclined endeavour which promotes best practices, the norm would be to structure healthcare and pharmacy practice in particular on platforms obtainable in the global arena.

“What we see more and more is that NGOs and International donors continue to encourage scenarios whereby more abuses are perpetrated against the very people they set out to assist. This is because every measure that is focused on allowing persons other than Registered Pharmacists and other trained personnel like Pharmacy Technicians to dabble into the professional responsibility of sales and dispensing of drugs fundamentally jeopardises the aims and objectives of the National Drug Policy 2005 which is inclined to delivering safe, efficacious and affordable drugs to the people of Nigeria.

“It is therefore very imperative to call on the Federal Government that the reforms we need with Patent Medicine Vending must focus on allowing Pharmacy Technicians who are part of global pharmacy workforce to take care of Patent Medicine Vending in rural communities or other areas where service delivery is lacking in pharmaceutical services,” the Lagos PSN chairman said.

She attributed the poor state of affairs to obvious weak regulation as every effort aimed at ensuring a free for all disposition in the sales of drugs by people who do not have formal training as professionals or sub-professional cadre will only serve to boost the worsening incident of easy access to drugs with dire consequences which boost drug misuse and abuse as well as drug faking which all continue to combine to devalue the Gross Domestic Product (GDP) and potentials of the pharmaceutical sector in the quest for national development and growth.

Consequently, the PSN Lagos State boss called for a Presidential Committee on Drug Distribution which would be headed by an experienced Registered Pharmacist not encumbered by the bureaucracy of the public service.

The proposed committee, she said, should have representatives of PCN, NAFDAC, PSN, ACPN, PMG-MAN, NIROPHARM and a key official of the Presidency not below the rank of a Director.

Pharm. Adeniran said, “We responsibly solicit that such a committee which shall have a timeline and Terms of Reference including:

.Enforcement of the spirit of NDDG with particular emphasis on strategies to attain closure of drug markets and achieve the movement to Co-ordinated Wholesale Centres (CWC) now approved in 7 city centres of Nigeria.

.Work out a sustainable reform in the business of Patent Medicine Vending by paying particular attention to the strict applicability of statutes in the enforcement window currently available in the pharmaceutical sector.

Ensuring the passage of Pharmacy Bill 2017 into an Act of Parliament that will rescue Pharmacy Practice which continues to sink albeit rapidly with the probability of complete extinction in Nigeria if the negative drift is not curbed soon enough.”

Pharm. Adeniran also called for the setting up of Workable Structures for Sustainable Healthcare System in Nigeria.

“In the last few months it has become very obvious that the JOHESU has become the major arrowhead in all efforts to restore dignity and pride to health workers apart from doctors through its unrelenting agitations.

“This fact is amplified by the reality that it is only JOHESU that has taken up the legal challenge of meeting the very desperate Medical and Dental Consultants Association of Nigeria (MDCAN) (through a representation by a SAN), which is canvassing a strange concept of healthcare at Federal High Court, Abuja where it is attempting to be bestowed with professional rights and privileges to regulate Pharmacy practice and other health services contrary to the enabling Acts of Parliament as appropriate for the different professions in Nigeria.

“JOHESU had endured a tortuous Alternate Dispute Resolution (ADR) process which ordinarily should last for 12 weeks or 6 months. The gains at the ADR were very significant apart from the inability to secure a meaningful budget for the adjustment of CONHESS scale as was done for CONMESS scale since 2014, whopping 5 years and 8 months ago.

“We of PSN Lagos are aware that the JOHESU has been engaging the FMOH and we call on the FMOH to immediately release the Specialised Committee of Stakeholders including the representatives of JOHESU which was promised at its interaction with JOHESU leaders almost one month ago,” Adeniran said.

“For the records, we urge the FMOH to fast-track the activities of this committee which will deal with challenges including Central Internship Placement for all health professionals; Payment of outstanding skipping allowances and related benefits for JOHESU members; Implementation of report on payment of Specialist Allowances to Pharmacists and other eligible health workers; Forwarding of memo to increase retirement age of health workers from 60 - 65 years to the National Council of Establishment, and Staff audit in all Federal Health Institutions (FHIs) to pave way for the redress of under-employment of JOHESU members,” Pharm. Adeniran further stated.

The Lagos PSN boss also called on the Presidency to give the necessary go-ahead to the release of the withheld salaries of JOHESU members in April and May 2018 as it was clearly a selectively discriminatory act to persecute the health workers by wicked personality cults loyal to only the self serving interests of the profession they belong to in that dispensation.

She reminded the Federal Government that doctors in JUTH and LUTH have proceeded on strike after the 2018 strike of JOHESU members without their salaries being seized. This is apart from ASUU in the Education Sector which was not unduly punished by the Minister-in-charge.

“We strongly urge President Buhari to approve the estimated funds to actualise the adjustment of CONHESS circular as was done for CONMESS by the National Salary, Income and Wages Commission since 2017,” she said.

Pharm. Adeniran then urged her colleagues to be wary of a delusional messianic complex which has ravaged those in the profession, advising that only hard work, consistency and diligence laden in prayers would deliver pharmacy profession from the forces which have held it to ransom.